Quick answer

For non-acute Achilles tendinopathy, complete rest is usually not the goal. Contemporary rehabilitation uses temporary load modification followed by progressive loading to rebuild tendon and calf capacity.

Article

Reduce the provocative dose, not all movement

A runner may temporarily reduce speed, hills or weekly volume while maintaining tolerable walking, cycling or modified running. The exact plan depends on irritability and goals.

Use symptoms intelligently

Some discomfort during rehabilitation can be acceptable, but large symptom escalation or substantially worse next-day stiffness may indicate that the load progressed too quickly. Pain rules should be individualised.

Build back toward real life

Rehabilitation ultimately needs to prepare the tendon for the patient’s required loads: prolonged walking, stairs, running, jumping or sport. Stopping at low-load exercises may leave a capacity gap.

Key points

  • The 2024 midportion CPG advises against complete rest in non-acute cases.
  • Activity modification is temporary, not permanent avoidance.
  • Return-to-sport decisions should consider strength and repeated-load tolerance, not pain alone.

Frequently Asked Questions

Should I walk if my Achilles hurts?

Often yes, within an individually tolerable level, unless an acute injury or other contraindication changes the plan.

Is pain during exercise always harmful?

No. Some pain can occur during tendon rehabilitation, but the acceptable level should be individualised and monitored.