Achilles tendinopathy treatment in Manchester
Calm a sore Achilles, rebuild its strength and get back to running without the morning limp.
Achilles tendon pain physio in Manchester city centre
Reviewed by Nick Chatziviltsos, PgDip, HCPC-registered physiotherapist (PH114351), November 2026
At a glance
Who gets it: Runners, people in jumping sports, and active adults aged 30 to 60.
Main symptom: Pain and stiffness in the Achilles, worst first thing in the morning or at the start of exercise.
Typical recovery: Tendons adapt slowly. Most people need 6 to 9 months of rehab to get back to full activity without pain.
Sessions: Most people need 4 to 8, spread over 3 to 4 months.
Avoid: Complete rest and stretching hard into the pain. Tendons need the right load, not none.
Get urgent help: A sudden snap or kick in the back of the heel, then trouble walking or rising onto your toes: go to A&E the same day.
The latest clinical guideline for physios treating Achilles pain is clear on one thing. Progressive loading of the tendon is the first-line treatment, and complete rest isn't needed. That means you can usually stay active while it gets better.
Achilles tendinopathy is one of the most common running injuries we see at our clinic inside F45 NQ on Piccadilly. It also affects people who've stepped up their walking, started a new class or switched to flatter shoes. The classic sign is a stiff, sore tendon first thing in the morning that loosens as you move.
Tendons recover more slowly than muscles, so this isn't a two-week fix. But with the right plan, most people see steady progress within the first few weeks and get back to everything they enjoy. This page, and your first session with us, is built around getting you there.
🛠️ How we treat Achilles tendinopathy
Every Achilles plan at Athos Physio follows the same three steps. What changes is what we find at each one.
Step 1. Find the root cause of your Achilles pain
The pain is in your tendon, but the reason it's overloaded is often in your training, your calf or the way you move. In your first 60-minute session we work out three things:
What's irritated: the middle of the tendon, where it attaches to the heel, the sheath around it, or a nearby bursa
What's overloading it: a jump in running distance, hills or speed work, more jumping in classes, new shoes, or a weak calf that tires early
What's keeping it sensitive: pushing through pain, stopping and starting, poor sleep, or worry that the tendon is about to snap
We show you on a 3D anatomy model on a tablet where the problem sits, so you understand why your tendon hurts and why your plan looks the way it does.
Step 2. Treat what's driving it
Calm the pain. Isometric calf holds often ease tendon pain within a session. We add soft tissue work and IASTM on a tight calf, and joint mobilisation if your ankle or big toe is stiff.
Get the load right. We find a level of running, walking and training your tendon can handle, rather than stopping everything. A temporary heel lift can help some people.
Use the right exercises for your type. Mid-portion and insertional tendinopathy need different set-ups. For insertional pain we keep calf raises on a flat floor at first, rather than dropping the heel off a step.
Treat the areas around it. Stiff ankles, weak hips or a big toe that won't bend can all push extra load into the Achilles. We work on those too.
Step 3. Build an Achilles that lasts
Most people stop once the morning stiffness goes, and that's why Achilles pain so often comes back. Step 3 makes your tendon strong and springy enough for what you want to do:
Progressive strength work, such as slow heavy calf raises, single-leg calf raises with added weight, seated soleus raises on a machine or with a barbell, and leg press calf raises.
Rehab on the gym floor. Being inside F45 NQ means we can load your calf with real weights and coach your technique, then move to skipping, pogo hops and bounding.
Practise what caused it. A structured return-to-run plan with hills and speed added back last, or a return to jumping in classes and sport.
A flare-up plan. What to do if the tendon gets sore again after a big week, so you can adjust your training without booking in.
We finish when you're back running, jumping or training at the level you want, not just when the morning stiffness has gone.
Want to know which type of Achilles pain you have and how much load it can take? Your first 60-minute session finds out and starts your plan the same day. Book your assessment →
🔍 What is Achilles tendinopathy?
Your Achilles tendon joins your calf muscles to your heel bone. It's the largest tendon in the body and works like a spring every time you walk, run or jump.
Tendinopathy happens when the tendon is loaded more than it can currently cope with. Its structure changes, it becomes sensitive and it handles less load. You may have heard it called Achilles tendonitis. That name suggests inflammation, but the main problem is the tendon's capacity, which is why loading it correctly is the treatment.
Types of Achilles pain we treat
Mid-portion tendinopathy: the tendon itself, about 2 to 6 cm above the heel; sore, sometimes thickened tendon, stiff in the morning, warms up with running.
Insertional tendinopathy: where the tendon attaches to the heel bone; pain right at the back of the heel, worse uphill and with shoes rubbing.
Paratendinopathy: the sheath around the tendon; swelling and sometimes a creaking feel when the ankle moves.
