Achilles tendinopathy is one of the two most common running injuries we see alongside IT band syndrome.
The usual story: morning stiffness at the back of the heel, a warm-up ache that fades after 1–2 km, and pain that returns in the last kilometre of a longer run.
Most JB runners who present have been doing the wrong thing for weeks - stretching, resting, avoiding - when they should have been loading.
Here's what works.
Mid-portion vs insertional tendinopathy
Mid-portion tendinopathy sits 2–6 cm above the heel bone. Classic morning stiffness, pain 2–6 cm above the calcaneus, responds very well to eccentric and heavy-slow-resistance loading.
Insertional tendinopathy is right at the heel bone insertion. The loading protocol is different - deep dorsiflexion aggravates insertional tendinopathy, so the eccentric "heel-drop below the step" protocol has to be modified (floor-level heel drops only, not below-step).
A good physio differentiates these at the first session. Mixing up the protocol is how patients stall.
The heavy-slow-resistance (HSR) protocol
For mid-portion Achilles, HSR has evidence comparable to or better than eccentric-only protocols, and patients often find it more tolerable.
Three times a week:
- Sets/reps: 3–4 sets × 15 reps, reducing reps as weight increases over 12 weeks.
- Tempo: 3 seconds lifting, 3 seconds lowering. Slow and controlled.
- Load: Start at bodyweight, progress to weighted (backpack with books, then dumbbells, then gym calf-raise machine). By week 6, most patients are loading 40–60% of bodyweight.
- Pain tolerance: 0–4/10 pain during loading is okay and expected. Pain should settle within 24 hours. If not, ease back one level.
Keep running during the protocol if possible - just keep pain below 4/10 during and within 24 hours after.
Complete rest is counterproductive.
Shockwave as an add-on (when stuck)
For cases that stall despite 8–12 weeks of proper HSR, shockwave therapy has good evidence as an adjunct.
Typical course: 4–6 sessions over 4–8 weeks, RM120-250 per session. We add it; we don't replace the loading with it.
Insertional tendinopathy modifications
For insertional presentations:
- Heel-raises from the floor, not off a step (no dorsiflexion below neutral).
- Heel-wedge in daily footwear for 4–6 weeks to offload the insertion.
- Slightly slower progression of load in the first 4 weeks.
- Same 3-second tempo and set/rep pattern as mid-portion.
Realistic timeline
- Week 2–3: First subjective improvement (less morning stiffness).
- Week 6–8: Meaningful running-related improvement - can run longer without end-range pain.
- Week 12: 70–80% resolution for most cases.
- Week 16+: Full return to previous running volume. Tendons take time; accept it.
Typical Johor RM costs
Achilles rehab: 6–10 sessions at RM120-250 per session over 12–16 weeks.
Physio pricing is shown as RM120-250 per session; total spend depends on the number of sessions needed.
How PhysioJohor matches Achilles cases
WhatsApp us with: mid-portion or insertional pain location, morning stiffness severity, weekly mileage, how long symptoms have been present, and what you've tried.
We match to a running-experienced physio who will prescribe the right HSR progression and not just "stretch your calves more."
Related guide: Physiotherapy in Johor - complete guide