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Achilles Tendinopathy Treatment in Dublin

By Dr Lawrence Woods

Achilles tendinopathy is pain and stiffness in the Achilles tendon, the thick tendon at the back of your heel. It is one of the most common running injuries [1]. This page explains what it is, what the research shows, and how we approach Achilles tendinopathy treatment at our clinic in Monkstown, Co. Dublin.

What is Achilles tendinopathy?

Tendinopathy means a tendon has become painful and less able to handle load. It usually builds up gradually, often after a change in training, such as running further or faster, adding hills or speed work, or changing shoes [2].

There are two main types:

  • Mid-portion: pain and sometimes thickening a few centimetres above the heel.
  • Insertional: pain where the tendon attaches to the heel bone. This type often takes longer to settle [2].

Typical symptoms are stiffness first thing in the morning or when you start to move, and pain that warms up during activity and then is worse afterwards or the next day.

Scans are not usually needed to diagnose it, and changes on a scan do not tell you how well you will recover [2].

What does the research show for Achilles tendinopathy treatment?

We follow the US physiotherapy guideline for Achilles tendinopathy (2024) [4] and the Dutch multidisciplinary guideline (2021) [2].

Loading exercise

Exercise that gradually loads the tendon is the main treatment, with the strongest grade of recommendation in the US guideline [4]. The guidelines recommend calf strengthening at least twice a week, as heavy as you can tolerate, for at least 12 weeks [2][4].

Different exercise programmes seem to work about as well as each other. In a Danish trial, heavy slow strength training three times a week worked as well as the traditional eccentric "heel drop" programme done twice a day, and took far less time [5]. So we choose a programme you can fit into your life and stick with.

For insertional tendinopathy, exercises usually start on a flat floor rather than off a step, as this puts less pressure on the tendon where it attaches [2].

Keep running, with changes

Complete rest is not needed [4]. In a Swedish trial, people who carried on running and jumping, guided by their pain levels, did as well as those who rested [6]. We use a simple pain-monitoring approach: some discomfort during activity is usually fine if it settles within 24 hours and your morning stiffness is not getting worse week to week [6]. We may suggest reducing speed, hills or distance for a while, and cross-training to keep your fitness.

Understanding the condition

The guidelines recommend education about the condition, how long it may take, and how to manage load, alongside exercise [2][4]. Give it at least 12 weeks before judging whether a programme is working [2][4]. Many people need longer.

Shockwave and laser

The evidence does not support these as routine add-ons for Achilles tendinopathy:

  • Shockwave: a 2026 review of 9 trials found no meaningful benefit over sham (placebo) shockwave for either type of Achilles tendinopathy [7]. An Australian trial found adding shockwave to exercise and education gave no extra benefit over sham for insertional tendinopathy [8].
  • Laser: the US guideline advises against low-level laser for mid-portion Achilles tendinopathy [4].

If you are still interested in either, we will explain the evidence and you can decide. We only use them alongside your exercise programme, never instead of it.

The Dutch guideline says other treatments can be discussed if there is no improvement after 3 months of good exercise care, with an honest discussion of the uncertainty [2]. If you are not improving, we will review your programme with you and talk about other options, including referral.

How we approach Achilles tendinopathy in Dublin

Our clinic in Monkstown, Co. Dublin is led by Dr Lawrence Woods, a chiropractor with over 30 years' experience, and Kate Ryan, a CORU-registered Chartered Physiotherapist and member of the Irish Society of Chartered Physiotherapists (ISCP), who has a special interest in running injuries and tendinopathy.

  • Assessment first. Your first visit is an assessment, which includes a first treatment if it is suitable. We look at your tendon, your strength and your training.
  • A loading plan built around you. A progressive strength programme, a plan for your running, and advice on managing load.
  • A review at your sixth visit. We check your progress against your goals. If you are not improving, we will say so and talk about other options.

Questions about Achilles tendinopathy

Should I stop running?

Usually not completely. Most people can keep running at a level the tendon tolerates while they build strength [4][6].

Should I stretch my calf?

Strengthening matters more than stretching. If you have insertional tendinopathy, avoid stretching your calf hard over the edge of a step, as this squeezes the tendon where it attaches [2].

Can I see you without a GP referral?

Yes, you can book directly. After your assessment, we may refer you to your GP if you need further tests.

If you would like an assessment, you can book an appointment, start with our online questionnaire, or contact us with any questions. See also our running injuries page.

Sources

  1. Kakouris N, Yener N, Fong DTP (2021). A systematic review of running-related musculoskeletal injuries in runners. Journal of Sport and Health Science 10(5):513–522. https://doi.org/10.1016/j.jshs.2021.04.001
  2. de Vos RJ, van der Vlist AC, Zwerver J, et al. (2021). Dutch multidisciplinary guideline on Achilles tendinopathy. British Journal of Sports Medicine 55(20):1125–1134. https://doi.org/10.1136/bjsports-2020-103867
  3. HSE (2024). Heel pain. Health Service Executive, Ireland. Page last reviewed 13 October 2024. https://www2.hse.ie/conditions/heel-pain/
  4. Chimenti RL, Neville C, Houck J, et al. (2024). Achilles pain, stiffness, and muscle power deficits: midportion Achilles tendinopathy revision – 2024. Journal of Orthopaedic & Sports Physical Therapy 54(12):CPG1–CPG32. https://doi.org/10.2519/jospt.2024.0302
  5. Beyer R, Kongsgaard M, Hougs Kjær B, et al. (2015). Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. American Journal of Sports Medicine 43(7):1704–1711. https://doi.org/10.1177/0363546515584760
  6. Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J (2007). Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. American Journal of Sports Medicine 35(6):897–906. https://doi.org/10.1177/0363546506298279
  7. Korakakis V, Kotsifaki A, Sotiralis Y, et al. (2026). Shockwave therapy for midportion and insertional Achilles tendinopathy: a nail in the coffin? A systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy 56(5):282–299. https://doi.org/10.2519/jospt.2026.13985
  8. Alsulaimani B, Perraton L, Vallance P, et al. (2025). Does shockwave therapy lead to better pain and function than sham over 12 weeks in people with insertional Achilles tendinopathy? A randomised controlled trial. Clinical Rehabilitation 39(2):174–186. https://doi.org/10.1177/02692155241295683