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Achilles pain and exercise: what should I discuss at assessment?
Pain or stiffness behind the heel can occur with Achilles tendinopathy, but an assessment is needed to identify the problem. A sudden injury requires a different approach from a gradually developing ache.
What to do after a sudden pop or snap at the back of the ankle
A snap or pop with difficulty walking or pushing off needs same-day assessment for a possible rupture, at a GP, urgent care clinic or the emergency department. Don’t wait for routine rehabilitation. Gradual symptoms can be assessed at an appointment.
Which Achilles pain details are useful to describe at assessment?
Tell us whether the pain began suddenly or gradually, where it hurts and how exercise or rest affects it. Mention increases in walking, running, hills or training.
What is Achilles tendinopathy?
Achilles tendinopathy is a painful problem with the Achilles tendon, which connects the calf muscles to the heel bone and helps you push up onto your toes. It can cause pain, stiffness and swelling at the back of the heel, and the tendon may feel warm, tender or thickened. It can affect the middle of the tendon or its attachment at the heel. Pain does not by itself show how much tissue damage is present.
What commonly contributes to Achilles pain?
A sudden increase in walking, running or sport is a common contributor. Other factors can include training with little variety or a lot of hill running, tight or weak calf muscles, stiff ankle joints, being overweight and some ongoing health problems. Your medicines and general health are also relevant, so bring a medication list to your assessment.
Why does Achilles pain at the heel attachment need a different approach?
Pain where the tendon attaches to the heel (insertional Achilles pain) may respond differently to stretching and pressure from the back of the shoe than pain higher up the tendon. Generic, aggressive stretching may aggravate some insertional presentations, which is why an unadapted online programme is not recommended.
What can I do for Achilles pain while waiting for an assessment?
Keep doing comfortable activity where appropriate, but avoid sudden spikes in hills, speed or jumping. Reducing time spent walking or running for long periods, while keeping other parts of your body active, can help. Guy’s and St Thomas’ also mentions short-term pain relief, ice wrapped in a towel and supportive footwear rather than flat shoes. Do not push through a sudden loss of strength or escalating pain.
Do I need a scan for Achilles pain?
Not routinely. An assessment can first clarify whether the presentation is typical. Imaging may help if the diagnosis is uncertain, a rupture is suspected or progress is not as expected, and we explain if a scan, medical review or referral is needed.
How long does Achilles tendinopathy take to improve?
There is no single timetable. Progress depends on the type of tendon problem, how long it has been present and how you respond as activity is built back up. Tendon problems often improve gradually, so steady progress over months is common. We review your response rather than working to a fixed date.
Is shockwave therapy needed for Achilles pain?
No. Shockwave may be considered as an addition for some persistent presentations after assessment, usually alongside a loading or strength programme rather than replacing it. Research findings are mixed and improvement is not assured. Any course is quoted separately, with an agreed point to check whether it is helping.
Should I stop all exercise with Achilles pain?
For diagnosed tendinopathy, suitable alternative activity may accompany reduced aggravating activity. Avoid unadapted programmes, particularly for pain at the heel attachment.
What does Achilles tendinopathy rehabilitation involve?
We’ll discuss progressive strengthening and activity changes around your goals and response, with review rather than a fixed timetable. Shockwave may suit some persistent symptoms after assessment.
Unsure how to return to your usual activity?
Tell us which activities you miss and which exercises you have tried.
Sources and clinical guidance
These sources support the general information above. Individual assessment may lead to different advice.
Sources checked 8 September 2026.