Achilles Tendinopathy in AFL: The Warning Signals Most Players Ignore

May 21

The Achilles tendon is one of the strongest structures in the human body. It also happens to be one of the most commonly injured in AFL. That combination should tell you something: the tendon doesn’t fail because it’s weak. It fails because it’s overloaded.

The Anatomy

The Achilles tendon is the conjoined tendon of the gastrocnemius and soleus muscles, inserting into the posterior calcaneus (heel bone). It is the thickest and strongest tendon in the body, capable of bearing loads of 6-8 times bodyweight during running.

Two zones are most prone to injury: the mid-portion, approximately 2-7cm above the heel bone insertion, where blood supply is lowest, and the insertional zone, where the tendon meets the calcaneus and compressive forces are highest.

Mid-portion tendinopathy is the most common presentation in AFL players. The tendon becomes disorganised, thickened, and painful under load. It is not an inflammatory condition in the traditional sense but a failed healing response to chronic overload.

How It Develops in AFL

The Achilles absorbs enormous cumulative load across an AFL season. High-speed running, kicking, and the repeated sprinting demands of the game combine with training loads to create a cumulative stress that exceeds the tendon’s recovery capacity, particularly during pre-season ramp-up.

Risk factors specific to AFL players include a rapid increase in running volume, inadequate calf strength training, and previous lower limb injury that alters running mechanics.

The Warning Signs

Morning stiffness that eases with movement. Pain at the start of a run that settles after 10 minutes. A palpable tender thickening in the tendon. These are the early signals. The mistake is playing through them because the pain eases with warm-up. The tendon is telling you something, and ignoring it delays recovery significantly.

Treatment

The evidence base for Achilles tendinopathy is stronger than almost any other tendon. Heavy slow resistance (HSR) training is the gold standard.

HSR protocol: Calf raises performed slowly (3 seconds up, 3 seconds down), loaded with a weighted pack, 3 sets of 15, three times per week over 12 weeks.

Eccentric loading (Alfredson protocol): 3 sets of 15 drops off a step, performed twice daily. Still valid, particularly for mid-portion tendinopathy.

Insertional tendinopathy requires modification: avoid loaded stretching and deep heel drops that compress the tendon against the calcaneus.

Return to Running

A structured return to running program is initiated once pain during the HSR protocol is minimal and consistent. Straight-line running before multi-directional work, low speed before high speed, low volume before high volume.

Full sprint clearance before return to unrestricted training.

Prevention

Pre-season calf strength assessment, maintaining year-round calf training through the off-season, and applying a 10% per week running load increase rule are the primary preventive measures. Tracking acute-to-chronic workload ratio for each player during the pre-season period identifies those at highest risk.

Want to understand this injury at a deeper anatomical level? The Club Physio’s online anatomy course breaks down the structures, biomechanics, and load patterns behind the most common sports injuries. Built for athletes and therapists alike. [Explore the course at theclubphysio.com.au]

josh zoppo