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The Achilles tendon is the thickest and strongest tendon in the human body. It is designed to withstand immense loads, acting as a spring that propels us forward when we walk, run, or jump. However, when this tendon becomes painful (Achilles Tendinopathy), it can feel like your heel is being gripped by a vice.
It often starts as a stiffness in the morning that “warms up” as you move, only to ache throbbingly later in the day. Over time, the pain becomes constant. It stops you from running. It makes walking upstairs difficult. It changes the way you move.
For years, this condition was called “tendinitis” (inflammation). Patients were told to rest and ice. We now know this is wrong. The condition is a Tendinopathy (degeneration). The collagen fibres have become disorganised and weak. But crucially, the pain is not just in the tissue; it is in the nervous system’s perception of load. At Breakthrough Pain & Performance, we treat the tendon and the brain to restore the spring in your step.
One of the classic signs of Achilles Tendinopathy is that it hurts when you start moving, feels better during the activity, and then hurts worse afterwards. This is the Warm-Up Effect.
This happens because movement drives fluid into the tendon, temporarily reducing stiffness. However, the pain is also modulated by the brain. When you have tendon pain, the brain develops Cortical Inhibition. It changes the way it recruits the calf muscles.
To protect the tendon, the brain alters the firing pattern of the Gastrocnemius and Soleus muscles. It makes them stiff and jerky. This lack of fluid control increases the shock load on the tendon, causing more damage.
We treat this inhibition. We use Metronome Training. By moving to an external beat, we bypass the brain’s protective inhibition. We force the cortex to re-engage with the muscle in a smooth, rhythmic way. This normalises the load on the tendon and reduces pain significantly.
When an Achilles is painful, the brain is in a high-threat state. It screams “stop” every time you load the foot. Standard calf raises can be too aggressive.
We use Isometric Loading (heavy static holds) as our first line of treatment. Research shows that holding a heavy load without moving (e.g., holding a calf raise position) for 45 seconds causes a massive release of inhibitory neurotransmitters in the brain.
It acts as a natural analgesic (painkiller). It calms the brain’s threat detection system instantly. It allows us to load the tendon safely, stimulating the cells (tenocytes) to start repairing the collagen without triggering a flare-up. We teach you exactly how to dose this “medicine” at home.
The Achilles is the end of the chain. It often takes the blame for failures higher up. Specifically, Gluteal Inhibition.
When you run or walk, your Gluteus Maximus should be the primary driver of propulsion. If your glutes are lazy or inhibited (common in desk workers), the brain has to find power elsewhere. It shifts the load down to the calf muscles.
The calf is not designed to be the primary engine; it is designed to be a spring. When forced to generate power, it overworks. The Achilles tendon gets overloaded and breaks down.
Treating the Achilles without fixing the glute is a waste of time. We assess your hip extension. We use P-DTR to wake up the glutes. Once the hips are driving the movement, the load on the Achilles drops, and the tendon can heal.
For the Achilles to function, the ankle joint (talocrural joint) must have adequate range of motion, specifically dorsiflexion (bending the foot up).
If the ankle joint is stiff—perhaps from an old sprain or just tight mechanics—the Achilles gets pinched or stretched excessively at the insertion point. This creates Insertional Tendinopathy (pain right on the heel bone).
We mobilise the ankle joint. We use Mulligan Mobilisations (movement with joint gliding) to restore the slide and glide of the bones. By giving the ankle more range, we stop the impingement on the tendon.
The old advice of “rest until it feels better” is disastrous for tendons. Tendons need load to stay healthy. If you rest completely, the tendon loses strength and structure. When you try to return to activity, the weakened tendon cannot cope, and the pain returns immediately.
We advocate for Optimal Loading. We keep you active. We might adjust your running volume or switch you to cycling temporarily, but we never stop loading the tendon. We use a “pain-monitoring” model. We teach you how much pain is safe (below 3/10) and how to interpret your body’s signals. We guide you through a progressive strengthening program that makes the tendon stronger than it was before the injury.
1. Pain Relief: Using isometric holds and P-DTR to settle the acute pain.
2. Mobilisation: Freeing up the ankle joint and the subtalar joint.
3. Kinetic Chain: Activating the glutes and core to offload the calf.
4. Rehabilitation: A structured, progressive loading program (Heavy Slow Resistance and Plyometrics) to build a bulletproof tendon.
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We provide a scientific path back to performance.
