Dry Needling for Achilles Tendonitis
Dry needling for Achilles pain
A familiar story: the first steps out of bed punch the back of the heel, jogging warms it up, and then a few hours later the stiffness returns. Many cases of Achilles pain (often called tendonitis or tendinopathy) include a strong muscle-driven element—stiff calf and deep flexor trigger points that overload the tendon and make every stride feel heavier than it should.
Dry needling for Achilles tendon pain addresses this muscular contribution. The approach targets the calf and lower-leg muscles that commonly refer pain to the mid-portion of the tendon or its insertion, helping lower the mechanical load on irritable tissue. When morning stiffness, post-run soreness, or push-off pain point to calf over-recruitment, reducing trigger-point irritability may improve comfort and create space for progressive loading to “retrain” the tendon.
For a plain-English overview of technique and what sessions involve, see the Dry Needling Guide. For muscle referral maps, visit the Trigger Points Guide.
For a deeper dive into non-surgical options and how muscle load influences healing, see the Achilles tendinitis treatment guide and the role of acupuncture for Achilles tendonitis.
Key Points
Most suitable cases: mid-portion Achilles soreness 2–6 cm above the heel, morning “start-up” pain, tender calf, or achy push-off during running or stair climbing.
Primary effect: targeted reduction in calf and deep-flexor trigger-point activity to decrease nociceptive drive and mechanical loading into the tendon.
Muscle coverage: gastrocnemius, soleus, plantaris, tibialis posterior, flexor hallucis longus, flexor digitorum longus, peroneals, and (when indicated) tibialis anterior.
Expected timeline: some notice change in 1–3 sessions; a short series of 4–6 visits is common. Chronic or calcific cases may require 10+ visits or ongoing care alongside a structured loading plan.
Practical trial: 3–5 sessions, with progression guided by morning-stiffness minutes, hop tests, and run-restart response.
Session pacing: dosing is conservative and advanced in step with tolerance and post-session response.
Achilles Tendon Pain: Brief Condition Overview
Achilles tendon pain typically reflects an over-time response to load, rather than sudden inflammation alone. Episodes often follow volume spikes, surface changes, or long-standing calf tightness that quietly raises tendon stress.
Signs & symptoms (common features):
Location & feel: tenderness at the mid-portion (2–6 cm above the heel) or at the insertion; thickened, “gritty” or stiff tendon.
Diurnal pattern: morning steps feel stiff or sore, symptoms ease with light movement, then return after activity or prolonged sitting.
Load sensitivity: pain with running, hopping, skipping, stairs, or uphill walking; worse after training spikes or footwear changes.
Musculoskeletal cues: tight or tender calf, deep ache along the posteromedial ankle, painful push-off, limited ankle dorsiflexion.
Typical treatment (commonly used approaches):
Symptom relief: gradual warm-ups, activity modification, and short-term use of heel lifts or taping when indicated.
Progressive loading: isometric → isotonic → energy-storage (plyometric) calf-complex work (e.g., straight- and bent-knee calf raises) to rebuild tendon capacity.
Adjuncts for muscle drivers: dry needling, soft-tissue techniques, and mobility/restoration of dorsiflexion or tibial glide when restricted.
Self-care basics: consistent sleep, adequate protein and overall nutrition, gradual mileage/progression, and footwear review.
For current guidance on loading, footwear, and recovery milestones, see the Achilles tendinitis treatment overview and the latest Achilles tendinopathy research summary (2025).
Achilles Tendon Pain Trigger Points
The muscles below are frequently involved when Achilles pain is driven by calf or lower-leg trigger points. Each is listed once with a brief referral pattern to guide focused palpation and treatment planning.
Gastrocnemius
Referral: Broad posterior calf to mid-portion Achilles line; often provokes morning “first-step” pain and post-run ache, especially with hills or speed work.
Soleus
Referral: Deep, band-like ache in the lower calf and along the Achilles; frequently linked to prolonged standing/walking and limited ankle dorsiflexion.
