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What is Achilles Tendinitis?
As the largest and most vulnerable tendon in the body, the Achilles tendon joins the gastrocnemius and soleus muscles of the lower leg to the calcaneus. Accounting for approximately 10–12 percent of all running injuries, inflammation or degeneration of this tendon is appropriately named Achilles tendinitis (also referred to as Achilles tendinopathy). Although the slow healing time for Achilles tendinitis is due to limited localized blood supply, bodyworkers can play a key role in restoring this tendon to its pre-injured state.
Symptoms of Achilles Tendinitis
Providing the power in the push-off phase of the gait cycle, the Achilles tendon can become irritated when the gastrocnemius and soleus muscles are stressed. Although this tendon is strong, its lack of flexibility can easily lead to inflammation, micro-tears, or rupture. Achilles tendinitis can be acute or chronic.
Signs of Acute Achilles Tendinitis
- Tendon pain during exercise. Achilles pain gradually comes on with prolonged activity and typically improves with rest.
- Swelling over the Achilles tendon.
- Redness over the affected area of the tendon.
- A creaking or crackling sensation may be felt when pressing into the tendon while moving the foot.
Signs of Chronic Achilles Tendinitis
Often more difficult to treat, chronic Achilles tendinitis may develop when the tendon is not treated properly or allowed to fully heal. When this problem becomes chronic, the pain may disappear after a warm-up yet return once activity stops. If the Achilles is repeatedly stressed, the injury worsens until running or walking becomes difficult. In addition to the symptoms of acute tendinitis, chronic cases may include:
- Pain and stiffness in the Achilles tendon in the morning. This pain may be described as diffuse along the tendon rather than specific.
- There may be nodules or lumps in the Achilles tendon, particularly 2–6 cm above the heel.
- Pain in the tendon when walking up a hill or up stairs.
Causes of Achilles Tendinitis
An injury typically occurring from overuse, Achilles tendinitis usually comes on gradually. Ignoring the early warning signs of Achilles pain allows symptoms to worsen until activity becomes too painful to continue. In general, the more fatigued the calf muscles are, the more stress is placed on the Achilles tendon.
Common causes include:
- Overuse – Sudden increases in activity or training intensity without adequate recovery
- Running up hills – Hill running increases Achilles stretch and loading with every stride
- Overpronation – Overly pronating the foot increases the strain placed on the Achilles tendon. As the foot rolls in and flattens, the lower leg rotates inwards causing a twisting motion. This twist puts an additional strain on the Achilles
- Tight or weak calf muscles – Fatigued or shortened gastrocnemius and soleus muscles place added strain on the Achilles
10 Solutions for Achilles Tendinitis
For best results, a sore or achy Achilles tendon responds best to early attention and load management. Left untreated, Achilles tendinitis can cause persistent pain or lead to tendon rupture, which may require surgery. Ten commonly advised solutions include:
- Resting the calf muscles and avoiding painful activity
- Applying cold therapy or ice for symptom relief and to reduce pain and swelling
- Wearing a heel pad to raise the heel, thus taking some of the strain off the Achilles tendon
- Wearing arch support insoles or orthotics to prevent overpronation and improve foot biomechanics
- Taking anti-inflammatory medication as directed by a healthcare provider
- Taping or bracing the lower leg to support the Achilles
- Immobilization (walking boot or cast) for more severe cases
- Therapeutic ultrasound or shockwave therapy when prescribed
- Administering sports massage to the lower extremities
- Strengthening the calf muscles to help reduce stress on the Achilles tendon. Controlled heel-lowering exercises (eccentrics), toe raises, and wall stretching are useful.
Whenever discussing approaches to Achilles tendinitis with clients, always emphasize avoiding excessive stretching. Taking this action has the potential to aggravate an already stressed Achilles.
Sports Massage for Achilles Tendinitis
Two sports massage techniques place bodyworkers among the most effective conservative care providers for Achilles tendinitis: transverse friction massage and strain-counterstrain techniques.
Transverse Friction Massage
Transverse friction massage is a massage technique that is often used for tendinitis. The massage strokes of transverse friction massage are deep and applied directly to the affected area, perpendicular to the direction of the tendon. When done properly, transverse friction massage can help reduce pain, improve blood flow to the surrounding area, and prevent or reduce the formation of scar tissue and adhesions in the connective tissue.
Strain-Counterstrain Techniques
Strain-counterstrain applied to the calf muscles helps unload excessive tension placed on the Achilles by tight or weakened muscles. A study published in The Journal of the American Osteopathic Association found that applying strain-counterstrain to the soleus and gastrocnemius muscles produced a significant reduction in localized tendon stress in subjects with Achilles tendinitis.
Long-Term Recovery and Prevention
While early and persistent attention to this injury often results in a full recovery, making sure the original cause of the tendinitis is addressed is the only way to prevent its recurrence. In addition to tackling the reason for Achilles pain, most practitioners recommend some combination of the above ten solutions to help an inflamed Achilles heal.
A massage therapist using strain-counterstrain and transverse friction massage techniques can play an important role in the timely healing of an inflamed Achilles tendon—and can even help prevent this injury from turning into a hard-to-treat chronic case of tendinitis.
Originally posted March 2008. Updated January 7, 2026.
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