Sore Achilles? Here Is What You Can Do Before Booking a Physio
Achilles Tendon Pain: How to Manage It Yourself at Home
Most Achilles tendon pain does not need urgent hands on treatment. With the right load management, targeted strength work and a bit of patience, you can settle a mild to moderate Achilles issue at home. Here is the honest, evidence based self management guide from our physio team at PHYZFIT Bexley North and Marrickville, plus the clear warning signs that mean it is time to book in.
Short Answer
Most mild to moderate Achilles tendon pain (tendinopathy) responds to a 6 to 12 week program of progressive loading, load management and modifying your training. Isometric holds calm the pain first, then heavy slow resistance heel raises rebuild the tendon. Rest alone does not fix Achilles tendinopathy and often makes it worse. Book a physio if your pain has not improved after 6 weeks of good self management, if it is getting worse, or if it started with a sudden snap or pop.
Below is the step by step self management protocol our physio team uses, when to book in, and the mistakes to avoid.
What is Achilles tendinopathy?
Your Achilles tendon is the thick rope of collagen that connects your calf muscles (gastrocnemius and soleus) to your heel bone (calcaneus). It is the largest and strongest tendon in the body and it takes big loads every step you take.
When the tendon is overloaded (too much running, sudden training increase, poor calf strength, hill work, footwear change) it can develop tendinopathy, which is a change in the tendon structure that produces pain, stiffness and reduced capacity. Two main patterns:
- Mid portion tendinopathy: pain 2 to 6 cm above the heel bone, often thickened on the tendon itself. Most common in runners and active adults.
- Insertional tendinopathy: pain right at where the tendon attaches to the heel bone. More common in older adults and often aggravated by uphill running and low drop shoes.
The two respond to slightly different loading programs, which is why an accurate diagnosis matters.
What NOT to do for Achilles tendon pain
Before we cover what works, here is what usually makes Achilles pain worse:
- Do not fully rest for weeks. Tendons need load to remodel. Weeks of complete rest often weakens the calf and makes the pain worse when you return.
- Do not aggressively stretch it. Deep calf stretching in acute Achilles pain can compress the tendon against the heel bone and flare things up, especially in insertional cases.
- Do not push through sharp pain. Mild discomfort during loading is fine. Sharp, worsening pain or pain that lingers past 24 hours means you have overdone it.
- Do not rush into cortisone. Cortisone injections into the Achilles are generally avoided because of the risk of tendon rupture.
- Do not ignore a sudden pop or snap. That can indicate an Achilles rupture and needs urgent medical review.
The 4 stage self management protocol
This is the same evidence based framework our physios use in clinic. Move through the stages based on your symptoms, not the calendar. If a stage flares your pain for more than 24 hours, step back to the previous one.
Calm the pain (Week 1 to 2)
Reduce running or jumping. Keep walking. Perform isometric calf raise holds: rise onto your toes on both feet, then shift most of your weight onto the sore side, hold 45 seconds. 5 sets. Rest 1 to 2 minutes between. Twice a day.
Build capacity (Week 2 to 6)
Heavy slow resistance calf raises. Both legs then single leg. 3 to 4 sets of 8 to 12 reps at a slow tempo (3 seconds up, 3 seconds down). Progressively add load with a backpack, dumbbell or gym calf machine. Every second day.
Return to running (Week 6 to 10)
Start walk-jog intervals on flat ground. Something like 4 minutes walk, 1 minute jog for 20 minutes. Progress gradually. Continue calf loading twice a week. Avoid hills initially.
Return to full training (Week 10+)
Return to your normal running, sport or gym program. Keep calf raises in twice a week as a maintenance dose. Progress kilometres by 10 percent per week.
Pain rule during loading: during the exercise and up to 24 hours after, pain up to 3 out of 10 is acceptable. Pain above 5 out of 10, or pain that lingers past 24 hours, means dial the load back next session.
Modify your training and daily load
- Reduce weekly running volume by 30 to 50 percent in the first 2 to 4 weeks. Zero running is rarely the answer.
- Cut hills until the pain has clearly settled. Uphill running loads the Achilles heavily.
- Add cycling or swimming to keep cardio without loading the tendon.
- Check your shoes. Older worn out shoes with a collapsed heel counter are a common contributor. For insertional cases, a slight heel drop (8 to 12 mm) can unload the tendon while it settles.
