Achilles Tendinopathy: What Runners Need to Know

Achilles Tendinopathy: What Runners Need to Know

Achilles tendinopathy is one of the most common running injuries—and one I’ve dealt with personally. Because of that, I’m especially passionate about helping runners navigate it. I know firsthand how frustrating it can be.

For a long time, this condition (sometimes called Achilles tendonitis, though that’s not the most accurate term) has been mismanaged. Many runners are told to just rest, ice, or stretch—but these strategies alone are often ineffective and can sometimes even slow recovery.

The Key: Load Management

The most important factor in treating Achilles tendinopathy in runners is load management.

In most cases, this injury develops after a spike in load. For runners, that might look like:

• Increased mileage, frequency, or intensity

• Changes in footwear (especially lower drop shoes like racing flats or spikes)

• Terrain changes (hills or treadmill running)

Calming Symptoms Without Losing Progress

In the early phase, the goal is to reduce pain while maintaining as much capacity as possible.

This might include:

• Reducing mileage

• Avoiding speed work and hills

• Temporarily wearing higher drop shoes

If possible, I encourage runners to keep running. Complete rest can reduce tendon and muscle capacity, which can make return to running harder.

A simple guideline for running with Achilles tendon pain:

• Keep pain at 3/10 or less during running

• Symptoms should return to baseline within 24 hours

It’s normal to feel stiffness at the start of a run that improves as you warm up. However, stop or modify if:

• Pain worsens during the run

• Your gait changes

If running isn’t tolerable, walking is a great way to maintain load—as long as symptoms allow.

A Simple Trick: Increase Cadence

Increasing cadence (steps per minute) can reduce Achilles tendon load by 3–6%.

You don’t need drastic changes:

• Increase cadence by 5–10%

• Aim for a general range of 170–180 steps/minute (especially if you’re currently below this)

Helpful cues:

• “Run quietly”

• “Pretend you’re running on ice”

• Use a metronome or BPM-based playlist

Use Isometrics for Pain Relief

Isometric calf exercises can help reduce pain in Achilles tendinopathy.

A great starting point:

• Single-leg calf hold

• 5 sets of 30–45 seconds

These are especially helpful in more irritable stages.

Build Back Stronger

Once symptoms calm down, the focus shifts to progressive calf strengthening for runners.

A typical progression:

1. Double-leg calf raises

2. Single-leg calf raises

3. Weighted calf raises

4. Plyometrics (final stage)

Plyometrics are important for restoring tendon stiffness and preparing for the demands of running.

How Much Pain Is OK?

Some discomfort during rehab is normal.

Use the same guideline:

• Pain ≤ 3/10

• Returns to baseline within 24 hours

Pain doesn’t always mean damage. With Achilles tendinopathy, the tissue often becomes more sensitive, meaning it reacts more easily to load—not necessarily that it’s being harmed.

Don’t Skip Strength Training

Improving overall lower body strength:

• Reduces risk of running injuries

• Improves performance

• Increases your body’s capacity to handle load

Strength training is one of the most effective long-term strategies for runners dealing with Achilles tendon pain.

Common Mistakes Runners Make with Achilles Tendinopathy

• Completely stopping activity
  Full rest often decreases tendon capacity and delays return to running.

• Stretching aggressively into pain
  Overstretching an already irritated tendon can worsen symptoms.

• Only relying on passive treatments (ice, massage, etc.)
  These may help short-term pain, but don’t address the root issue: load tolerance.

• Progressing exercises too quickly
  Tendons need time to adapt—rushing loading can flare symptoms.

• Ignoring early warning signs
  Morning stiffness and mild pain are often the first signs—addressing them early can prevent bigger issues.

Final Thoughts

Achilles tendinopathy can be challenging, especially when it’s hard to know when to push and when to back off.

Having guidance from a clinician who understands running can make a huge difference. You don’t have to figure this out on your own.

If you’re dealing with Achilles pain from running and aren’t sure how to manage it, reach out or schedule an evaluation—I’d be happy to help.