About Achilles Tendinopathy or Tendinitis

The Achilles tendon is the largest tendon in the human body and runs from a person’s heelbone to the calf. It’s also the strongest tendon, which isn’t surprising considering its role in helping humans to both walk upright and play sports. So, it’s also not surprising that this tendon is subject to all manner of injuries, including chronic Achilles tendinopathy and Achilles insertional tendinopathy.

Classical Achilles tendinopathy is the swelling and inflammation of the Achilles tendon. Achilles insertional tendinopathy is the degeneration of the tendon right where it attaches to the heel bone. Achilles tendinopathy is considered a degenerative disease, which means that it will get worse over time if it’s not treated. Complications of untreated, chronic Achilles tendinopathy can lead to tiny tears in the tendon. This in turn can lead to a complete rupture.

The injury is mostly found in sports that require running and jumping, like basketball, volleyball and soccer. It’s an overuse injury that’s caused when the tendon is constantly exposed to excessive stress. The condition tends to afflict people in middle age who have been stressing their Achilles tendon for a long time, leading to the fibers of the tendon being progressively broken down.

The condition can be made worse by wearing the wrong footwear and abrupt changes in the patient’s training program. People who engage in a sport without warming up first are also at risk for Achilles tendinopathy.

Achilles tendinopathy symptoms include pain at the back of the lower leg. The pain can range from somewhat uncomfortable to excruciating. Sometimes the patient only feels pain when he or she is active. Other people feel pain in the tendon even when they’re resting. The patient might also experience thickening and swelling around the tendon. There might also be morning stiffness around the tendon and the lower leg in general.

Immediate treatment for a patient’s Achilles tendinopathy symptoms is RICE therapy. This means:

• Rest
Rest the lower leg.

• Ice
A cold pad or an ice pack should be applied to the injured area. The pad should be left on for 20 to 30 minutes every two hours for at least three days.

• Compression
Compressing the injury can mean wrapping it in a crepe bandage from the joint beneath it to the joint above it. With Achilles tendonitis, this may mean bandaging the lower leg from the toes to the knee.

• Elevation
The leg should be elevated. After this, the patient should find a doctor. The physicians at New York Dynamic Neuromuscular Rehabilitation are highly skilled and experienced at treating sports injuries.

Short term treatment for Achilles tendinopathy may include the doctor ordering the patient to rest for between five and 10 days. He or she may also have the patient wear a brace or a boot to support the ankle and refer the patient to a physical therapist to strengthen the Achilles tendon. The doctor will also prescribe pain-killers for any discomfort.

If the condition doesn’t respond to the above treatment, the doctor might investigate the injury further with ultrasound or MRI scans. After that, treatment for Achilles tendinopathy might involve injections guided by ultrasound or even surgery. Surgery is sometimes used with severe cases of Achilles insertional tendinopathy. This risk for this condition may not only be stress to the Achilles tendon but other diseases like psoriasis, gout, bursitis, high cholesterol levels, skeletal abnormalities and the use of drugs like corticosteroids.

Surgery for insertional Achilles tendonitis is used to remove any of the damaged tissue, possible bits of bone that are causing irritation and inflamed bursae. These are little pouches that hold a fluid that lubricates the joints and other structures.

A doctor referred physical therapist will have the patients perform Achilles tendinopathy exercises as they heal from their injury. During the early stages of the recovery, the physical therapist might recommend exercises called bent and straight knee eccentric calf drops. They might be a little challenging for the patient because they’re actually supposed to be painful at first. The injured leg is used to lower the body during the exercise.

Other Achilles tendinopathy exercises are bench presses and shoulder presses, both of which use dumbbells and are performed while seated. The physical therapist might also recommend exercises that stabilize the patient’s core, like the dead bug. This unfortunately named exercise probably got its name because it’s done while lying on the back. The dead bug is a type of pilates exercise and should be done only after the patient has become proficient at single arm and leg raises.

As the healing process goes on the patient’s pain and morning stiffness should be greatly reduced. Now, the patient can use weights with the straight knee and eccentric calf-drops and can progress to walking lunges and exercises like lawnmowers and A-walks. The physical therapist can also start the patient on exercises that strengthen his or her lower limps, like barbell squats. They can also begin to use a stationery bicycle set for a low to medium intensity and begin to work on a cross trainer and a stepper.

Later, the patient should keep up with the calf drops and can begin walking the jogging on a treadmill till they are free of pain. The patient can also use weights on his or her lower limbs.

Just before the patient returns to their sport of choice, he or she should be able to lift heavier leg weights, perform various kinds of hops and jumps, run and perform full training and drills for their sport of choice, all without pain. The leg that had been injured should have no less than 90 percent of the ability of the uninjured leg.

The patient should understand that it will take at least a few weeks for him or her to return to the point where they can participate in their favorite sport. They will also have to take care in the future to wear the proper gear, do warm-up exercises, and train properly to make sure that the injury doesn’t recur.

Give New York Dynamic Neuromuscular Rehabilitation a call today for more information on our options for innovative treatment for Achilles tendinopathy.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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