Achilles Tendinitis

Exercises and text used with permission from: Injury Free Running; Dr. Tom Michaud

Our goal today is to give you the latest scientific evidence on preventing an achilles tendonitis injury. This page will explain the problem and show you multiple things you can do to reduce pain and start to recover.


  • Achilles Tendinitis is a very common running injury. Over 1 million pages appear on a Google search
  • Itis – inflamation – examples: appendicitis, laryngitis, etc.
  • Osis – degeneration of the tissue
  • Itis vs. Osis
    • If tendonitis is actually the case, rather than tendonosis, we need to reconsider anti-inflammatories as a treatment option and consider strengthening and exercising the area
Achilles Tendonitis - Utah Sports and Wellness

Figure A (click to enlarge)

Achilles Anatomy:

  • Medial and lateral
  • Anterior and posterior
  • Plantar and dorsal
  • Gastrocnemius and Soleus muscles
  • Calcaneus (heel bone)
  • Muscles, tendons, and ligaments
  • Mark the painful area with a marker

Notes on the Achilles tendon:  

  • It gets weaker as we get older
  • Runs ~ 5” from the back of the heel to meet the 2 muscles of the calve

Warm up Routine to Reduce Chance of Achilles Injuries:

  • Run at least a minute per mile slower than your normal pace for the first mile
  • Stay on flat surfaces
  • Rear foot landing will reduce stress on the Achilles
  • Minimalist shoes should be avoided

3 Primary Types of Achilles Tendonitis

  1. Insertional Tendinitis
  2. Paratenonitis
  3. Non-Insertional Tendinosis
Achilles tendonitis standing exercise - Utah Sports and Wellness

Figure B (click to enlarge)

Insertional Tendinitis ID and Treatment

  • Diagnosis:
    • Pain is at attachment point (at the heel). More common in high arched inflexible runners
    • Inflammation
  • Self Treatment Exercise (Figure B):
    • Strengthen forward most aspect of tendon
      • Standing on a level surface while holding a weight with one hand and balancing against the wall with the other, raise both heels as high as you can. (A) Then slowly lower yourself on just the injured leg side (B).
  • Other Self Treatment Options
    • Possible lateral heel wedge
    • Never use a heel lift: temporary relief comes at a cost down the road
    • Regularly stretch your calves: MILD tension 10x per day for less than 20 seconds
    • Night brace
    • Phenocane: safe alternative to NSAIDs
  • Professional Treatment
    • FSM pain treatment at Utah Sports and Wellness

Pareatenonitis ID and Treatment

  • Diagnosis:
    • Inflammation of the outer sheath of the tendon creates a palpable LUMP ~ 2” above the Achilles attachment. This is caused by micro trauma to the area
    • More common in runners who overpronate
    • Continued running will cause and increase in size of lump until it gets so painful you’ll have to stop running
  • Self Treatment:
    • Ice
    • Night brace
    • Over the counter inserts
  • Professional Treatment
    • FSM Microcurrent
    • Left untreated, this injury can get very serious and the tissue can degenerate, creating the need for a 6 month healing period with no running.

Non-Insertional Tendinosis ID and Treatment

  • Diagnosis:
    • Osis = wear and tear or degeneration of the tissue
    • An increase in the range of ankle dorsiflexion (toes to the nose) on the side of the injured Achilles tendon is a clinical sign of advancing Tendonopathy.
    • Ok to run as long as the pain stays below a 5 on a scale of 10 (Silbernagel et al, 2007)

Figure C (click to enlarge)

Self Treatments :

  • Heavy load eccentric exercises (Figure C)
    • Using both legs, you raise your heels as high as possible and then remove the uninjured leg from the stair. The injured leg is then gradually lowered through a full range of motion. The uninjured leg is then placed back on the stairway and both legs are again used to raise the heels as high as possible. Three sets of 15 repetitions are performed twice a day with the knees both straight and bent.
  • Tibialis Posterior Exercises
  • Alternately raising and lowering your arches against resistance. 3 sets of 25 reps performed daily.
  • Flexor Digitorum Longus
    • Look at the insole of your running shoe. When this muscle is strong, you will see well-defined indents beneath the tips of the second through fifth toe, whereas a weak muscle produces no marks beneath the toes and shows signs of excessive wear in the center of the forefoot only.
    • Professional Treatments:
      • Deep tissue massage
      • AMIT muscle work at Utah Sports and Wellness to determine if the muscles have shut down .



    Have More Questions About Treating Achilles Tendonitis?

    Take a look at the interactive Treatment Progress Guide that we have created. It explains the entire process of sports injury treatment at Utah Sports and Wellness.