Achilles tendinopathy
Achilles tendinopathy involves pain and reduced load tolerance in the Achilles tendon, usually as a result of repeated or rapidly increased loading. Symptoms typically develop gradually and may occur in the middle portion of the tendon or near its attachment to the heel bone.
Mild pain or stiffness in the Achilles tendon, often more noticeable at the beginning of activity or in the morning. The player can usually walk and train with some modification, but symptoms may increase after loading.
Symptoms often develop when the load placed on the Achilles tendon increases faster than the tendon can adapt. In football players, this may occur with increases in running, sprinting, jumping or changes of direction.
Common contributing factors
- •Rapid increases in training or match load
- •High amounts of sprinting, jumping or changes of direction
- •Insufficient calf strength or load tolerance
- •Prolonged or repeated loading without adequate recovery
- •Previous Achilles tendon symptoms
The Achilles tendon adapts to loading, and regular progressive calf strengthening can improve its load tolerance. Training load should be increased gradually, particularly after periods of reduced activity or before a new season.
- •Train the calf muscles regularly with progressive loading
- •Increase sprinting, jumping and running gradually
- •Avoid large sudden changes in training and match load
- •Allow adequate recovery between demanding sessions
- •Pay attention to recurring morning stiffness or increasing Achilles tendon pain
Temporarily reduce activities that clearly provoke symptoms, particularly high volumes of sprinting and jumping. Complete rest is usually not necessary. Adjust the load so symptoms remain manageable and do not clearly worsen afterwards.
Load modification
Modify running, jumping and other loading according to symptoms while maintaining activation of the calf muscles.
Goals
Reduce irritation and establish a level of loading that is tolerated without clear worsening.
Progression criteria
Daily activities are tolerated without clear worsening and the post-exercise response is stable or improving.
Progressive strengthening
Gradually increase the load on the calf muscles through exercises such as calf raises with progressively increasing resistance and volume.
Goals
Improve calf strength and Achilles tendon load tolerance.
Progression criteria
Strength training is tolerated without increasing symptoms and the player can perform repeated calf raises with good control.
Running and football-specific loading
Gradually reintroduce running, acceleration, sprinting, jumping and changes of direction.
Goals
Restore the ability to tolerate the loading demands of football.
Progression criteria
Football-specific loading can be completed without clear worsening during or after training.
- Can walk and jog without significant pain or worsening
- Can perform progressive calf raises with good control
- Can perform running, acceleration, sprinting and jumping without significant worsening
- Can tolerate football-specific activities at an appropriate load
- Symptoms remain stable or improve between training sessions
The information in the Injury Center is for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare professional for diagnosis and treatment.
Achilles tendinopathy
Achilles tendinopathy involves pain and reduced load tolerance in the Achilles tendon, usually as a result of repeated or rapidly increased loading. Symptoms typically develop gradually and may occur in the middle portion of the tendon or near its attachment to the heel bone.
Mild — Varierar betydligt. Lättare besvär kan förbättras inom några veckor, men återgång till full fotbollsbelastning kan ta längre tid beroende på hur länge besvären funnits och hur senan reagerar på belastning.
Symptoms
Mild pain or stiffness in the Achilles tendon, often more noticeable at the beginning of activity or in the morning. The player can usually walk and train with some modification, but symptoms may increase after loading.
Acute Treatment
Temporarily reduce activities that clearly provoke symptoms, particularly high volumes of sprinting and jumping. Complete rest is usually not necessary. Adjust the load so symptoms remain manageable and do not clearly worsen afterwards.
Rehabilitation
Modify running, jumping and other loading according to symptoms while maintaining activation of the calf muscles.
Goals
Reduce irritation and establish a level of loading that is tolerated without clear worsening.
Progression criteria
Daily activities are tolerated without clear worsening and the post-exercise response is stable or improving.
Gradually increase the load on the calf muscles through exercises such as calf raises with progressively increasing resistance and volume.
Goals
Improve calf strength and Achilles tendon load tolerance.
Progression criteria
Strength training is tolerated without increasing symptoms and the player can perform repeated calf raises with good control.
Gradually reintroduce running, acceleration, sprinting, jumping and changes of direction.
Goals
Restore the ability to tolerate the loading demands of football.
Progression criteria
Football-specific loading can be completed without clear worsening during or after training.
