Achilles Tendinopathy

Tendinopathy is a tendon that's been asked to do more than it's currently adapted for. The tendon isn't torn, and it isn't inflamed in the usual sense — it has changed its structure in response to overload, and it's sensitive. That's why the classic pattern is stiffness first thing and pain after activity, rather than a sharp injury you can point to.

It matters because the treatment that works is almost the opposite of instinct. Rest calms symptoms but doesn't make the tendon more capable, so the pain returns. Progressive loading — asking the tendon to do a little more, on a schedule — is what changes it.

Where it hurts changes what we do. Mid-portion tendinopathy, a few centimeters above the heel, usually tolerates and responds to full-range calf loading. Insertional tendinopathy, right at the heel bone, is irritated by deep stretch and heel-drop positions, so we load it through a smaller range at first. Getting this right early avoids weeks of doing the right exercise the wrong way.

Runners adding mileage or hills, athletes returning after a layoff, and lifters who added running or plyometrics. It also shows up in people who switched to a lower-drop or minimalist shoe, and in anyone whose calf strength quietly stopped keeping up with their training. In Los Angeles, hill routes and the jump from flat paths to trails are common triggers.

I look at the tendon itself, but also the calf's actual capacity — how many single-leg calf raises you can do, how it handles speed and load — along with ankle mobility and how your foot and calf absorb force when you run. Combined with what changed in your training, that shows what overloaded the tendon and what it needs to rebuild.

The early weeks focus on calming the tendon without unloading it entirely: hands-on work for the calf, and a running week the tendon can handle. Then the core of the work is progressive calf loading — heavy, slow, and gradually harder — which is the best-supported treatment for tendinopathy.

As the tendon tolerates more, we add spring-like work like hops and running-specific loading, then rebuild mileage and terrain in steps. Each stage has a clear marker, so you know when the tendon is ready for the next one rather than guessing.

Tendinopathy rehab lives or dies on the details — the range you load through, how heavy, how often, how you feel the next morning. A full hour, 1-on-1, every visit means those details get set and adjusted in real time, and direct messaging between sessions means a rough morning gets an answer the same day, not at the next appointment.

Wear something you can run and do calf work in. We'll go through your training history and what changed, examine the tendon and calf, test your calf capacity, and look at how you move. You'll leave knowing which type of Achilles tendinopathy you're dealing with, what to change this week, and what the loading progression looks like from here.