The Back Pain Doctor
Achilles tendinopathy is an overuse-related condition of the Achilles tendon, causing pain, stiffness and reduced tolerance for loading activities such as running and jumping. It can affect the mid-portion of the tendon or its attachment at the heel.
The foundation of treatment is a progressive loading (strengthening) program, which has the strongest evidence for Achilles tendinopathy. This is combined with managing overall load so the tendon is challenged but not overwhelmed. Recovery is typically measured in months rather than weeks.
Where symptoms persist despite a well-executed loading program, additional options such as shockwave therapy may be considered, particularly for mid-portion tendinopathy. We assess your tendon, confirm the type and location of the problem, and give you a realistic plan.
The options below include the treatments offered at The Back Pain Doctor. Listing a treatment does not mean it is recommended for this condition. The evidence, likely benefit and role of each option are considered against the diagnosis, examination findings, imaging where appropriate, patient goals, risks, cost and alternatives.
This is the starting point for most musculoskeletal conditions.
The priority is to identify the likely pain generator, explain the condition clearly, modify aggravating load and build a realistic plan to restore strength, movement and confidence.
Best supported when the diagnosis is a suitable tendinopathy or plantar heel pain presentation.
Shockwave may be clinically relevant when symptoms persist despite appropriate load management and rehabilitation. It remains an adjunct, not a substitute for progressive loading and diagnosis-specific care.
Read moreEvidence varies substantially by condition, tissue and preparation method.
PRP may be discussed in selected tendon or joint presentations. It should not be presented as a guaranteed regenerative treatment, and uncertainty, cost and alternatives should be discussed.
Read moreBest used for specific inflammatory or irritable pain generators, usually for short-term relief.
An injection may help when a joint, bursa, tendon sheath or other defined structure is driving symptoms. It is not a cure and needs to be weighed against risks, recurrence and the need for rehabilitation.
Read moreClinical evidence is still developing and guideline support is limited.
EMTT may be discussed as an adjunct in selected presentations, but should be presented with clear uncertainty and never as a replacement for diagnosis, load management or rehabilitation.
Read moreEvidence is condition-specific and generally less established than exercise-based care.
Prolotherapy may be considered in carefully selected chronic ligament, tendon or joint-related pain presentations, but it is not a first-line treatment.
Read moreMost relevant when focal myofascial pain is a clear contributor.
Trigger point treatment may reduce pain from focal muscle spasm or myofascial tenderness. It should be paired with movement restoration, strength work and recurrence prevention.
Read moreRelevant only when the history and examination support nerve irritation or entrapment.
Nerve-focused treatment may be discussed when there is a plausible peripheral nerve pain generator. Progressive weakness, major neurological deficit or red flags require a different pathway.
Read moreThis is general information only. Suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of uncertainty, expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
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