I have chronic pain in my right Achilles tendon. It has been ongoing for two years. I’ve tried medications, physiotherapy, stretching, warming and anti-inflammatory creams. Nothing helps. I run several kilometers every day and occasionally play football. I’m afraid that my tendon might rupture, just like it happened to my friend a few years ago. What can I do to prevent that?

This is a very common question from my patients with Achilles tendon inflammation who are physically active. The simple answer is that the chance of an inflamed Achilles tendon rupturing is actually very small. The very fact that pain is present reduces the load during walking and sports activities in such a way that the body spontaneously shifts a greater overall load onto the uninjured limb. It is possible, for example, to walk in a way that distributes 60% of the load onto the painless leg compared to 40% on the injured one, without it manifesting as a limp or a visible change in walking or running rhythm. In this way, pain becomes a protective mechanism.

The vast majority of Achilles tendon ruptures occur without prior pain. This happens because a part of the chronic degenerative changes in the tendon can occur without pain. When there is no pain, there are no protective mechanisms, and without them, the risk of additional damage is very high.

However, despite your poor experience with physiotherapy so far, I recommend that you find an experienced physiotherapist in your area who will thoroughly examine not only your tendon but your entire lower extremity, hypothesize about the cause of the chronic inflammation, and work with you on interventions that should lead to the final healing of the chronic damage, and consequently, the cessation of pain.

Continuing sports activities with pain puts you at risk of developing new overuse syndromes in other parts of your lower extremities or spine.