🎙️ Episode 6: Achilles Tendinopathy: What Actually Matters with Professor Peter Malliaras

 

Achilles tendinopathy is one of the most common and persistent injuries in runners, and one of the most challenging conditions clinicians manage.

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Despite decades of research, there is still confusion around what truly drives Achilles pain. Tendon structure versus symptoms, how much loading is enough, the role of imaging, and whether popular interventions like isometrics, collagen, or anti-inflammatories genuinely improve outcomes.

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In this episode of The Rehab Runway Podcast, Luke Nelson is joined by Peter Malliaras, world-renowned physiotherapist and tendon researcher, to unpack what actually matters when assessing and managing Achilles tendinopathy in runners.

This episode blends current tendon science with real-world clinical reasoning, helping runners and health professionals move beyond one-size-fits-all rehab programs.

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🧠 What You’ll Learn in This Episode

 

Achilles Tendon Structure and Function

• How Achilles subtendons (gastrocnemius vs soleus) influence loading

• The role of non-uniform tendon strain

• When plantaris involvement should be considered

• Why tendon structure does not always explain pain

 

Assessment and Clinical Decision-Making

• Key differential diagnoses in Achilles tendon pain

• Is subtyping Achilles tendinopathy clinically useful

• How sleep, stress, metabolic health, and load tolerance influence recovery

• The impact of fear, kinesiophobia, and pain interpretation

 

Physical Capacity and Performance Assessment

• Strength, endurance, and energy storage capacity testing

• Rate of force development and plyometric readiness

• Symmetry versus absolute capacity

• Seated versus standing calf raises and when each matters

 

Imaging and Technology in Achilles Rehab

• When imaging helps guide management and when it does not

• Why scans rarely predict pain or recurrence

• The benefits and limitations of technology in tendon assessment

 

Evidence-Based Management Strategies

• Short-term pain relief without compromising tendon adaptation

• Load management for midportion versus insertional Achilles pain

• Common rehab mistakes clinicians still make

• Why one-size-fits-all loading programs fail

 

Isometrics, the Berlin Approach and Tendon Loading

• Long-hold versus short-hold isometrics

• Yielding versus overcoming contractions

• The Berlin approach compared with Keith Baar’s long-hold isometric model

• Pain modulation versus long-term tendon adaptation

 

Adjunct Treatments and Recovery Tools

• What the evidence actually says about collagen supplementation

• Anti-inflammatories and tendon biology

• PRP, corticosteroid injections, high-volume injections

• When shockwave therapy may or may not be useful

 

🏃 Take-Home Messages

For runners:
Your Achilles tendon is often far more adaptable than you think. Pain does not automatically mean damage, and consistent, appropriate loading is usually the solution rather than rest alone.

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For clinicians:
Do not scare patients with imaging findings. Do not fear loading. Do the simple things well, and treat the person, not just the tendon.

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🎓 About the Guest

Peter Malliaras is a world-renowned physiotherapist, tendon researcher, educator, and podcast host, recognised globally for translating tendinopathy research into real-world clinical practice.

Connect with Peter:

• Instagram: @Tendinopathyrehab

• Education, courses, and blogs: https://www.tendinopathyrehab.com/

 

🎧 Listen to the Episode

Available now on Spotify, Apple Podcasts, and all major podcast platforms.

 

If you found this episode useful, please consider sharing it with a runner or colleague, or leaving a review. It genuinely helps the podcast reach more people.

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👉 Listen on Spotify

👉 Listen on iTunes

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🎙️ About the Host

Hosted by Luke Nelson, Sports & Exercise Chiropractor, running coach, and strength coach.​​​​​​​

• 📱 Follow Luke on Instagram: @sportschiroluke

• 🌐 Learn more & explore upcoming courses: www.healthhp.com.au​​​​

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