Key Points:
- Achilles tendon pain is common in runners due to overuse and biomechanical factors.
- Early physiotherapy intervention speeds up recovery and prevents chronic issues.
- Sports physio offers customised manual therapy and exercises to improve function and reduce pain.
- MGS Physiotherapy provides one-on-one care to get you back running safely.
Running and Achilles Tendon Pain
You’re not alone if you’re a runner and experiencing a dull ache, sharp pain, or stiffness at the back of your ankle. Running and Achilles tendon pain go hand in hand, especially if you increase your training load too quickly, have tight calf muscles, or wear the wrong shoes.
Early symptoms may begin as a mild ache or mild discomfort, which is often the first sign of a developing issue. Achilles discomfort is often an early warning sign and should not be ignored, as it can be the start of an overuse injury. Achilles tendinitis is characterised by dull or sharp pain anywhere along the back of the tendon, but usually close to the heel.
The Achilles tendon is a large, vital tendon that connects your calf muscles to your heel bone, playing a crucial role in running, jumping, and walking. The Achilles tendon connects the calf muscles to the heel bone and is involved in running, jumping, and pushing off with the toes. Overuse can lead to inflammation or degeneration of the tendon, resulting in Achilles tendinopathy – a condition that can become chronic if left untreated.
A sudden increase in training load is a common culprit for Achilles tendon pain in runners.
For runners who experience shin splints alongside Achilles pain, check out our article on managing shin splints to support your overall lower limb health.
Diagnosing Achilles Tendinopathy
Accurate diagnosis of Achilles tendinopathy is key to managing Achilles tendon pain and preventing further injury. When you see a healthcare professional for Achilles pain, they will review your symptoms, medical history and activity levels to understand the cause of your tendon pain. A full physical exam will assess ankle and calf mobility, strength and tenderness.
The affected area is typically the lower portion of the Achilles tendon, and treatment should focus on this region. Pain in the lower Achilles region is more serious as there is limited blood flow, helping to distinguish Achilles tendinitis from other conditions affecting the tendon or surrounding tissues.
Sometimes imaging, like ultrasound or MRI, may be used to confirm the diagnosis and rule out other issues like partial tears or heel bone problems. If symptoms are persistent or severe, seek early medical advice. Early diagnosis and treatment can manage Achilles tendinitis, reduce the risk of chronic pain and get you back to your normal activities sooner.
Common Causes of Achilles Tendon Pain in Runners
Some of the most common causes of Achilles tendon pain in runners are:
- Increased training volume or intensity
- Sudden increase in running distance or intensity
- Tight calf muscles limit ankle mobility
- Poor running technique and biomechanics
- Inadequate footwear with no heel support or worn-out shoes
- Running on hard surfaces or hills, or steep inclines, without proper conditioning
- Repetitive stress from frequent runs without adequate recovery
Long-distance runners are more prone to Achilles tendon pain due to the cumulative repetitive stress from frequent runs and challenging terrain, such as steep inclines.
Knowing the cause of your pain is key. Running mechanics such as heel striking and improper placement of the heels during running can increase strain on the Achilles tendon. Proper foot and foot mechanics are essential, and strengthening the feet can help prevent Achilles issues. At MGS Physiotherapy, our sports physios assess your individual biomechanics, muscle flexibility and running technique to provide customised treatment plans.
The Role of Calf Muscles in Achilles Health
Your calf muscles, the gastrocnemius and soleus, are vital for supporting the Achilles tendon during running and other activities. Maintaining their strength and flexibility is essential to prevent overuse injuries like Achilles tendinitis. Tight or weak calf muscles increase stress on the Achilles tendon, a common cause of Achilles pain in runners.
To prevent Achilles tendinitis and promote tendon health, regularly perform calf raises, heel drops, and stretching exercises targeting the lower leg. Strengthening and stretching the calves not only reduces the risk of Achilles tendon injury but also enhances running efficiency and resilience. Addressing muscle imbalances helps prevent future pain and keeps you active. Self-massage can also relieve irritation and inflammation in the Achilles area.
Why Early Physio Intervention Matters
Ignoring Achilles pain often leads to worsening symptoms and longer recovery times. Early intervention with sports physio can:
- Reduce pain and inflammation through manual therapy techniques
- Increase tendon loading capacity through progressive strengthening exercises
- Improve flexibility and ankle mobility to reduce stress on the tendon
- Correct running mechanics to prevent re-injury
- Get you back to running faster and safer
How Sports Physio Treats Achilles Tendon Pain
At MGS Physiotherapy we use:
1. Full Assessment
A thorough assessment is essential for managing Achilles tendon pain effectively. Your physiotherapist will begin by reviewing your medical history, symptoms, training habits, and any previous injuries to identify the root causes of your tendon pain.
