Achilles tendinopathy in runners: symptoms, load and rehabilitation
Updated: Sep 18
By Luke Dunmore, Osteopath | Chatswood
Achilles pain is common in runners, but complete rest is rarely the whole solution. Once the cause has been assessed, management usually involves adjusting training and progressively rebuilding tendon capacity. Here is what runners need to know about symptoms, training changes and rehabilitation.
What is Achilles tendinopathy?
Achilles tendinopathy describes pain and reduced function in the tendon connecting the calf muscles to the heel. The term ‘tendinopathy’ is generally more useful than ‘tendinitis’ because persistent tendon pain does not necessarily mean the tendon is simply inflamed. Inflammation can still play a role; the terminology should not be used to suggest otherwise.
Symptoms can develop when the demands placed on the tendon exceed its current capacity. A recent increase in running volume, faster sessions, hills or a return to training after time away may contribute. Training load is one part of the picture, alongside recovery, health and individual factors.
Mid-portion or insertional Achilles pain?
Mid-portion Achilles tendinopathy is usually felt a few centimetres above the heel. Insertional Achilles tendinopathy is felt where the tendon attaches to the heel bone.
This distinction matters because insertional symptoms can be aggravated by compression when the ankle bends deeply upwards. Heel drops off a step and aggressive calf stretching may therefore be less appropriate early in insertional rehabilitation. An assessment helps guide exercise selection rather than applying the same routine to every painful tendon.
Common symptoms
Morning stiffness or pain during the first few steps
Pain at the beginning of a run that may ease as you warm up
Symptoms that increase after running or the following morning
Tenderness or thickening through the tendon
Reduced calf strength or difficulty hopping
These symptoms can fit tendinopathy, but they do not confirm the diagnosis on their own. Other causes of heel and calf pain need different management.
Do you need to stop running?
Not always. Some runners can continue at a modified level while rehabilitation begins. The appropriate amount depends on pain, next-day symptoms, strength, running demands and how irritable the tendon is.
Reducing hills, speed, total volume or consecutive running days may help bring symptoms to a manageable level. Avoid pushing through worsening pain or a limp. If symptoms build from session to session or your normal walking is affected, reduce the load and seek an assessment. Temporary rest can be appropriate, but rest alone does not rebuild capacity for running.
How is Achilles tendinopathy rehabilitated?
Progressive calf loading is central to most Achilles rehabilitation programmes. Depending on your symptoms and ability, this may include tolerable holds or calf raises, progressing towards heavier resistance, single-leg work and eventually faster loading, hopping and running-specific drills.
Exercise range and loading should match the location and irritability of your symptoms. Insertional pain may need a temporary reduction in deep ankle movement and tendon compression. There is no single exercise dosage suitable for everyone.
How long does recovery take?
Tendon rehabilitation often takes months rather than days. Progress is not always linear, and temporary symptom fluctuations do not automatically mean the tendon has been damaged again. Consistent loading, appropriate running modification and gradual progression are usually more useful than repeatedly stopping and restarting without a plan.
When should you seek an assessment?
Seek assessment if pain is persistent, worsening or limiting normal walking and running. A sudden snap or pop, feeling as though someone has kicked the back of your ankle, or new difficulty pushing off could indicate an Achilles rupture. Stop running and seek urgent assessment, even if you can still walk.
Running injury assessment in Chatswood
Luke Dunmore is a UK-trained osteopath with a background in sports rehabilitation and a clinical interest in running injuries. As an avid runner who recently completed the Sydney Marathon, he understands how frustrating it can be to balance rehabilitation with training goals.
At Dunmore Osteopathy, based at The Body Project, 6 Help Street, Chatswood, an assessment can explore your symptoms, calf function and recent training before developing an individual rehabilitation plan. This article provides general information, not a diagnosis or individual exercise prescription.
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