Establish the location
Mid-portion and insertional Achilles problems need different loading, so this is settled before any programme starts.
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Shockwave & chiropracticAchilles tendinopathy and tendon pain treatment in Morgan Hill, CA
Stiff and sore for the first few minutes of a run or the first steps of the day, then it warms up — and it has been doing that for months.
Mid-portion or insertional? It matters
Mid-portion tendinopathy sits a few centimetres above the heel bone and is the more common and more treatable of the two. Insertional problems occur where the tendon meets the heel, and they respond differently — notably, deep stretching and full-range heel drops that help the mid-portion often aggravate an insertional presentation.
Getting this distinction right is the single most useful thing an assessment does here, because the same exercise programme can help one and inflame the other.
The warm-up pattern is diagnostic
The classic story is stiffness and pain at the start of activity that eases as you warm up, then returns afterwards or the following morning. That pattern reflects the tendon’s response to load rather than active inflammation, and it is a large part of why anti-inflammatory treatment underwhelms in chronic cases.
It also matters for tracking progress: how you feel the morning after is a better guide to whether load was appropriate than how you felt during it.
Where shockwave fits
Mid-portion Achilles tendinopathy has reasonable supporting evidence for shockwave, particularly in cases that haven’t responded to a properly executed loading programme. The tendon is superficial, so a radial device can target it well.
The pairing is not optional here. Across the Achilles literature, the loading programme is the primary intervention and shockwave is the adjunct that helps when loading alone has plateaued. If you have not yet done a structured calf loading programme, that is usually where to start rather than with sessions.
Device details, pricing and contraindications are on the shockwave therapy page.
The one that needs urgent attention
A sudden sharp pain or a snapping sensation at the back of the ankle, often described as being kicked, with difficulty pushing off or standing on tiptoe, can indicate an Achilles rupture. That needs prompt medical assessment, not a course of shockwave.
Also worth flagging: certain antibiotics, notably fluoroquinolones, and systemic steroid use are associated with tendon injury. Tell Dr. Diana if either applies to you. Inflammatory arthritis can also present with Achilles pain and is managed differently.
At your first visit
What we look for
- History of your symptom pattern, training or walking load, and footwear changes
- Palpation to establish whether the problem is mid-portion or insertional
- Calf strength and endurance testing, including single-leg heel raises
- Ankle range of motion and foot posture assessment
- Review of medications associated with tendon injury, and screening for rupture
- A frank view on whether loading alone should come first
Next step
An assessment first. Shockwave suits some presentations and not others, and Dr. Diana will tell you which yours is before you book a course.
Or call (408) 778-6770.
Our approach
How we work on achilles tendinopathy
Load first, properly
A structured, progressive calf loading programme. For most people this is the primary treatment, not the warm-up act.
Add shockwave where it stalls
Radial pressure wave, typically three to six sessions a week apart, for tendons that have plateaued despite good loading.
Address the mechanics
Ankle, midfoot and hip assessment and treatment, since calf load depends on what happens above and below it.
Manage the load honestly
Training volume, surfaces, heel drop in footwear, and a graded return rather than an all-or-nothing one.
Track the morning after
Progress is judged on next-day symptoms, which keeps both of us honest about whether the plan is working.
This describes our general clinical approach and is not a promise of a specific outcome. Every case is assessed individually, and results vary between patients.
Before you book
Achilles tendinopathy — common questions
Should I stretch it?
Depends entirely on which type you have. Deep stretching and full-range heel drops off a step can help mid-portion problems and frequently aggravate insertional ones. This is exactly why the assessment matters before you follow a programme you found online.
Can I keep running?
Often yes, at a modified volume and intensity. Complete rest tends to leave you with a weaker tendon and the same problem on return. We use your next-morning symptoms to decide how much is appropriate.
How long does it take?
Chronic Achilles tendinopathy is realistically a several-month project, and consistency with loading matters more than anything else in the plan. Shockwave may speed things along where progress has stalled, but it doesn’t change the underlying biology of tendon remodelling.
Do I need a scan?
Usually not. Diagnosis is mostly clinical, and imaging findings correlate poorly with symptoms in tendons. Imaging becomes useful if rupture is suspected, if the presentation is atypical, or if you’re not progressing as expected.
I’m on an antibiotic. Does that matter?
It can. Fluoroquinolone antibiotics are associated with tendon problems including Achilles rupture. Mention any current or recent course, and any oral steroid use, at your assessment — it may change the timing and the plan.
Ready to find the why?
Most new patients are seen within the same week. Call the office, or send a short request and we'll get back to you.