Achilles Tendinopathy: What the Latest 2024 Guidelines Recommend
Dear Readers,
We’re excited to share the updated 2024 Clinical Practice Guideline (CPG) from the Journal of Orthopaedic & Sports Physical Therapy on midportion Achilles tendinopathy—a condition many of our patients will be familiar with.
These revised guidelines provide strong support for what we already prioritise in practice at HealthPlus: progressive tendon loading, tailored to symptom irritability, patient education, and a multimodal approach when needed.
What’s New (and What We’re Already Doing Right)
The updated guideline reinforces a number of key strategies:
Tendon Loading is First-Line
- Use mechanical loading exercises (eccentric, concentric, heavy-load slow-speed) as tolerated
- Frequency: at least 3 times per week
- This intervention shows clear improvements in pain and function across various exercise formats
Tailored to Symptom Irritability
- The CPG includes a decision tree and guidance for adjusting loading intensity based on whether the patient presents with high or low symptom irritability
- A patient with swelling, warmth, and pain at rest requires a gentler approach than someone with discomfort only during or after higher-load activity
Patient Education is Essential
- Patients should be educated about modifiable and non-modifiable risk factors, expected recovery timelines, and the value of staying active within pain limits
- Both pain science education and pathoanatomic explanations can be effective—choose based on the individual
What Else to Consider
Manual Therapy & Taping
- Joint and soft tissue mobilisation may help, especially where movement is limited
- Rigid taping or heel lifts may offer temporary support during activity
No Strong Evidence For or Against:
- Extracorporeal Shockwave Therapy (ESWT) is excluded from this guideline, though previous reviews suggest moderate benefit when paired with loading
- Orthoses and laser therapy show conflicting or limited evidence
Why This Matters for HealthPlus
This guideline aligns closely with our values—especially:
- Personalised care plans based on irritability and load tolerance
- Emphasis on education and expectation setting to empower our patients
- Thoughtful use of hands-on therapy and adjuncts when evidence supports it
Whether you’re a clinician refining your rehab approach or a patient navigating a stubborn case of Achilles pain, this is a must-read.
Reference:
Chimenti, R. L., et al. (2024). Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision – 2024. J Orthop Sports Phys Ther, 54(12): CPG1–CPG32. https://doi.org/10.2519/jospt.2024.0302
