A Wallabies fly-half, a goose step, and a tendon
In the second half against Argentina on 6 August 2022, Quade Cooper went for one of his trademark goose steps and didn’t come back up. He clutched his heel. The replays were unambiguous to anyone who has ever seen an Achilles tendon rupture in real time. Cooper had torn his Achilles, on the same field he had played some of the best rugby of his career on, in front of a sold-out Australian crowd.
A rupture is not the same thing as Achilles tendinopathy. A rupture is the catastrophic, all-at-once failure of the tendon — the snap, the inability to push off, the immediate end of the game. Tendinopathy is the slow version. It is the tendon that has been quietly degrading for months or years, with thickening, stiffness in the mornings, and pain that comes on with the first hill of a run and lingers for the rest of the day. Most people who develop tendinopathy will never rupture. But almost every ruptured tendon, when examined after the fact, shows evidence of pre-existing pathology that nobody had treated.
It is also not just one rugby player. Achilles trouble runs through the football codes here in a way that is hard to ignore once you start looking. Nic Naitanui, the West Coast Eagles ruckman whose vertical leap defined a generation of Australian rules, was finally undone by his Achilles — surgery in June 2023, then retirement, because the tendon that had launched all those marks had been grumbling since February and would not come back. In rugby union, Wallabies lock Will Skelton ruptured his Achilles trying to step in a Top 14 game for La Rochelle in March 2026; “see you next year,” he told his fans. In the NRL, Melbourne Storm winger Xavier Coates had Achilles surgery in February 2026, then re-ruptured the same tendon at training in June, ending his season. Ruckmen, locks and wingers — different body types, different sports, same tendon failing in much the same way.
This is the part of the story that matters for the rest of us. Cooper, Naitanui, Skelton and Coates made the news because they are professionals. The version that doesn’t make the news is the runner at your local park who has stopped running because their Achilles hurts every morning, the netball player whose calf feels like a piano wire, the tradie whose first ten steps out of bed are a hobble. Same tendon. Different stage of the same problem.
What Achilles tendinopathy actually is
For decades it was called Achilles tendinitis. The -itis suffix means inflammation. That was the model: an inflamed tendon, the way an inflamed throat is inflamed. The treatment followed from the model — rest it, ice it, take anti-inflammatories, wait for the swelling to go down.
The problem is the model was wrong. When researchers started looking at painful tendons under a microscope and on detailed imaging, they didn’t find much inflammation at all. What they found was disorganised collagen, abnormal blood vessel ingrowth, and structural disorganisation. The tendon was not inflamed. It was degenerating. The condition was renamed tendinopathy to reflect this.
This rewrites the treatment. You cannot rest a tendon back to organised collagen. You can only load it back. Cells that build tendon respond to mechanical signals. Take the signal away — by resting, by avoiding the load that hurts, by wearing the foot into a permanent boot — and the tendon does not get better. It gets quieter for a while, then worse the moment you ask it to do anything.
Professor Jill Cook, of La Trobe University in Melbourne, has spent a career making this point. Cook, who developed the continuum model of tendon pathology with Craig Purdam in 2009, has been blunt in her public commentary, podcasts and Physio Network interviews: tendons love load, and rarely should complete rest be recommended, because it usually does more harm than good. The same view runs through the work of Ebonie Rio at La Trobe, of Karim Khan (originally Australian, now at the University of British Columbia and editor-in-chief of the British Journal of Sports Medicine), and of Peter Brukner, the Melbourne sports physician whose textbook Clinical Sports Medicine trained two generations of physios. The Australian sports medicine establishment is unusually unified on this point. The tendon needs work, not rest.
What not to do
Three things people with Achilles pain try first that don’t work, in rough order of how unhelpful they are.
Complete rest. Two or three weeks off feels like the responsible thing to do. It is not. The tendon adapts down — it loses capacity — and the moment you return to the activity you stopped, you are returning at a lower capacity than when you left. Most people then re-flare immediately, conclude that running has now permanently broken them, and rest some more. This is the most common reason a six-week problem becomes a six-month problem.
Static stretching for ten minutes a day. Loaded the tendon does need. Stretched and unloaded, less so. Stretching feels useful, particularly in the morning when the tendon is stiff. It is not harmful. It is just not the treatment.
Anti-inflammatories. They reduce pain. They do not address the degeneration. Worse, there is reasonable evidence that long courses of NSAIDs blunt the very collagen-remodelling response that successful rehabilitation relies on. Use them sparingly for short symptomatic relief, not as a treatment plan.
Cortisone injections into the tendon itself. Specifically not the answer. Multiple trials have shown short-term pain relief followed by worse outcomes at six and twelve months, with some evidence of increased rupture risk in the structurally compromised tendon. If a clinician offers to inject the body of your tendon with cortisone, ask why.
The soleus problem
This is the part most people, and a surprising number of clinicians, get wrong.
Your calf is not one muscle. It is two. The gastrocnemius is the big, visible, two-headed muscle that gives the calf its shape and that crosses both the knee and the ankle. Underneath it sits the soleus — flatter, deeper, only crossing the ankle, and largely invisible from the outside.
These two muscles share the Achilles tendon. They do not share the work equally.
When you walk, and when you run at most normal training paces, the soleus is doing most of the work. It generates more of the force that the Achilles tendon transmits to your heel than the gastrocnemius does. The gastrocnemius contributes more during fast running and explosive jumping. But the slow, repetitive loading that drives most cases of Achilles tendinopathy — that is largely a soleus story.
