Overcoming Achilles Tendinopathy After Years of Pain: A Combined Injection and Strengthening Approach

Introduction
Achilles tendinopathy can be one of the most stubborn and frustrating conditions to manage, especially when it resists traditional treatments like rest, stretching and massage. In this case study, we highlight how McFerran Physio helped a 62-year-old woman return to pain-free activity after years of chronic Achilles pain — using the latest evidence-based approach that combined strength-based rehab and a high-volume ultrasound-guided injection.

Patient Background
The patient, a 62-year-old retired woman, came to McFerran Physio after suffering from persistent Achilles tendon pain for several years. Normally active, she enjoyed gardening, walking, and caring for her grandchildren, but her pain had become increasingly limiting:

• She could no longer walk long distances.
• Mornings were especially difficult with severe stiffness and pain.
• Basic daily movement was becoming more painful and frustrating.

She had already seen several other practitioners, receiving massage and stretching exercises — with minimal lasting improvement.

Assessment & Diagnosis

Clinical Findings

• Pain during calf raises.
• Localized tenderness to palpation of the Achilles tendon.
• Full ankle range of motion, but pain clearly centered on the Achilles

Combined with the patient history of morning stiffness, pain on walking, and no signs of nerve involvement or other pathology, we confidently diagnosed her with Achilles tendinopathy.

Patient Education: What Is Tendinopathy?

We explained:

• Achilles tendinopathy is not inflammation (despite being called “tendinitis” in the past).
• The condition involves disorganised collagen and nerve and blood vessel ingrowth known as
• Strengthening is the primary evidence-based treatment, aimed at improving tendon capacity and structure.

The Achilles tendon attaches the calf muscles (gastrocnemius and soleus) to the heel bone, and targeted calf strengthening is essential to recovery.

Initial Treatment Plan

Phase 1: Strengthening & Pain Reduction

We introduced:

• Calf raises with a straight knee (for gastrocnemius) Calf raises one leg
• Calf raises with a bent knee (for soleus) Calf raise with knee bent one leg
• Isometric loading exercises to reduce pain

However, despite early engagement, the patient:

• Struggled with calf raises due to pain
• Reported little relief from massage, acupuncture, or dry needling

High-Volume Injection Referral

Recognising that pain was preventing progress, we discussed the option of a high-volume injection:

What is a High-Volume Injection?

• An ultrasound-guided injection that uses sterile fluid (saline).
• Targets the neovascular tissue in the tendon.
• Helps strip away excess nerve and blood vessel growth, reducing pain.

Thanks to McFerran Physio’s direct referral rights, we immediately referred the patient to the Nuffield Hospital in Bristol — avoiding delays through the GP. Bristol Hospital, Private Hospital in the South West | Nuffield Health

Outcome

• The scan confirmed marked neovascularization.
• The injection was performed successfully and safely.
• The patient returned to McFerran Physio shortly after with zero pain for the first time in years.

Rehabilitation After Injection

With pain reduced, we progressed her into structured loading rehab:

• Single-leg calf raises on a Smith machine at the clinic.
• At home, she used a weighted backpack filled with tins to replicate gym resistance.
• Advanced to heavier loads, both straight- and bent-knee positions.
• Exercises tailored to her environment and preferences, including:
  • Stair-based loading.
  • Backpack resistance calf raises.
  • Progressive reps and volume over time.

Patient Outcome

Within a few weeks of the injection and strengthening plan:

• Pain on walking and stair use had disappeared.
• Morning stiffness was gone.
• She resumed gardening, walking, and caring for grandchildren.
• Continued strengthening twice per week to maintain tendon resilience.

Conclusion

This case is a perfect example of integrated, evidence-based care in action:

• Understanding the real pathology behind tendinopathy.
• Educating and empowering the patient.
• Leveraging direct access to ultrasound-guided intervention.
• Providing practical rehab, adapted to home or gym environments.

At McFerran Physio, we don’t just treat symptoms — we dig deeper to find the right approach, using up-to-date clinical research and our in-house gym and private referral network.

If you’re dealing with persistent Achilles pain and nothing seems to help, we can guide you through a modern, effective plan that works.

Book your assessment today and take the first step toward pain-free movement.