Achilles Tendinopathy
Expert care for Achilles Tendinopathy at Gentle Care Chiropractic in West Linn, Oregon.
Understanding Achilles Tendinopathy
Also known as: Achilles Tendinosis, Achilles Tendinitis, Mid-Portion or Insertional Achilles Tendinopathy The Achilles tendon (the thickest and strongest tendon in the body) connects your calf muscles to the heel bone. With repetitive overload, the tendon's repair capacity falls behind its loading demands, producing disorganized collagen, thickening, and pain. Mid-portion tendinopathy occurs two to six centimeters above the heel; insertional tendinopathy sits right at the bone attachment and is managed slightly differently because the loading mechanics differ. Both respond to the same core principle: progressive loading is medicine.
Stiffness and tenderness in the Achilles first thing in the morning or after sitting ("warming up" as you get moving) with an aching return after activity, is the classic pattern. The tendon may feel thickened or nodular. Middle-aged recreational athletes, runners ramping up training, and people with tight calves are most affected. The backbone of treatment is loading.
We guide you through an eccentric heel-drop program (Alfredson protocol for mid-portion, modified for insertional cases) which reorganizes and strengthens the tendon over time. IASTM and ART reduce adhesions. Class IV laser and shockwave therapy (particularly for chronic, stubborn cases) support healing. Ankle and subtalar mobilization restores normal joint play.
We coach load management, heel lift use, and footwear selection. Most patients improve substantially within eight to twelve weeks. A positive Thompson test (squeezing the calf doesn't produce foot movement) or a sudden pop with calf pain warrants immediate rupture evaluation. We may recommend: Graston/IASTM, ART, extremity adjustments, mobilization, Class IV laser, shockwave therapy, eccentric loading protocol, orthotics Seek immediate care if: You felt a sudden pop or "kick in the calf" with weakness pushing off: this may indicate Achilles rupture requiring urgent evaluation.
How We Can Help
At Gentle Care Chiropractic, we take a multi-disciplinary approach, addressing the root cause of your condition, not just the symptoms.
Chiropractic Adjustments
Precise spinal and joint corrections to restore alignment, relieve nerve pressure, and reduce pain. Manual or instrument-assisted based on your needs.
Massage Therapy
Therapeutic massage releases muscle tension, improves circulation to injured tissue, and works synergistically with adjustments for faster recovery.
Physical Rehabilitation
Customized exercise programs strengthen supporting muscles, restore range of motion, and help prevent future flare-ups.
Laser Therapy
Cold laser therapy uses targeted light wavelengths to stimulate cellular healing, reduce inflammation, and relieve deep tissue pain without heat or discomfort.
Electrical Stimulation
E-stim therapy reduces pain and muscle spasm, improves circulation, and supports the healing process. Especially effective for acute injuries.
Personalized Care Plan
Every patient is different. We combine these therapies in a plan tailored to your diagnosis, goals, and lifestyle for the best possible outcome.
Frequently Asked Questions
Common questions about Achilles Tendinopathy, answered by our team.
What's the difference between Achilles "tendinitis" and "tendinosis" — and does it change my treatment?
Tendinitis implies acute inflammation, which was the old model. Modern imaging and histology consistently show that in people with chronic Achilles pain, the tendon contains disorganized collagen and has actually lost the inflammatory cells associated with true tendinitis. Tendinosis (or the broader term tendinopathy) reflects this degenerative picture more accurately. It changes treatment meaningfully: anti-inflammatories are less useful for true tendinosis, while progressive loading — which reorganizes collagen — is the cornerstone of care regardless of what you call it.
I was told to do heel drops off a step. But they make my pain worse. Am I doing them wrong?
Possibly — and it may also depend on where your pain is. Heel drops that bring the heel below the step level (the classic Alfredson protocol) work well for mid-portion tendinopathy (pain 2 to 6 cm above the heel). But for insertional Achilles tendinopathy (pain right at the heel bone), that end-range dorsiflexion compresses the tendon at the bony attachment and reliably makes things worse. Insertional cases require a modified protocol — flat-ground heel raises without dipping below horizontal — at least until the tendon is further along in recovery.
Can I keep running while my Achilles is being treated?
Often yes, with careful load management. The principle is to keep below the symptom threshold: mild morning stiffness that warms up within a few minutes and settles within 24 hours of a run is generally acceptable. Reducing volume by 30 to 50%, eliminating hills and speed work, using a small heel lift to temporarily offload the tendon, and keeping a close eye on morning stiffness as a guide are the practical levers. Complete rest is rarely beneficial and often delays recovery by reducing the loading stimulus the tendon needs to heal.
How long until I can train normally again?
Most people with mid-portion Achilles tendinopathy see substantial improvement within 8 to 12 weeks of a consistent loading program. Insertional cases and those with longer symptom duration or significant tendon thickening tend to take 3 to 6 months. The landmark Alfredson eccentric trial showed over 80% of patients returned to pre-injury running within 12 weeks — but that required daily loading exercises, not intermittent effort. Consistency with the loading program is the most reliable predictor of timeline.
My tendon feels thickened and nodular. Is that permanent damage?
Tendon thickening (a nodule in the mid-substance) is a structural change that reflects past overload and repair, and on imaging it can look alarming. The good news is that pain and function do not correlate tightly with structural appearance: many people with visible nodular thickening become completely pain-free and return to full sport. The nodule itself may partially remodel over years but often persists on imaging even after symptoms fully resolve. What matters clinically is function and pain — not what the tendon looks like on ultrasound.
Ready to Find Relief?
You don't have to live with Achilles Tendinopathy. Our team at Gentle Care Chiropractic is here to help you recover and get back to doing what you love.