When your Achilles will not let you push off the way you used to, every run, every hill, every calf raise feels like a test you are not sure you will pass. Whether it flares during distance running or heavy calf work in the gym, the pattern is the same: morning stiffness, load sensitivity, and a growing list of things you are avoiding. You are dealing with a tendon that needs loading, not more rest.
How we approach Achilles tendinopathy
You have probably tried stretching your calf, rolling it out, maybe doing some light heel raises. Those are reasonable starting points, but Achilles tendinopathy responds to heavy, progressive loading, not gentle maintenance. We assess whether the issue is insertional or mid-portion, because the rehab differs. We look at your calf capacity (soleus and gastrocnemius separately), your movement demands (whether that is running gait, squat depth, or box jump landings), and how your training load has changed. The tendon adapts to what you ask of it. We make sure you are asking the right things.
What treatment looks like
Rehab follows a staged progression. In the early reactive phase, we use isometric holds to settle symptoms and start building load tolerance. From there, we progress to heavy, slow isotonic calf raises to force tendon adaptation. The final stage reintroduces plyometric loading and sport-specific drills to prepare the tendon for the demands you need it to handle. For chronic cases that have not responded to loading alone, shockwave therapy is an evidence-based adjunct we use to accelerate the process.
Who can help
Any of our physiotherapists can assess and treat Achilles tendinopathy. If foot and ankle biomechanics are part of the picture, Ivan Tam can look at the lower limb mechanics in detail. If you are a runner, Nicholas Ho and Isabelle Chow both work with runners and can assess loading and calf capacity. If your Achilles pain is connected to lifting, CrossFit, or heavy gym training, TJ Chen can assess how your training is loading the tendon.
Go deeper
Our guide on Achilles tendinopathy breaks down the three rehab stages, the difference between insertional and mid-portion presentations, and when shockwave makes sense. Read the full guide on Achilles tendinopathy →