Mid Portion Achilles Tendinopathy: Unlocking the Secrets to Injury-Free Running

Last Updated: January 01, 2024 | Author: James Leigh

What is Mid-Portion Achilles Tendinopathy?

Mid-portion Achilles tendinopathy is a chronic tendon injury (chronic achilles tendinopathy) affecting the strongest tendon in the human body – the Achilles tendon. The condition, commonly experienced by athletes and weekend warriors alike, is characterized by pain, swelling, and impaired function of the mid portion Achilles tendon. This region – about 2 to 6 centimeters above the insertion on the heel bone – is particularly susceptible to degeneration due to its limited blood supply and increased stress during physical activities.

Mid Portion Achilles Tendinopathy

Symptoms: Recognizing the Warning Signs of MidPortion Achilles Tendinopathy

- Localized Achilles tendon pain in the mid-portion of the tendon

- Stiffness, particularly morning stiffness

- A tendon thickness detectable through palpation or imaging

- Tenderness when pressing on the affected area

- Difficulty and discomfort during activities that load the tendon, such as running and jumping

Causes and Risk Factors: Unraveling the Mystery of Mid-Portion Achilles Tendinopathy

While the exact cause of mid-portion Achilles tendinopathy remains elusive, several risk factors have been identified:

- Overuse or repetitive tendon loading during high-impact activities like running and jumping

- Biomechanical factors, including muscle imbalances (muscle tendon unit), foot structure, and gait abnormalities

- Inappropriate footwear that fails to support the foot and ankle properly

- Age, as tendon health declines with age

- A personal history of previous tendon injuries or other lower limb problems

Diagnosis: Identifying Mid-Portion Achilles Tendinopathy with Confidence

A thorough clinical examination, combined with imaging techniques such as ultrasound or magnetic resonance imaging (MRI), can help pinpoint the presence of mid-portion Achilles tendinopathy. Sports medicine professionals may also use sports assessment tools, such as the Victoria Institute of Sport Assessment for Achilles (VISA-A), to evaluate the clinical severity of the condition and monitor progress during treatment.

Building the Path to Recovery: Evidence-Based Management of Mid-Portion Achilles Tendinopathy

With the right treatment you managing achilles tendinopathy can be easy, most individuals can overcome mid-portion Achilles tendonitis and return to their pre-injury level of function by then.

  • Physical Therapy and Exercise

  • A well-designed exercise program is the cornerstone of mid-portion Achilles tendinopathy treatment. Consider trying the following techniques:

    - Eccentric exercises: Focusing on the lengthening phase of a movement, eccentric exercise has been shown to promote tendon healing and reduce mid portion achilles pain effectively, making them a crucial part of any rehabilitation program.

    - Stretching: Targeting both the gastrocnemius muscles and soleus muscles, regular calf stretching can aid in improving flexibility and alleviating symptoms.

    - Strengthening: Improving calf strength can help reduce the load on the Achilles tendon, thereby minimizing the risk of further injury.

  • Modifying Lifestyle Factors

  • Identifying and addressing biomechanical issues, such as overpronation or poor foot posture, and ensuring that proper achilles tendonitis-friendly footwear is worn during physical activities can be crucial in managing mid-portion Achilles tendinopathy.

  • Additional Treatment Modalities

  • Additional treatments, typically reserved for cases that don't respond to the traditional therapy methods, should be discussed with a healthcare professional. Some options include:

    - Shockwave therapy: This non-invasive treatment involves the application of shockwaves to the affected tendon, promoting pain relief and tissue regeneration.

    - PRP injections: Platelet-rich plasma (PRP) injections utilize the patient's own blood components to boost the tendon's natural healing process.

Differential Diagnosis: Rule out Other Conditions Impacting Your Achilles Tendon

It is important to arrive at an accurate differential diagnosis for your Achilles tendon issues. Other conditions that may present with similar symptoms to mid-portion Achilles tendinopathy include:

- Insertional Achilles tendinopathy: Affecting the tendon's lower insertion point on the heel bone, insertional Achilles tendinopathy may mimic mid-portion symptoms but requires a different approach to treatment.

- Achilles tendon rupture: A sudden, severe tear in the tendon can lead to reduced function and significant pain. Prompt diagnosis and treatment are essential.

- Chronic Achilles tendinosis: This condition involves the degeneration of the Achilles tendon fibers, leading to loss of strength and function over time.

Your healthcare provider will perform a thorough examination and, if necessary, imaging tests to determine the most appropriate diagnosis and subsequent treatment plan.

  • Outcomes and Outcome Measures: Tracking Progress and Ensuring Success

  • Outcome measures play a crucial role in monitoring your progress and determining the effectiveness of your treatment. Commonly used outcome measures for mid-portion Achilles tendinopathy treatment include:

    - Victorian Institute of Sport Assessment for Achilles (VISA-A): This reliable index evaluates pain, function, and sports participation to track changes over time.

    - Ankle range of motion (ROM): ROM measures in the ankle joint can help assess improvements in pain-free mobility.

    - Participant satisfaction: Personal satisfaction with the results of your treatment is key to long-term success.

    Remember to discuss your goals and expectations with your healthcare provider, and monitor your progress throughout the treatment process to ensure you continue to make gains toward a pain-free and active lifestyle.