Plantaris
Referral: Narrow, high-tension line along the medial calf with pinpoint tenderness near the Achilles; can mimic mid-portion tendinopathy.
Tibialis Posterior
Referral: Posteromedial ankle and arch, sometimes blending into the medial Achilles border; often flares with walking/running or unstable footwear.
Flexor Hallucis Longus (FHL)
Referral: Medial posterior ankle and Achilles region, accentuated with toe-off and plantarflexion; common in forefoot runners and dancers.
Flexor Digitorum Longus (FDL)
Referral: Deep posteromedial calf/ankle with radiation toward the medial arch and along the Achilles line during repetitive loading or uneven terrain.
Peroneus Longus
Referral: Lateral calf/ankle wrapping posteriorly toward the peroneal–Achilles junction; often reactive after cutting, cambered surfaces, or tempo work.
Peroneus Brevis
Referral: Focal lateral/posterolateral ankle and distal calf; can contribute to “pinch” sensations near the Achilles during push-off.
Tibialis Anterior
Referral: Anterolateral shin with perceived pull into the ankle; compensatory overuse may increase Achilles load when dorsiflexion strategy dominates.
Links route to individual muscle pages for detailed exam cues and self-care guidance. For broader context on session flow and dosing, see the Dry Needling Guide. For condition-level evidence, review Achilles tendinitis treatment, acupuncture for Achilles tendonitis, and the latest Achilles tendinopathy research.
How Dry Needling Fits Achilles Tendon Pain With Calf/Lower-Leg Drivers
Dry needling for Achilles tendon pain is most relevant when flares reliably track with muscle-driven load—classic examples include first-step morning stiffness, a post-run ache along the tendon, or a “tug” at push-off that returns after hills, speed work, or long walks/standing. In these cases, hyper-irritable trigger points in the gastrocnemius, soleus, plantaris, tibialis posterior, flexor hallucis longus, flexor digitorum longus, and peroneals can refer pain toward the Achilles line and increase local tension. That extra calf and deep-flexor drive raises mechanical demand on an already sensitive tendon, reinforcing a cycle of guarding, limited dorsiflexion, and recurrent symptoms.
Treatment uses a thin, solid filiform needle to stimulate the specific neuromuscular points identified on examination. It is common to feel a brief, deep ache, a small “twitch,” or a familiar line of sensation that tracks from the calf into the Achilles region; these responses indicate accurate targeting.
Sessions begin with a modest dose and progress based on post-visit response. By dampening over-recruitment in the calf complex and synergists, dry needling can reduce background load on the tendon and make it easier to tolerate progressive strengthening and return-to-run drills. For an overview of session flow and technique, see the Dry Needling Guide.
What to Expect in a Session (Comfort, Pacing, Soreness)
A typical appointment reviews symptom history (onset, training loads, footwear, morning-stiffness duration) and screens ankle/calf range, strength, and single-leg loading (heel-rise, hop). Palpation then identifies taut bands and reproduces familiar referral along the Achilles line or calf.
During needling, a localized ache or brief twitch may occur and usually settles within seconds. Initial sessions are brief and targeted, with the number of sites kept modest and increased as tolerance improves.
Post-session soreness commonly feels workout-like and can last 24–72 hours. Simple after-care—hydration and comfortable ankle/calf mobility—typically keeps symptoms predictable and short-lived. An overview of visit flow is available in the Dry Needling Guide.
Relief Timeline & Visit Cadence
Early change (1–3 sessions): decreases in morning-stiffness minutes, improved push-off comfort, and fewer “hot spots” along the tendon or calf.
Short course (4–6 sessions): meaningful reductions in daily pain and improved tolerance to progressive calf loading, stair work, and easy runs.
Chronic or recurrent patterns: calcific change, long-standing overuse, or multi-site involvement may require 10+ visits or ongoing care, coordinated with a graded loading plan.