Return to Play
- ☐ Can walk and jog without significant pain or worsening
- ☐ Can perform progressive calf raises with good control
- ☐ Can perform running, acceleration, sprinting and jumping without significant worsening
- ☐ Can tolerate football-specific activities at an appropriate load
- ☐ Symptoms remain stable or improve between training sessions
Moderate — Ofta flera veckor till månader. Tidsförloppet påverkas bland annat av besvärens varaktighet, belastningstolerans och hur progressiv rehabilitering tolereras.
Symptoms
More pronounced Achilles tendon pain and stiffness that affects running, sprinting, jumping or other loading. Pain may persist after activity and morning stiffness is often more noticeable.
Acute Treatment
Reduce or temporarily pause the most provocative activities, particularly sprinting and jumping, and replace them with better-tolerated activities when appropriate. Start or continue progressive rehabilitation under controlled loading.
Rehabilitation
Establish a tolerable loading level and work on progressive calf strengthening.
Goals
Reduce symptoms and improve tendon and calf muscle capacity.
Progression criteria
Loading can be increased without clear and persistent worsening of symptoms.
Progressive strength training with sufficient load and gradually increasing volume or resistance.
Goals
Restore sufficient strength and load tolerance for running and jumping.
Progression criteria
Can complete heavy calf training and repeated calf raises with good control without clear worsening.
Gradual return to running, acceleration, sprinting, jumping and changes of direction before full training and match play.
Goals
Tolerate the repeated and explosive loading demands of football.
Progression criteria
Full football-specific loading can be completed without clear worsening during or after activity.
Return to Play
- ☐ Full walking and running are tolerated
- ☐ The calf muscles have sufficient strength and endurance
- ☐ Acceleration and sprinting can be performed without significant worsening
- ☐ Jumping and changes of direction can be performed with good control
- ☐ A full football training session can be completed without significant symptom increase afterwards
Severe — Varierar kraftigt. Vid hälseneruptur handlar återgång till fotboll ofta om flera månader och bör styras av skadans omfattning, behandling och uppnådda funktionella kriterier.
Symptoms
Severe or rapidly increasing pain, marked functional impairment or sudden pain during an explosive movement may indicate a more significant tendon injury, including Achilles tendon rupture. The person may have difficulty walking or bearing weight normally.
Acute Treatment
Stop the sporting activity and avoid significant loading or stretching of the tendon. If an Achilles tendon rupture or other serious injury is suspected, seek medical assessment promptly. Do not repeatedly test or manipulate the tendon yourself.
Rehabilitation
Suspected Achilles tendon rupture or other significant tendon injury requires medical assessment and diagnosis before rehabilitation is planned.
Goals
Determine the extent of the injury and the appropriate treatment strategy.
Progression criteria
Medical assessment has been completed and an individualized rehabilitation plan is in place.
Rehabilitation is progressed step by step according to a medical or physiotherapy plan with gradually increasing loading.
Goals
Restore mobility, strength, function and load tolerance.
Progression criteria
Function and strength improve according to the individual rehabilitation plan and higher loading is tolerated.
Running, sprinting, jumping and changes of direction are gradually reintroduced before full football training and match play.
Goals
Restore sufficient capacity for the explosive and repeated loading demands of football.
Progression criteria
All relevant football activities can be completed with adequate function and without significant symptom worsening.
Return to Play
- ☐ Medical or physiotherapy assessment supports return to sport
- ☐ Full mobility and sufficient strength have been restored
- ☐ Running, acceleration, sprinting and jumping can be performed without significant symptoms
- ☐ Football-specific activities can be performed with sufficient capacity
- ☐ Loading can be progressed to full training without clear worsening
When to Seek Medical Care
Most load-related Achilles tendon problems can be managed with load modification and progressive rehabilitation. Medical assessment is important, however, in cases of sudden severe pain or clear loss of function.
- Sudden severe Achilles tendon pain, particularly during sprinting, jumping or other explosive activity
- A sensation of being kicked or struck in the back of the calf
- Difficulty walking normally or pushing off with the foot
- Marked swelling or a visible gap in the Achilles tendon
- Symptoms that do not improve despite load modification and rehabilitation
- Recurring or worsening pain that limits sport and daily activities
References
- Achilles Tendinopathy — Aspetar (https://www.aspetar.com/en)
- Clinical Practice Guidelines for Achilles Tendinopathy — Journal of Orthopaedic & Sports Physical Therapy (https://www.jospt.org/)