Often when we start to get muscle or joint pain, our first reaction can be “something is wrong, I might need a scan”. The Achilles tendon is no different, being the second most common running injury (behind knee pain) many people with pain are curious to know:

“Do I need a scan to make sure I won’t make it worse?”

Usually for non-traumatic tendon injuries the answer is usually no.

As with most musculoskeletal injuries, radiological scans can be both useful, and confusing to managing a condition. Mainly because a scan won’t detect your pain and can add little to the clinical picture that is important to your individual presentation.

The most common scan requested for a painful achilles tendon is an ultrasound due to its ease of use and accuracy. It can be a reasonably easy and inexpensive measure to test the tendon, but the results can be misleading and rarely helpful for most people with Achilles tendinopathy.


This can be for 4 main reasons:

  1. The results seen on a tendon scan may not change even if pain is completely resolved and a full rehabilitation program has been completed.
  2. A scan may actually produce a worse result than the actual function of the tendon. i.e. it may look really swollen and degenerative, but you can still run, walk, gym at a really high level, therefore you shouldn’t reduce your activity just because the scan shows degeneration.
  3. People who do not have pain can have changes and tendinopathy detected on scans.
  4. It may lead to unnecessary interventions-like injections or surgery when other less invasive methods have not been introduced.


The best result is to treat the tendon function not the scan- a common approach to many musculoskeletal injuries. Usually a scan may not be required to confirm existence of tendinopathy, but if the symptoms continue to exist and do not follow the likely time frame a scan can be helpful to rule out other injuries to the area, like small tears or surrounding tissue. At The Injury Clinic we may discuss the use of a scan with you based on your functional testing, history of symptoms, activity goals and results from strength testing. If you have previously had a scan and you are concerned about the results, it is always best to bring these to your consultation and discuss it with our team.




De-la-Cruz-Torres, B., Barrera-García-Martín, I., de la Cueva-Reguera, M., Bravo-Aguilar, M., Abuin-Porras, V., & Romero-Morales, C. (2020). Ultrasound imaging features of the Achilles Tendon in dancers. Is there a correlation between the imaging and clinical findings? A cross-sectional study. Physical Therapy in Sport.

Lieberthal, K., Paterson, K. L., Cook, J., Kiss, Z., Girdwood, M., & Bradshaw, E. J. (2019). Prevalence and factors associated with asymptomatic Achilles tendon pathology in male distance runners. Physical Therapy in Sport, 39, 64-68.



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