Achilles Tendon Pain

The Achilles tendon is one of the strongest tissues in the human body. Its primary function is to transmit the force generated by the calf muscles to the foot, enabling actions such as walking, running, jumping, and propelling oneself forward during movement.

It is mainly composed of collagen fibers organized to withstand high amounts of tension. However, when the load it receives exceeds its capacity to adapt, pain, stiffness, or functional impairment may arise.

Why Can Achilles Tendon Pain Develop?

Pain can occur due to factors such as:

• Sudden increase in physical activity

• Repetitive overload

• Lack of recovery

• Impaired ankle mobility

• Changes in gait or running mechanics

• Strength deficits in the lower kinetic chain

Often, treatment focuses solely on the tendon, but the Achilles is part of a much broader muscular and fascial chain.

The Glute-Achilles Connection

The posterior aspect of the body functions as a continuous kinetic chain. The gluteus, hamstrings, calves, and Achilles tendon work together to produce and transmit force during movement.

When there is a dysfunction in this chain, for example:

• Poor gluteal activation

• Lack of hip control

• Calf overload

• Ankle stiffness

The body may alter load distribution, increasing the demand placed on the Achilles tendon.

Therefore, in some patients, the source of the overload is not located solely in the tendon, but in how the entire lower limb manages movement.

The Importance of the Posterior Chain

The gastrocnemius and soleus muscles have a direct relationship with the Achilles tendon because they are responsible

for transmitting force to it.

When there is:

• Excessive muscle tension

• Poor shock-absorption capacity

• Lack of progressive strength,

the tendon may receive more load than it can tolerate.

This can lead to symptoms such as:

• Pain in the back of the ankle

• Stiffness upon waking up

• Discomfort during walking or running

• Tenderness to touch in the area

Achilles Tendon and Foot Biomechanics

The foot is the foundation where this entire kinetic chain ends.

Alterations in:

• Foot strike and support

• Ankle mobility

• Gait control

can alter how the tendon receives forces.

This is why it is essential to assess from the heel to the hip, rather than focusing solely on the painful site.

Physiotherapy Treatment

Treatment aims to restore the tendon's capacity to tolerate load progressively.

• Manual Therapy and Myofascial Release

To address tissue restrictions around the calves, soleus, and posterior chain. • Radiofrequency Therapy

As an adjunct, it can help improve tissue response, promote local circulation, and reduce the sensation of stiffness.

• Deep Dry Needling

Can be used on muscles associated with overload, such as the calves or soleus, when clinically indicated. • Invasive Therapies: Percutaneous Electrolysis / Invasive Techniques

In certain cases, this can be used to stimulate tissue repair and remodeling processes, promoting the reorganization of collagen fibers during recovery.

• Therapeutic Exercise

This is one of the primary tools for restoring tendon capacity through progressive and controlled loading.