What Is the Evidence-Based Treatment for Achilles Tendinopathy?

Achilles tendinopathy presents with tendon pain that intensifies during and after loading activity. Effective management targets both symptom resolution and measurable structural improvement in the tendon.

First-line treatment approach

The structured regimen is built around a specific eccentric calf muscle training programme, integrated within a broader multifactorial approach — the complete protocol, including the precise combination of interventions and their sequencing, is available in full below.

Clinical goals at 12 weeks

Resolution of Achilles tendon pain during loading activity
Decreased Achilles tendon volume on MRI
Decreased Achilles tendon signal intensity on MRI

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1136/bjsm.2007.035543

Alfredson's model of eccentric training involves no concentric loading and emphasises the need for patients to complete the exercise protocol despite pain in the tendon.
If patients experience no tendon pain doing this programme, the load should be increased until the exercises provoke pain.
Generally, the initial treatment consists of a multifactorial approach that may include a combination of rest (complete or modified activity), medication (NSAIDs, corticosteroids), orthotic treatment (heel lift, change of shoes, corrections of malalignments), stretching and strength training.
A night splint has been shown to be an effective intervention for Achilles tendinopathy.
A greater reduction in pain was seen when the night splint was combined with a 12-week eccentric exercise programme.
The same 12-week programme resulted in a decrease in tendon volume assessed with MRI, as well as a decrease in tendon signal intensity by 23%.

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