The Best Evidence-Based Treatment Strategy for Achilles Tendinopathy
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In today's video we go over, The Best Evidence-Based Treatment Strategy for Achilles Tendinopathy - FPF Show Episode 187:
What is the most effective evidence-based treatment for Achilles tendinopathy? In this episode, we break down what the research actually says about progressive tendon loading and how physical therapists should be treating Achilles tendinopathy in clinical practice.
Achilles tendinopathy rehab has evolved far beyond rest, stretching, and passive treatments. Current evidence strongly supports progressive loading strategies to improve pain, function, and tendon capacity — but many clinicians still struggle with exercise selection, load progression, and symptom management.
In this discussion, we cover:
✅The current evidence on Achilles tendinopathy treatment
✅Why progressive tendon loading outperforms passive care
✅How to apply isometric, isotonic, and heavy slow resistance loading
✅Pain monitoring and flare-up rules for Achilles rehab
✅Common mistakes physical therapists make with Achilles loading
✅How to progress load safely without delaying return to sport
✅When symptoms are acceptable — and when they’re not
This episode is designed for physical therapists, rehab clinicians, and PT students who want to move beyond outdated protocols and confidently apply evidence-based Achilles tendinopathy rehabilitation in both athletic and general populations.
Timestamps
- 00:00 What Is the Best Loading Protocol for Achilles Tendinopathy?
- 01:19 Isometrics vs Eccentrics vs Heavy Slow Resistance
- 01:51 The Study: 4-Stage Progressive Loading for Achilles Tendinopathy
- 02:32 Why Isometrics Were Included (Lessons from Patellar Tendinopathy)
- 04:59 Do Different Loading Methods Actually Perform Differently?
- 05:48 Pain Monitoring Model vs Dialing Things Back
- 06:59 Study Methods: Who Was Included (and Excluded)?
- 09:44 Treating Chronic vs Acute Achilles Tendinopathy
- 11:04 Outcome Measures Used in the Study
- 12:00 Overview of the 4-Stage Progressive Loading Program
- 12:22 Pain Rules & Progression Criteria (≤3/10 Model)
- 14:09 Should Runners Stop Running With Achilles Tendinopathy?
- 15:04 Stage 1: Isometric Loading (Exact Prescription)
- 16:59 Is This Too Much Volume? Patient Compliance Discussion
- 18:24 Stage 2: Functional Strength + Reduced Isometrics
- 19:24 Weekly Schedule Breakdown (Stage 2)
- 23:51 Stage 3: Heavy Slow Resistance Progression
- 27:19 Stage 4: Plyometrics + Return to Running
- 28:01 Critique: Are Plyometrics Dosed Well Enough?
- 29:46 Return-to-Run Progression (Distances & Speeds)
- 31:23 Final Weekly Program Structure
- 31:25 Results: Did Progressive Loading Work?
- 31:34 VISA-A Improvements at 6 and 12 Months
- 32:12 Tendon Structure Changes on Ultrasound
- 33:36 How Long Does Each Rehab Phase Actually Take?
- 46:04 Achilles Tendon Exercise Progressions (EASY to HARD)
Ready for every tendon,
- Dan Pope DPT,OCS,CSCS
Show Notes / Relevant Articles:
- FPF Mini Course - 7 Reasons Why Injuries Happen in the Gym and What to do About it
- Evidence Based Guide to Achilles Tendinopathy for Physical Therapists [Assessment and Treatment]
- Physical Therapy Evaluation and Treatment of Achilles Tendinopathy in a Runner [Case Study]
- Achilles Tendon Exercise Progressions (EASY to HARD)
- Want to earn some CEUs for physical therapists, physical therapy assistants & ATCs for watching this content? Click HERE to sign up for FPF "Insiders Academy" for just a dollar. You can earn CEUs for watching this content. Plus, you'll gain access to over 14 MASTER courses, 50+ cheat sheets, 100+ webinars, e-books and complete guides. You'll also get private access to the "Insiders Academy" community where you can have all of your questions answered by me.
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Thank you!
Dan Pope DPT, OCS, CSCS
References:
- Krogh TP, Jensen TT, Madsen MN, Fredberg U. An Isometric and Functionally Based 4-Stage Progressive Loading Program in Achilles Tendinopathy: A 12-Month Pilot Study. Transl Sports Med. 2022 May 24;2022:6268590. doi: 10.1155/2022/6268590. PMID: 38655172; PMCID: PMC11022783.