Retrocalcaneal bursitis: a fluid sac between the tendon and heel bone; tender just above and in front of the tendon attachment.
Achilles rupture: a full tear of the tendon; sudden snap or kick feeling, can't push off; get help now (see the warning signs listed on this page).
Calf strain: a tear in the calf muscle higher up; sudden pain in the muscle during a sprint or jump.
Working out which of these you have is the first job of your assessment. It changes which exercises help, which ones to pause and how fast you can progress.
⚠️ Achilles tendinopathy symptoms
Most Achilles tendinopathy shows a mix of these:
Pain and stiffness in the tendon at the back of the ankle or heel
Stiffness first thing in the morning or after sitting, which eases as you get moving
Pain at the start of a run that may ease, then returns afterwards or the next morning
A tender, sometimes thickened or swollen area on the tendon
Pain going up on your toes, hopping, skipping or climbing stairs
For insertional pain, soreness where shoes rub on the back of the heel
Is it your Achilles, your calf or your heel?
Pain at the back of the lower leg doesn't always come from the tendon. These clues help us tell them apart:
Sudden pain in the calf muscle during a sprint or jump, with tenderness higher up the leg, is more likely a calf strain. See calf strain.
Pain under the heel, worst with your first steps in the morning, points to plantar fasciitis. See plantar fasciitis.
Pain on the outside of the ankle, behind the bony bump, is more likely the peroneal tendons. See peroneal tendonitis.
Pain in both heels with long morning stiffness, or with psoriasis, bowel problems or other painful joints, can be an inflammatory condition. See your GP.
A throbbing, swollen calf without an injury needs ruling out for a blood clot. See the warning signs listed on this page.
We test each of these at your first session rather than guessing from the symptoms alone.
🔍 What causes Achilles tendinopathy?
It's rarely one thing. Tendon pain usually builds when the load on the tendon rises faster than it can adapt. It often appears a day or two after a big week, not during the session that caused it.
Common triggers we see in Manchester
Training for a race. Building towards the Manchester Marathon or a half, adding distance, hills and speed work at the same time.
Lots of jumping. Skipping, burpees, box jumps and pogo work in F45 and HIIT classes, especially after a break.
A change of shoes. Moving to flatter or more minimal trainers, or from work shoes with a heel to flats.
Weekend warrior loading. Sitting at a desk all week, then a long run, a hike or five-a-side at the weekend.
Weak or tired calves. If your calf can't do many single-leg raises, the tendon takes more of the strain.
Age and health. Tendons become less resilient from your 30s. Some antibiotics, called fluoroquinolones, are also linked to tendon problems.
Myths about Achilles pain
Rest doesn't fix it on its own. The pain often settles, then returns as soon as you run again, because the tendon hasn't got stronger. Stretching isn't the main treatment either, and dropping the heel off a step can irritate insertional pain. And mild pain during the right exercises isn't a sign of damage.
🧪 How we assess Achilles tendinopathy
Your first session lasts 60 minutes, so there's time to assess properly and start treatment the same day. Here's what happens:
Your story (10 to 15 minutes). When it started, what your training looked like in the weeks before, your shoes, and how the tendon feels in the morning and the day after a run. We use the VISA-A questionnaire to measure how much it affects you, so we can track progress.
Safety screen. We check for the warning signs listed on this page, including the Simmonds (calf squeeze) test, to make sure the tendon hasn't ruptured.
Finding the sore spot. We feel along the tendon and use the arc sign and Royal London Hospital test to tell mid-portion pain from insertional pain or a problem in the sheath.
Calf strength and endurance. How many single-leg calf raises you can do on each side, and how high you rise. This is often the clearest measure of what's missing.
Spring and control. Hopping on each leg, if your tendon is ready, to see how it copes with fast loading.
Ankle, foot and hip checks. The weight-bearing lunge test for ankle bend, big toe movement, and hip strength, so we don't miss what's adding load.
Your diagnosis and plan. In plain English: what's irritated, why now, how much running or training to keep doing this week, and how many sessions we expect you to need.
You'll leave with treatment already started, the first two or three exercises of your custom rehab plan, and a clear plan for the next few weeks. If anything suggests a tear or another condition, we'll tell you and arrange a referral or write to your GP.
🛠️ Achilles tendinopathy treatment at Athos Physio
We don't just tell you to rest and stretch. Every plan is built around your type of tendinopathy and what you want to get back to, and moves through four phases. How fast you move depends on how your tendon responds, not on the calendar.
Settle (weeks 0 to 2). Ease pain and find a load the tendon accepts. Isometric calf holds, soft tissue work and IASTM on the calf, adjusted running or walking, cycling or swimming to keep fit.