- Add a heel lift temporarily in both shoes for insertional pain, roughly 8 to 12 mm, for the first 2 to 4 weeks.
- Sleep and nutrition matter. Tendons rebuild in recovery, not during load.
Not sure which loading program is right for you?
A 30 minute assessment saves weeks of trial and error.
When should you actually see a physio?
Book in with a physio if any of these apply:
- You have followed a good loading program for 6 weeks and there has been no meaningful improvement
- The pain is getting worse, not better
- You have marked swelling, redness or heat around the tendon
- You noticed a sudden snap or pop and cannot rise up on your toes on that leg (possible Achilles rupture — this needs urgent medical review, ideally same day)
- The pain is right at the insertion (heel bone) and getting worse with your current program
- You are unable to load the tendon at all without severe pain
- You have multiple tendon injuries at the same time (possible systemic contributor)
- You are on fluoroquinolone antibiotics (increased risk of tendon rupture) and develop Achilles pain
⚠ Signs of a possible Achilles rupture — seek urgent medical review
- Sudden sharp pain, often described as being kicked in the back of the calf
- An audible pop or snap
- Sudden inability to rise onto your toes or push off the ground on that leg
- A palpable gap in the tendon
- Rapid swelling and bruising in the back of the lower leg
Achilles ruptures need surgical or specialist review, ideally within 24 to 48 hours.
What does a physio do differently?
If you have followed the self management steps and it is not settling, our physio team (Julian De Rosa, Ari Moushis and Sam Nunan) can:
- Confirm the exact diagnosis (mid portion vs insertional, tendinopathy vs partial tear, ruling out plantaris or paratendinopathy)
- Prescribe a loading program dialled to your capacity and sport
- Use hands on treatment to unload the calf and improve ankle mobility
- Deliver shockwave therapy for stubborn or long standing cases
- Use dry needling for tight calf trigger points contributing to the tendon load
- Review your running gait and footwear
- Coordinate imaging (ultrasound or MRI) if needed
- Refer to a sports doctor if a specialist opinion is required
Julian is head physio for NPL football club Fraser Park FC and treats Achilles tendinopathy in runners, footballers and gym goers every week.
How long does Achilles pain take to settle?
- Mild reactive tendinopathy (early stage, less than 6 weeks): 4 to 8 weeks of loading
- Moderate tendinopathy (6 weeks to 3 months): 8 to 12 weeks
- Chronic tendinopathy (over 3 months): 3 to 6 months, sometimes longer
- Insertional cases: tend to take slightly longer than mid portion cases
We support patients across Bexley, Kingsgrove, Beverly Hills, Bardwell Park, Earlwood, Rockdale, Kogarah and Hurstville from Bexley North, and Marrickville, Newtown, Enmore, Dulwich Hill and Petersham from Marrickville.
Frequently asked questions about Achilles pain
Often yes, at reduced volume, provided pain stays under 3 out of 10 during and after running and morning stiffness is not worsening. Complete rest usually delays recovery.
Aggressive calf stretching can compress the tendon, especially in insertional cases, and often flares symptoms. Loading (calf raises) is much more effective than stretching for tendon recovery.
Usually not straight away. Imaging is considered if there has been a sudden traumatic event, if there is significant weakness or if pain has not responded to 6 to 8 weeks of good rehab.
Yes and they are the gold standard. Start with double leg isometric holds, progress to slow heavy calf raises, then to single leg. Follow the pain rule and progress gradually.
Shockwave can help stubborn tendinopathy that has not settled with 8 to 12 weeks of loading. It works best when combined with continued loading, not as a standalone treatment.
Yes. Medicare covers 5 sessions per year under a Chronic Disease Management plan. Private health Extras rebates through HICAPS on the day. Workers Compensation, CTP and NDIS (plan managed and self managed only) are all accepted.
Ready for Us to Help You With Your Pain?
If your Achilles is not responding to the self management program, book a physiotherapy assessment at PHYZFIT Bexley North or Marrickville with Ari Moushis, Sam Nunan or Julian De Rosa. Same day appointments are usually available.
📍 20 Shaw Street, Bexley North 2207
📍 4 Carrington Road, Marrickville 2204 (inside World Gym)
✉ admin@phyzfit.com.au
PHYZFIT Health and Rehab | Bexley North and Marrickville, Sydney | Helping you rebuild trust in your body and live a life without limits.