    Powerful Rehabilitation Strategies: Plyometric Exercises and Manual Therapy

    Rehabilitation is an essential component of successful recovery from mid-portion Achilles tendinopathy. Besides eccentric exercises and stretching, integrating plyometric exercises and manual therapy can further maximize the benefits of physical therapy.

  • Plyometric Exercises: Boosting Tendon Function and Performance

  • Plyometric exercises involve rapid contractions and lengthening of the muscle-tendon unit, enhancing not only tendon health but also overall athletic performance. Evidence suggests that they can be an effective addition to a comprehensive rehabilitation program for mid-portion Achilles tendinopathy.

    Some plyometric exercises for Achilles tendon rehab include:

    - Ankle hops: A gentle introduction to plyometrics, ankle hops involve small, rapid jumps with minimal knee bend.

    - Drop jumps: Stepping off a low box and quickly rebounding into a jump, helping to improve tendon's shock absorption ability.

    It's crucial to introduce plyometric exercises gradually and under the guidance of a qualified professional, as doing them too soon or with improper form may exacerbate the issue.

  • Manual Therapy: Elevating Your Rehab Experience

  • Manual therapy entails various hands-on techniques provided by a skilled physical therapist to alleviate pain, mobilize stiff joints, and promote tissue healing. Integrating manual therapy techniques, like soft tissue mobilization, into rehabilitation protocols for mid-portion Achilles tendinopathy can be highly beneficial.

The Role of Collagen Synthesis in Tendon Health: The Building Blocks of Recovery

Collagen, the most abundant protein in the human body, is essential for the strength and stability of tendons. During the healing process of mid-portion Achilles tendinopathy, collagen synthesis helps rebuild the tendon's internal structure.

As you progress through your treatment plan, understanding the importance of collagen production can help you consistently adopt the necessary nutrition, lifestyle, and therapeutic factors that promote optimal tendon repair. Consider exploring targeted nutritional supplements or diet changes under the guidance of your healthcare provider or nutritionist to further support your tendon's recovery process.

Prevention: Shielding Your Achilles Tendon from Future Harm

Taking steps to prevent mid-portion Achilles tendinopathy recurrence is pivotal for long-term success. Some strategies include:

- Gradually increasing the intensity and duration of physical activities

- Ensuring proper warm-up and cooldown techniques during workouts

- Wearing appropriate and supportive footwear for athletic activities

- Addressing any biomechanical issues and muscle imbalances through physical therapy and exercise

- Maintaining a healthy body weight to reduce stress on the tendon

Conclusion: Reclaim Your Athletic Glory Without Pain

With a greater understanding of mid-portion Achilles tendinopathy and its underlying causes, you can now take control of your recovery and long-term success. By diligently following your treatment plan and making smart lifestyle choices, you'll be one step closer to injury-free running and rediscovering the true joy of athletic performance.

Remember, you have the power to overcome mid-portion Achilles tendinopathy and reclaim your life. Embrace this challenge, and let it be the catalyst for growth, resilience, and a newfound appreciation for the incredible capabilities of your body!

Frequently Asked Questions:

How do you treat mid-substance Achilles tendinopathy?

Treatment for mid-portion Achilles tendinopathy revolves around a multi-faceted approach that includes physical therapy, eccentric exercises, patient education, and lifestyle modifications. In some cases, other interventions such as shockwave therapy and platelet-rich plasma (PRP) injections may also be considered.

What are alternative and complementary treatments for mid-portion Achilles tendinopathy?

In some cases, alternative treatments like acupuncture, yoga, and herbal supplements may provide relief. However, their efficacy in treating mid-portion Achilles tendinopathy is still being researched. Consult your healthcare professional to find the best treatment plan tailored to your unique needs.


1. American College of Sports Medicine (ACSM)

- ACSM's Guidelines for Exercise Testing and Prescription (10th Edition)

- https://www.acsm.org/public-information/books/20205110/resources-guidelines-for-exercise-testing

2. British Journal of Sports Medicine (BJSM)

- Alfredson, H. & Cook, J. (2007). A treatment algorithm for managing Achilles tendinopathy: new treatment options.

- https://bjsm.bmj.com/content/41/4/211

3. Clinical Journal of Sport Medicine (CJSM)

- Malliaras, P., Barton, C. J., Reeves, N. D., & Langberg, H. (2013). Achilles and patellar tendinopathy loading programmes: a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness.

- https://journals.lww.com/cjsportsmed/Abstract/2013/05000/Achilles_and_Patellar_Tendinopathy_Loading.6.aspx

4. The Journal of Orthopaedic and Sports Physical Therapy (JOSPT)

- Silbernagel, K. G., Thomeé, R., & Karlsson, J. (2011). Eccentric overload training for the treatment of tendinopathy.

- https://www.jospt.org/doi/full/10.2519/jospt.2011.OP.0085

5. Physiopedia: Achilles Tendinopathy

- https://www.physio-pedia.com/Achilles_Tendinopathy

Author Box
James Leigh

James Leigh

James Leigh is a certified health professional, physiotherapist, and a seasoned runner who wins Boston Marathon, with a wealth of experience under his belt. Passionate about sharing his expertise with fellow runners. James is your go-to expert for your health, wellness and running tips.