The standard calf exercise — heel raises with a straight knee — heavily loads the gastrocnemius and lets the soleus get away with relatively little. To load the soleus properly, you need to bend the knee, usually to around 70 degrees, and do the heel raise from there. Seated calf raises. Smith-machine bent-knee calf raises. Heavy, slow, controlled.
If your Achilles rehab so far has been straight-knee calf raises only, you have been loading the muscle that matters less for the activity you actually want to return to. This is the single most consistent fixable gap we see. It is not exotic. It is just under-recognised.
How long this actually takes
Tendons remodel slowly. Honest timelines from the research:
- Twelve weeks before you should expect a meaningful change in pain and function.
- Three to six months for full return to your sport or running volume.
- Up to twelve months of ongoing vigilance, because relapse in the first year — particularly during the early reload phase — is common.
This is not a six-week problem. Plan accordingly. The injuries that go badly are not usually the worst injuries; they are the ones where the patient was promised a quick fix and lost faith at week eight.
Red flags — when to see a doctor today
A sudden, unmistakeable snap or pop at the back of the ankle, an inability to push off the toes, a visible gap or dent in the tendon a few centimetres above the heel, severe weakness on rising onto tiptoes: see a sports physician or emergency department the same day. These are the signs of a rupture. The first 48 to 72 hours matter for the surgical decision.
Pain at the back of the heel that has been creeping up for weeks and is worst with the first steps in the morning is almost never a rupture. It is almost certainly tendinopathy, and it is not an emergency. It does, however, need treatment.
What good treatment looks like
A simple framework:
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A physio or sports medicine doctor who diagnoses you clinically, not by ordering an ultrasound first. Imaging is often misleading — many people without symptoms have tendon changes on scan, and many people with symptoms have scans that change very little over a course of successful treatment.
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A structured loading programme over twelve weeks minimum. Heavy, slow, both straight-knee and bent-knee calf raises, progressed over time. Some pain during loading is acceptable — up to about a 5 out of 10 — provided it settles by the next morning. Pain-free rehabilitation is not the goal.
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Honest training-load management. Reduce running volume, don’t necessarily stop. Switch surfaces. Slow the paces. Keep moving while you load.
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Tools that can take some load off the tendon during the reactive flare-up and the return to running. A small heel lift inside both shoes is well-established. Compression garments are part of this picture. This is where the Orthopaedic Sleeve sits, and it is worth being precise about what it does and what it does not.
The Sleeve: load off the tendon, every step
Most days of recovery are not the day you do your calf raises. They are the days in between — the walk to the kitchen, the school run, the cumulative thousands of steps that the tendon has to absorb whether you want it to or not. That ambulatory micro-loading is the part of the picture most rehab programs do not address. The loaded calf raises in the clinic ask the tendon to handle a calibrated dose. The rest of the day asks it to handle whatever happens. For a tendon trying to remodel, the second number is often the one that decides whether you progress this week or flare.
The Orthopaedic Sleeve was developed to address exactly this. It is a daily-wear brace, not a clinic device — designed to take a measurable share of the load off the healing tendon during the ordinary walking that fills the time between your loading sessions. The mechanism was characterised in detail by the University of Queensland in their Final Report, June 2025.
The headline numbers from that testing, in plain English: during standing balance with eyes open, the muscle activation of the medial gastrocnemius was 32% lower with the Sleeve on, statistically significant at the group level (p=0.002). During walking, the time the heel spent on the ground was 5.1% shorter (p=0.009) — a small change that compounds over thousands of steps. On a biomechanical model of Achilles tendon force during walking, the peak force came down by an average of 1.7% across the group, with individual reductions reaching 8.1% in the participants who responded most. And during the push-off phase of walking — the moment your tendon is loaded hardest with every step — individual calf-muscle activation reductions across the triceps surae ranged from 20% to 48% in some participants. The soleus, specifically, came down by an individual maximum of 20.4%.
Frame these the way they are meant to be framed: load taken off the tendon, every step, all day. Not on the day you have your loading session. On every day in between, when the cumulative micro-stress is what is actually slowing the patient down.
The Sleeve is not a cure. It does not replace the loaded calf raises. It does not replace the soleus work or the patience. It is the daily-wear tool that takes a measurable bite out of the load the tendon has to deal with between your rehab sessions — so that when you do your loading work, the tendon is not already at its limit from the walking around you had to do to get there. Used that way, alongside the rehabilitation, it is one of the tools that gives you the best chance of getting all the way back.
What to do this week
If you have a sore Achilles, the next three steps are simple. Book a sports physio or sports medicine doctor. Start adding bent-knee calf work to whatever you are already doing. Drop your running volume by a third for the next two weeks, but do not stop moving. And during all the walking you are still doing between sessions, consider the Sleeve as the daily-wear tool that takes some of that ambient load off the tendon while you do the actual rehabilitation.
Cooper made it back. Eight months after a full rupture he was on a rugby pitch again. Your tendinopathy, caught earlier and managed properly, has a far better road ahead than that.
Selected sources: Cooper rupture reporting via rugby.com.au and ESPN (Aug 2022–Apr 2023); Naitanui Achilles surgery reporting via afl.com.au and ESPN (June 2023); Skelton Achilles rupture reporting via rugby.com.au and ESPN (March 2026); Coates Achilles surgery and re-rupture reporting via Wikipedia and Racing and Sports (Feb–June 2026); Prof Jill Cook, La Trobe University, public commentary via Physio Network and BJSM Podcast; Chimenti et al., JOSPT 2024 Midportion Achilles Tendinopathy CPG; University of Queensland Final Report on Sleeve mechanism testing, June 2025.