07922 884 788

Calf & shin

Achilles tendinopathy

Pain and stiffness in the tendon above the heel — worst on the first steps of the morning.

What it typically feels like

  • Stiffness and pain in the tendon on the first steps of the day
  • A tender, sometimes thickened area a few centimetres above the heel
  • Easing as you warm up, then worse afterwards
  • Pain pushing off when running or climbing stairs

The Achilles is the strongest tendon in the body and takes several times body weight with every running stride. It responds well to load applied gradually, and badly to load applied suddenly.

What usually causes it

  • A sudden increase in running volume, speed or hill work.
  • Tight or weak calves, so the tendon absorbs what the muscle should have.
  • A change of footwear, particularly dropping to a lower heel.
  • Restricted ankle movement, changing how the foot loads.

An important warning

A sudden, severe pain like being kicked or shot in the back of the ankle, usually with an audible snap and an inability to push off, may be an Achilles rupture. That is an emergency — go to A&E the same day. It is frequently mistaken for a bad calf strain, and delay affects the outcome.

Ordinary tendinopathy comes on gradually over weeks. Rupture happens in an instant.

What treatment involves

Soft tissue work through the calf complex to reduce the pull on the tendon, work on the tendon itself, and restoring ankle mobility.

Then loading. As with any tendon, the treatment that changes the tissue is progressive strengthening — calf raises loaded and built up steadily over months. Hands-on work makes that possible and more comfortable; it does not replace it.

How long

Months, not weeks, and improvement is gradual rather than sudden. Tendons are slow. The people who recover fully are the ones who keep going with the loading after it stops hurting.

What is actually in the calf & shin

Two bones, a calf built in two layers, and the thickest tendon in the body — all of it absorbing several times body weight on every stride.

Gastrocnemius
The superficial calf muscle, crossing both the knee and the ankle. It is the one that cramps, and the one that tears when a sprint starts badly.
Soleus
Underneath gastrocnemius, crossing the ankle only. Less dramatic and more often the actual problem in a calf that stays tight however much it is stretched. It also refers pain into the heel.
Achilles tendon
Where both calf muscles converge onto the heel bone. Extremely strong, relatively poorly supplied with blood, and slow to recover as a result.
Tibialis anterior and posterior
Front and deep-back of the shin, controlling the foot as it lands and holding up the arch. Shin pain along the inner border usually involves the deep posterior group.

Why it goes wrong

Nearly everything here is a training-load story: too much, too soon, or on a new surface or in new shoes. Shin pain spread along the inner border of the bone behaves quite differently from pain at one sharply defined point, and the second warrants caution and a medical opinion rather than more running. Achilles problems in particular respond to being loaded properly and progressively, and get worse with complete rest.

3D anatomy See the structures involved on the interactive model

The honest next step

This page describes what is common, not what you have. The only way to know is to have it assessed — and your first session includes a full assessment, so you leave knowing what is actually going on.

Book an assessment Call 07922 884 788