Strengthen (weeks 2 to 12). Build calf and tendon capacity. Slow heavy calf raises, single-leg and weighted calf raises, seated soleus raises, leg press calf work, 3 or more times a week.
Spring (weeks 8 to 16). Get the tendon ready for fast loading. Skipping, pogo hops, bounding and short plyometric drills, with strength work carried on.
Return and prevent (week 12 onwards). Back to full running or sport, and stop it coming back. A graded return-to-run plan, hills and speed added last, a long-term calf strength routine and a flare-up plan.
Hands-on treatment helps most in the first phase. It eases calf tightness and makes exercise easier, but it works best alongside loading, not instead of it. That matches the clinical guideline.
Throughout, you'll get a clear home programme, usually 3 to 5 exercises taking 15 minutes a day. We review and progress it each session. Most people need 4 to 8 sessions spread over 3 to 4 months, with more time between sessions as you progress.
What actually works for Achilles tendinopathy?
The Academy of Orthopaedic Physical Therapy published an updated clinical practice guideline for mid-portion Achilles tendinopathy in 2024 (JOSPT, Chimenti et al.). Our approach follows it.
Recommended: progressive tendon loading as the first-line treatment, with loads as heavy as you can tolerate; loading exercises at least 3 times a week; education about the tendon and how to manage load, alongside exercise; staying active within your pain limits, rather than complete rest; calf stretching if ankle movement is limited, and a heel lift for a short time if it helps.
Not recommended or not well supported: low-level laser therapy; ultrasound therapy on its own; insoles (orthoses), where the evidence is mixed and no recommendation is made.
This is why most of your time at Athos Physio goes on progressive calf and tendon loading. If your pain hasn't improved after a full programme, other options such as shockwave therapy can be considered. We don't offer it, but we'll tell you if it's worth exploring and where to go.
⏱️ How long does Achilles tendinopathy take to heal?
Tendons adapt slowly. Guy's and St Thomas' NHS Trust says most people need 6 to 9 months of rehab to return to full activity without pain, and that flare-ups along the way are normal. These are typical ranges we see. Your timeline depends on how long you've had it, your type and how consistently you do the plan.
Recent mid-portion (under 3 months): feeling much better: 6 to 12 weeks; back to full running or sport: 3 to 6 months.
Long-standing mid-portion: feeling much better: 3 to 4 months; back to full running or sport: 6 to 9 months.
Insertional: feeling much better: 3 to 4 months; back to full running or sport: 6 to 12 months.
Paratendinopathy: feeling much better: 2 to 6 weeks; back to full running or sport: 6 to 12 weeks.
"Back to full running or sport" means your normal distances, hills and speed work, not just walking without pain. That last step is where most people stop too early, and it's the step that protects you from the next flare-up.
✅ Achilles pain when running, training and at work
If you run
Change one thing at a time. Drop hills and speed work first, and keep easy, flat running if your tendon allows.
Use a 24-hour rule. Pain up to 3 out of 10 during a run is usually fine, as long as the tendon is no stiffer the next morning.
Avoid sudden shoe changes. Stick with the trainers you know. Moving to flatter shoes adds load to the tendon.
Plan your race build-up. Increase your weekly distance gradually and build in lighter weeks.
If you train in the gym or in classes
Swap the jumping. In F45 and HIIT sessions, swap skipping, burpees and box jumps for bike or rower work until we add jumping back in.
Keep lifting. Squats, deadlifts and upper body work usually carry on as normal.
Do your calf work first. Heavy calf raises at the start of a session, when you're fresh, get the best results.
At work and at home
Ease into the morning. Move your ankle up and down 20 times before you get out of bed.
Wear a small heel. A trainer with a slight heel is kinder to a sore tendon than flats, flip-flops or going barefoot.
For insertional pain, avoid shoes with a stiff back that presses on the heel.
Break up long sitting. Stand and do 10 calf raises every hour or so, to stop the tendon stiffening up.
Self-help in the first few days
Reduce, don't stop: cut running or walking to a level that keeps pain mild
Try a 30 to 45 second calf hold (standing on your toes) five times, which often eases pain
Use ice wrapped in a towel for 15 to 20 minutes if the tendon feels hot and sore
Don't stretch off a step edge if your pain is at the heel attachment
Can I keep running with Achilles tendinopathy?
Often, yes. Complete rest isn't needed, and continuing to run at the right level keeps you fit and the tendon loaded.
You can usually keep running if pain stays at 3 out of 10 or less during the run, settles within 24 hours, and the tendon is no stiffer the next morning.
Cut back if pain climbs during a run, you limp afterwards, or morning stiffness gets worse. Drop distance, speed and hills, and keep up your strength work.
