13/10/2026
“Just rest it” is the most common — and least evidence-based — advice given for Achilles pain 🏃
A recent update to the JOSPT Clinical Practice Guideline on midportion Achilles tendinopathy (Chimenti et al., 2024) is the third revision since 2010, folding in 26 new studies. Here are a few things worth knowing that didn’t quite fit into the slides:
🤕 It’s not “tendinitis” 🤕 The guideline is explicit in saying that this isn’t an inflammatory condition — it’s the tendon’s structural response to load it isn’t coping with yet. That distinction matters because it’s exactly why anti-inflammatories and total rest tend to underperform, and why loading (done right) is the Grade A recommendation — the guideline’s highest strength-of-evidence rating.
⚠️ Real risk factors, not myths ⚠️ Alongside prior tendon injury and reduced calf strength, the review flags quinolone antibiotic use, higher alcohol intake, and training through cold conditions as genuine contributors — factors that rarely come up in the “foot posture and bad shoes” conversation.
📋 There’s no one “correct” protocol 📋 Eccentric loading, isometrics, heavy-slow resistance — none of them beat the others outright. What the guideline says actually drives the decision is tendon irritability: how reactive it is right now. That’s a clinical judgement call, not a program you pull off the internet and apply blind — which is exactly where things go wrong when people self-manage from a generic routine.
If your Achilles has been nagging for weeks, our Functional Running Assessment measures your tendon and calf loading capacity directly, and the Run Ready group strength class builds the progressive strength this guideline points to — both guided by a clinician who can read your irritability level and build the right plan around it, not a one-size-fits-all fix 🏋🏼♀️
Book an appointment now via the link in our bio or by contacting us on 📞 0477 500 228 and we’ll help you get back to doing what you love sooner! 🐶