A 3–5 session practical trial is recommended, tracking simple metrics (morning-stiffness duration, single-leg hop count/comfort, run-restart pain at 24–48 hours). If progress stalls, variables are adjusted—muscle priorities, needle dose/spacing, or load-progression scheme.
Dry Needling for Achilles Pain Research
Dry Needling Combined With Exercise for Achilles Tendinopathy (2025)
A recent meta-analysis of randomized clinical trials found that combining dry needling with exercise leads to greater pain reduction and improved functional outcomes for patients with Achilles tendinopathy compared to exercise alone. Across four trials involving 255 patients, those treated with dry needling showed superior pain relief and rehabilitation results, supporting the addition of dry needling to standard Achilles tendinopathy protocols. For specific protocol details and outcome metrics, review this meta-analysis on dry needling and exercise for Achilles tendon pain.
Trigger Point Dry Needling Added to Manual Therapy and Exercise for Achilles Tendinopathy (2020)
This feasibility study compared the effects of trigger point dry needling plus manual therapy and exercise (TDN+MT+Ex) to manual therapy and exercise alone (MT+Ex) in patients with Achilles tendinopathy. Both groups showed significant improvements in pain, strength, and functional scores at 4 weeks and 3 months, but no statistically significant difference was found between them.
The researchers suggest that while dry needling is feasible for Achilles pain management, larger studies are needed to fully establish its added benefit. Protocol and practical details appear in this feasibility trial of trigger point dry needling for Achilles tendinopathy.
Pilot Study: Dry Needling Induces Tendon Gene Expression Changes (2021, Animal Study)
This animal pilot study investigated the effects of dry needling on healthy rat Achilles tendons, finding that dry needling increased expression of genes associated with collagen regeneration and tissue remodeling, including Cox2, Mmp2, Col3a1, and Scx, without detectable histological tendon damage.
While direct application to clinical practice requires human studies, these findings help explain the potential molecular mechanisms behind dry needling for tendon repair. See molecular results and methodology in this animal study on dry needling and Achilles tendon gene expression.
Frequently Asked Questions (FAQ)
Can dry needling help with Achilles pain?
It can be helpful when a muscle-driven component is evident—e.g., consistent calf muscle tension that precedes or accompanies flares and is reproducible on examination. In such cases, reducing trigger-point activity may lower the mechanical input that aggravates symptoms.
Does dry needling help mid-portion vs insertional Achilles pain?
It is most applicable when calf and deep-flexor trigger points are prominent on exam, commonly seen in mid-portion presentations.
In insertional pain, loading strategy and local tissue management remain central; adjunct needling is considered if calf over-recruitment or deep-flexor tenderness is evident.
How many sessions are needed before results are clear?
A practical trial is 3–5 sessions. Some individuals notice change sooner, while others require a short series to shift frequency or intensity. If progress is not observable in tracked metrics, treatment variables are revised accordingly.
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Sources:
Chen, Y., et al. (2025). Effectiveness of Dry Needling Combined With Exercise Versus Exercise Alone on Pain and Function in Achilles Tendinopathy: A Meta-analysis of Randomized Clinical Trials. Clinical Rehabilitation, 39(9), 1401–1407. https://pmc.ncbi.nlm.nih.gov/articles/PMC12538665/
Dunning, J., et al. (2020). Trigger point dry needling, manual therapy and exercise versus manual therapy and exercise for Achilles tendinopathy: A feasibility randomized controlled trial. Journal of Manual & Manipulative Therapy, 28(1), 42–52. https://pmc.ncbi.nlm.nih.gov/articles/PMC8550527/
Bell, A., Castro, R., & Mishra, A. (2021). Dry Needling of a Healthy Rat Achilles Tendon Increases Its Gene Expression of Repair and Extracellular Matrix Genes Without Histological Damage. Pain Medicine, 22(2), 363–372. https://pubmed.ncbi.nlm.nih.gov/33155027/
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