Mid-Portion Achilles Tendinopathy: Why is R.I.C.E not helping?

The Achilles tendon is the longest tendon in the body. It tolerates great loads, up to 10 times your body weight when sprinting and jumping. It is an extension of the gastrocnemius and soleus (calf muscles) and attaches these muscles to the heel bone. It is a very important part of lower limb mechanics as it gives you the ability to push off during walking, running and jumping. When the tendon gets overloaded across time and is unable to heal sufficiently, this can lead to a condition called Mid-Portion Achilles Tendinopathy.

This is a common yet chronic condition seen in both recreational athletes and sports people alike and common among older adults. Symptoms include pain and stiffness in the tendon typically first thing in the morning and before and after exercise. Depending on the severity of the condition pain may be experienced during exercise as well. Risk factors include; a sudden increase in exercise intensity and duration, decreased recovery time between exercise, excessive foot pronation, poor footwear, poor muscle flexibility, decreased joint range of motion, or a sudden change of exercise surface. Some recent advances in treatment for Mid-Portion Achilles Tendinopathy include using isometric contractions for pain relief and looking at the role of tendon neuroplasticity in rehabilitation programmes.

This Tendinopathy is classified as a degenerative condition due to a failed healing response rather than an inflammatory condition. The changes that occur in the tendon do not follow the inflammatory healing response, which means the usual approach of R.I.C.E, rest, ice, elevation and compression does not work in the chronic stages of this condition. Tendons need to be loaded appropriately to promote healing but too much loading can be detrimental. Confused?! That’s where and Accredited Physiologist can help.

At Absolute Balance an Accredited Exercise Physiologist can help determine what is the best course of action for you coupled with appropriate exercise prescription. We will also prescribe a graded return to sport plan based on your sporting and exercise requirements. Our guidance will assist you on the way to a speedy recovery as well as treating any other pre-disposing risk factors to reduce the risk of reoccurrence. For more information or to book an assessment contact Absolute Balance today or visit our website www.absolutebalance.com.au for more blog topics.


Lisa Wallbutton (BSR, MClinicalExPhysiol(Rehab))

Accredited Exercise Physiologist (AEP) (ESSAM)

P – 9244 5580  M – 0477 577 919 F – 92445582



Rio, E., Kidgell, D., Moseley, G. L., Gaida, J., Docking, S., Purdam, C., & Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendiopathy. British Journal of Sports Medicine, 49, 1277-1283.

Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G. L., Pearce, A., & Cook, J. (2016). Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. British Journal of Sports Medicine, 50, 209-215.

Silbernagel, K. G., & Crossley, K. (2015). A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendiopathy: Rationale and Implementation. Journal of Orthopedic and Sports Physical Therapy, 45(11), 876-886.