Achilles Tendinopathy Treatment in Bromley
The Achilles is the thick cord joining the calf muscles to the back of the heel bone. It takes several times your body weight with every running stride. Tendinopathy describes a tendon that has become painful, often slightly thickened, and stiff after rest. The classic story is soreness first thing that warms up during activity, then grumbles that evening and is worse the next day.
Plenty of the people we see in Bromley with this are runners who put their mileage up, added hills, or came back after a lay-off too quickly. Just as many are not sporty at all: a new job on their feet, a walking holiday, a change of shoes. It becomes more common over forty, and the first complaint is usually stiffness rather than pain.
How to tell if that is what you have
How the symptoms behave tells you more than any test.
- Stiffness and soreness in the tendon on the first steps of the day.
- Pain that warms up during activity and returns, worse, hours later.
- A tender, sometimes thickened section of tendon when pinched.
- Pain on hopping, or on a single-leg heel raise.
- Two patterns: mid-portion pain a few centimetres above the heel, and insertional pain where the tendon meets the heel bone. The insertional version dislikes stretching, hills and stiff shoe backs.
A calf tear comes on suddenly during activity, sits higher in the muscle and usually bruises. Swelling where a shoe rubs at the back of the heel may be a bursa.
What actually causes it
This is a load problem rather than an inflammation. Tendon adapts to what it is asked to do, but slowly. When demand climbs faster than it can adapt, the tissue changes: collagen becomes disorganised, the tendon holds more water, and new vessels and nerve endings grow into it. Classic inflammation is largely absent.
This is why rest alone tends to fail. Stop running for six weeks and the pain settles, but the tendon has lost capacity rather than gained it, so the first proper run brings it back. Controlled, progressive loading is what changes the tissue, and it is slow. Other contributors are calf weakness, a sudden switch to flatter shoes, and occasionally fluoroquinolone antibiotics such as ciprofloxacin, which carry a recognised small risk of tendon problems.
How we treat it at the clinic
Assessment first: which part of the tendon, how irritable it is, and what changed beforehand.
An exercise programme does the real work: isometric holds while the tendon is irritable, then slow heavy heel raises, then spring and speed if you run. Progressive loading has much the strongest evidence here, and needs months of consistency.
Deep tissue massage through the calf reduces the tightness that makes early morning steps miserable, and makes loading easier to keep up. Medical acupuncture into the calf can help persistent aching. Both sit around the exercise rather than replacing it, and we avoid heavy work directly over an irritable insertion, which tends to flare it.
What you can do yourself
- Reduce the provoking load rather than all activity: cut hills, speed and jumping first.
- Use the next morning as your gauge: stiffer than usual means yesterday was too much, the same or better means the dose was right.
- A small heel raise in both shoes takes tension off the tendon. With insertional pain, avoid deep calf stretching and hard shoe backs.
- Do slow calf raises with the knee straight and again bent, three times a week, and keep going once it feels better. Stopping the moment it settles is the usual route back to square one.
How long it takes
Weeks and months, not days. Most people feel a difference in morning stiffness within four to six weeks, but meaningful recovery takes three months at the very least, and six to twelve months is common in tendons sore for a year or more.
Runners usually get back to running well before the tendon is fully rehabilitated, which is fine if the loading continues. If there is no progress after three months, a GP review may lead to imaging, an NHS physiotherapy referral or a specialist opinion.
When to see a doctor instead
One situation is urgent. If you felt a sudden pop or snap, or the sensation of being kicked in the back of the ankle, and then could not push off or stand on tiptoe on that leg, go to A&E or an urgent treatment centre the same day. That can mean a ruptured Achilles and needs prompt assessment. Do not talk yourself out of it because you can still limp — a rupture is often less painful than people expect.
Also seek medical advice if you notice:
- A visible gap or dent in the tendon when you run a finger along it.
- A calf that is swollen, warm, red or tender throughout, which needs a clot ruled out.
- Tendon pain starting within days or weeks of taking a fluoroquinolone antibiotic.
- A hot, red, swollen ankle with fever.
- Numbness, pins and needles, or pain travelling down from the back.
Book Achilles treatment in Bromley
We are at Carlton Chambers, 5 Station Road, Bromley BR2 0EY. The entrance is the red side gate to the right of the building, a three-minute walk from Shortlands station. As well as Bromley, we regularly see people from Beckenham, Shortlands, Hayes, West Wickham, Chislehurst, Petts Wood and Orpington.
Call 07896 257328 to talk it over, or book an appointment online. See our prices, or the location page for directions.
Written by Dharam Vyas, sports therapist and clinic director at SMSM Therapy, Bromley.