Understanding when to transition from rest to a structured Achilles loading programme is vital for long-term recovery. At ALO Physiotherapy, we recommend a clinical assessment if you are experiencing any of the following symptoms:

• Morning Stiffness: A “tight” or “stuck” sensation in the back of the heel or lower calf that takes several minutes of walking to loosen.
• Insertional Pain: Point-specific tenderness or swelling where the tendon meets the heel bone, often aggravated by flat shoes or uphill walking.
• The “Essential Gap” Weakness: Noticing a significant loss of power or a “heavy” feeling in the leg when attempting to push off or climb stairs.
• Thickening of the Tendon: Visible or palpable lumps along the mid-portion of the Achilles that feel sensitive to touch.
• Post-Rupture Transition: If you are nearing the end of your time in a walking boot and require a specialist rupture rehab protocol to safely bridge the gap back to impact sports.
• Loading Sensitivity: Pain that disappears during exercise but returns with increased intensity several hours later or the following morning.

Understanding the root cause of Achilles dysfunction is the first step in preventing recurrence. While sudden trauma leads to a rupture, most insertional Achilles and mid-portion issues develop due to “maladaptation” where the stress placed on the tendon exceeds its ability to recover.

At ALO Physiotherapy, we identify the following primary causes for these concerns:

• The “Essential Gap” in Training: Often, injuries occur when there is a sudden spike in activity, without a foundation of HSR to prepare the tissue.
• Biomechanical Misalignment: Collapsing arches or restricted ankle mobility can place uneven “torsional” stress on the tendon, leading to microtears.
• Inappropriate Footwear: Transitioning too quickly to “minimalist” shoes or wearing worn out trainers can increase the strain on the Achilles loading mechanism.
• Kinetic Chain Weakness: If the glutes and calf muscles are weak, the Achilles is forced to compensate by absorbing more force than it is designed to handle.
• Poor Loading Cycles: Repetitive eccentric stress; such as frequent downhill running or jumping, without adequate recovery time prevents the tendon from remodeling effectively.
• Age and Metabolic Factors: As we age, the tendon’s blood supply naturally decreases, making it less resilient to sudden changes in intensity and more prone to degenerative changes.

There is no one size fits all approach to rehabilitation, ALO builds treatment plans around your needs. We do incorporate some common treatment options, that can include:

• Physiotherapy: The foundation of rehab. It involves assessment, gait analysis, and a structured loading program, essential for tendon healing.
• Human Performance Screening: Crucial for identifying biomechanical issues such as overpronation or hip weakness, that may have caused the injury in the first place.
• Clinical Pilates: Excellent for late-stage rehab to improve balance, calf endurance, and kinetic chain stability.
• Shockwave Therapy (ESWT): One of the most evidence-backed treatments for chronic Achilles tendinopathy. It uses sound waves to stimulate healing in “stuck” or non-healing tendon tissue.
• Tecar Therapy & Cryoultrasound: These use heat or cold combined with ultrasound to reduce acute inflammation and speed up cellular metabolism.
• Massage Therapy & Acupuncture: Useful for releasing tension in the calf and soleus muscles, which directly pull on the Achilles.
• Vibra3.0 Vibration Therapy: Can be used to improve muscle activation and proprioception without overstressing the tendon.