Sports Injury Focus – Achilles Tendon Injury


Achilles Injury – Signs and symptoms:

Immediate sharp pain in the back and bottom of your leg. Right above the ankle joint. Often happens when running or jumping and gets worse/comes on gradually as you run.  Sometimes this can build up over a period of time and is aggravated by movement, especially walking up hill or stairs. Calms down with rest and sometimes you can feel crepitus ( creaking) of the tendon.

* Week 1

Complete rest.

Apply lots of ice. Swap footwear to soft, comfy, high-heeled shoes. No need for strapping or supports other than to apply ice.

Every hour for 10 minutes is recommended.

Typically, an athlete suffering with an Achilles tendon issue would be advised to go swimming, take one or two gentle walks (on the flat) and when possible, work on core stability exercises with a balance ball.

The right selection of footwear is important – avoid plimsoles or sandals. Find and wear a pair of trainers with a nice thick “heel” to prevent any tension on the tendon.

From a Physio point of view – after about days 2-3, I’d begin some deep massage and very gentle stretching and work on the ankle joint to prevent any stiffness or get rid of any swelling.

I’d also massage the calf muscle and check the lower back for any stiffness to rule out any nerve problems that could create more long-term problems.

* Week 2

Ice continues – often until day 10 depending upon how much bleeding has taken place and how badly damaged the muscle tear is.

Typically, the athlete would now be exercising on a bike, swimming would continue and towards the end of week 2, I’d be aiming to have the athlete doing some very gentle jogging.

The player or athlete can expect to feel some form of burning sensation, but as long as it isn’t “cramping” or “biting” this is fine – and a good thing.

From a Physio point of view – massage is now vital.
It’s now that the scar tissue build up is “dangerous” and if the massage isn’t done, it’s the number 1 reason for an Achilles tearing again in the first two weeks back to running or playing.

* Week 3

Ice has stopped. Now, heat is being used rather than ice in this stage.

Stretching is now vital. I’d be recommending the athlete to attend Yoga classes, increase the amount of Pilates exercises and that he or she be working on their balance (using a ball).

Fitness levels are increased significantly. Swimming, cycling, gentle jogging is stepped up (still on the flat). And by the end of this phase, the athlete may or may not be asked to be doing three quarter pace running by now.

From a Physio point of view – hands-on treatment is vital, massage continues and work on the Achilles, calf, hamstrings, gluteal muscles and lower back is essential to prevent future reoccurrence.

Ankle joint and balance work is important too. PNF stretching is also introduced. Static, Isometric exercises to the calf and achilles tendon is initiated.

* Week 4

Athlete 90% fit.

CV work increases and a return to practice and full drills are possible and the goal, by the end of week 4.

Athlete is put through drills that will include sprints, shuttles and plyometric work, including running backwards.

Note: Hill running and sand is disqualified for at least 3 more months for this type of injury.From a Physio point of view – hands-on massage continues, PNF stretching is vital and passive and active eccentric stretching and strength work is stepped up.

* Week 5

Athlete returns to sport.
Fitness and performance work increases.

From a Physio point of view – massage continues to prevent scar tissue build up and stretching is continued before, during and after training sessions.

Note: Daily hands-on massage will be needed for approximately another 2-3 weeks to prevent scar tissue (collagen) tightening the muscles.

Review Of Recovery:

Take it very easy early on, stretch and mobilize the injury at just the right time and no Achilies injury can every recover fully without deep massage or the right amount of rehabilitative work. Especially strength starting with static/isometric to a more dynamic eccentric type exercise.

Secret Tip(s):

Too much rest in the first few weeks will increase the likelihood on re-injury.

Stay off the beach when running for at least 3 months post injury.

Don’t be fooled by the lack of pain after two weeks either. It does not mean you are fit to play or run and if you haven’t followed all of the protocol listed above, you will damage the tendon again sometime soon. If you are able to do plyometrics comfortably – i.e. run jump and push off the affected leg. Then you have a good chance of preventing the issue from returning again in future.

If you’d like more info on this, and some further easy, actionable tips on other sports injuries too. We have a free guide that we can send you. Connect with us on 020 87474 029(Chiswick) , 020 87887 804(Putney) or email us on and tell us what’s going on.



About the Author: Leslie Abrahams and the Bodies Under Construction team

Every week, for over 20 years, 100’s of people aged have consulted Leslie Abrahams and the Team at Bodies Under Construction looking for answers to concerning questions about, and for, a fast end to their health worries and physical pains and stiffness.
He has previously worked and travelled with high-level athletes in the field of cycling and volleyball. Leslie also has a special interest in Spinal Treatments and Rehabilitation, lower limb injuries, and has experience dealing with patients post injury or surgery.

Leslie is a Master Trainer for the world renowned Australian Physiotherapy and Pilates Institute(APPI). He is regular key note speaker at conferences and travels internationally to present on modified exercise for rehabilitation. Leslie is the founder of Bodies Under Construction Clinics situated in Chiswick and Putney, London. South West London’s Specialist Private Physiotherapy Practice for People of all ages, but especially those in their 30’s. 40’s, 50’s and 60’s and above, who want to keep healthy and active.

Leslie Abrahams