Stop and get checked if pain is sharp, getting steadily worse, or you felt a snap or sudden give in the tendon.
We'll set your running limits at your first session, and build them back up as your calf strength returns.
Related conditions
Calf strain: a sudden pull or tightness in the back of the lower leg
Plantar fasciitis: heel pain that's worst with your first steps in the morning
Shin splints: an ache along the inner edge of the shin bone when you run
Running injuries: every running injury we treat, from knees to feet
❓ Achilles tendinopathy FAQs
🚨 Physio, GP or A&E?
Most Achilles pain is safe to manage with a physio. A few symptoms need a doctor, and a sudden rupture needs help the same day.
Book a physio (no GP referral needed): Achilles pain and morning stiffness that built up with running, walking or training; Achilles pain that hasn't improved after 2 weeks of easing off; Achilles pain that keeps coming back every time you increase your training.
See your GP: pain in both heels or other joints, morning stiffness lasting over an hour, or a history of psoriasis or inflammatory bowel disease; new tendon pain after taking a fluoroquinolone antibiotic, such as ciprofloxacin (speak to your GP or pharmacist promptly).
Call your GP urgently or 111: a hot, red, swollen heel with a high temperature or feeling shivery (call your GP urgently or 111); a throbbing, swollen calf, especially after a long journey or surgery (call your GP urgently or 111; it could be a blood clot (DVT)).
Call 999 or go to A&E: a sudden snap or feeling of being kicked in the back of the leg, then trouble walking, pushing off or standing on tiptoe (go to A&E or an urgent treatment centre the same day; it could be a rupture); calf pain or swelling with chest pain or breathlessness.
If you're ever unsure, ring us on 07475 433300 and we'll tell you honestly whether you should see us or someone else first.
Not sure if it's tendinopathy or something more? Book a free 15-minute call and we'll tell you honestly. Book a free call →
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Yes. Progressive loading exercise is the first-line treatment in the latest clinical guideline for Achilles tendinopathy. A physio sets the right exercises and load for your type and stage.
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They describe the same problem. Tendinopathy is the more accurate term, because the main issue is a change in the tendon's capacity rather than inflammation.
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Most people improve steadily over 3 to 4 months of rehab. Getting back to full activity without pain often takes 6 to 9 months, especially if you've had it a long time.
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Progressive calf raises are the core: isometric holds to ease pain, then slow heavy raises, single-leg and weighted versions, and seated soleus work. Hopping and skipping come later.
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Stretching isn't the main treatment. It can help if your ankle is stiff, but dropping the heel off a step can irritate insertional pain. Strengthening is far more effective.
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The tendon stiffens overnight, so the first steps out of bed are often the most painful. Morning stiffness is also a useful guide: if it gets worse after a run, you did too much.
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It's uncommon. Good rehab builds tendon strength. If you ever feel a sudden snap or a kick in the back of the leg, go to A&E or an urgent treatment centre the same day.
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Usually not. Achilles tendinopathy is diagnosed from your history and an examination. A scan is useful if we suspect a tear or your pain isn't responding as expected.
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No. You can book directly with us. If you're claiming on health insurance, check with your insurer first, as some ask for a GP referral or an authorisation code.
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Yes. We work with Bupa, WPA, Vitality and Aviva. Bring your membership number and authorisation code when you book.
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Your first 60-minute assessment and treatment is £95. Follow-up sessions are £55 for 30 minutes, £95 for 60 minutes or £135 for 90 minutes. See our price list for all fees.
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Yes. Book a free 15-minute consultation and we'll tell you honestly whether physio is the right next step for your Achilles.
📍 Book Achilles tendinopathy physio in Manchester city centre
Athos Physio is inside F45 NQ, 77 Piccadilly, Manchester M1 2BU, a two-minute walk from Piccadilly station and Piccadilly Gardens. We're open 7am to 8pm, Monday to Friday, so you can come in before or after work.
Your first appointment is a 60-minute assessment and treatment (£95). Follow-ups are £55 for 30 minutes, £95 for 60 minutes or £135 for 90 minutes. We work with Bupa, WPA, Vitality and Aviva, and you can see all our fees on the price list.
Can't get into town? We also offer home physio visits and online physiotherapy. Not sure physio is right for you? Book a free 15-minute call and we'll talk it through.
Call or WhatsApp 07475 433300, or book online.
Other services: Physiotherapy and active rehab · Sports massage · Pregnancy and postnatal physio · Home visits · Online physio
Written by Nick Chatziviltsos, physiotherapist and founder of Athos Physio, BSc (Hons) Physiotherapy, HCPC registered. Last reviewed: November 2026.
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We are based in Manchester city centre a couple of minutes walk from Piccadilly train station and Piccadilly Gardens Square