During the physical exam, they’ll check the Achilles tendon and surrounding areas for tenderness, swelling, and injury signs, while assessing ankle and calf mobility, strength, and lower leg function. Imaging such as ultrasound or MRI may be used if needed to assess tendon damage or exclude serious issues.
Understanding when your pain started, what worsens it, and your recovery goals helps tailor a treatment plan that addresses your injury and prevents future problems. This comprehensive assessment sets the foundation for a faster, safer return to running and other activities.
1. Full Assessment We assess biomechanical factors such as calf tightness, hip weakness, poor foot mechanics or foot alignment issues.
Assessment may also include whether custom orthotics or heel lifts are required to correct foot alignment and reduce stress on the Achilles tendon if the affected foot is overpronating or unstable. During evaluation, it is important to monitor both Achilles tendons for any signs of irritation or injury, as this can help prevent further complications and guide appropriate treatment.
If your Achilles pain has developed after an ankle sprain, our ankle sprain rehabilitation services can help address underlying instability and get you back to full function.
2. Manual Therapy
Deep tissue massage, trigger point release and joint mobilisation to reduce pain and improve ankle mobility.
3. Customised Exercise Programmes
Strengthening exercises for the calf complex and Achilles tendon are crucial and need to be tailored to your current capacity to avoid overloading the tendons. A customised exercise program is a primary treatment option for Achilles tendinitis and related injuries. Your physio will guide you through a progressive loading programme including eccentric calf raises to strengthen the tendon and restore resilience. In chronic Achilles tendinopathy, exercises may also help break down scar tissue that can form along the tendon and limit flexibility.
4. Gait and Running Retraining
Changes to your running form may be required to reduce tendon overload. Your physio may recommend starting with a slower pace and avoiding uneven ground to minimise tendon loading and prevent aggravation of symptoms. This may include cadence modifications or foot strike adjustments depending on your assessment findings. If you have insertional Achilles pain, you need to monitor symptoms during activities and adjust your running or cross-training accordingly.
5. Return-to-Run Planning
Gradual reintroduction to running is essential to prevent setbacks. Full recovery from Achilles tendinitis can take six to eight weeks, depending on the severity of the injury and your adherence to the rehabilitation programme. Your physio will develop a personalised return-to-run programme to build tendon tolerance safely. If you experience Achilles pain or discomfort during your return-to-run programme, consult your physio to adjust your programme and prevent further injury. If the pain persists beyond six to eight weeks, further assessment or changes to your rehabilitation plan may be necessary.
Load Tolerance and Recovery
Building load tolerance in the Achilles tendon is key to a successful recovery from Achilles tendinitis. Load tolerance refers to the tendon’s ability to handle the stresses of running and other activities without becoming inflamed or painful. If the Achilles tendon is overloaded too quickly, it can lead to further injury and prolong the recovery period.
To treat Achilles tendinitis effectively, you need to gradually introduce stress to the tendon through a structured running training programme. This may mean reducing running intensity, taking rest days and using cross-training or pool running to maintain fitness while minimising tendon strain.
These activity modifications are especially important for those with an Achilles injury, as they help avoid aggravating the injury while promoting healing and a safe return to activity. Progressive strengthening exercises help the tendon adapt and become more resilient over time. Always listen to your body – if pain increases or persists, take a break and consult your physio to adjust your recovery plan. A step-by-step approach is key to tendon healing and safe return to running.
Cross Training for Recovery
Cross-training is an effective way to recover from Achilles tendinitis. It allows you to maintain fitness without overloading the Achilles tendon. Low-impact activities like cycling, swimming, and using the elliptical support tendon healing and reduce the risk of aggravating Achilles pain.
When returning to running, choose running shoes with good support, cushioning, and heel elevation to lessen strain on the Achilles tendon and aid recovery.
Cross-training also strengthens the lower leg, corrects muscle imbalances, and improves flexibility, key factors in preventing future Achilles tendon injuries. Mixing workouts promotes healing, reduces discomfort, and helps you return to running with confidence and resilience. It’s an essential part of recovery and injury prevention for anyone managing Achilles tendinopathy.
Experience and Expectations
When managing Achilles tendon pain, patience and realistic expectations are essential. Achilles tendonitis can be stubborn, especially with repetitive stress or longer-lasting symptoms. Recovery varies based on injury severity, overall health, and adherence to treatment.
Prevent further injury by adjusting your running training, reducing intensity, avoiding steep inclines and uneven ground, and gradually increasing mileage. Stretch tight calf muscles and strengthen the lower leg to support tendon healing. Supportive shoes, custom orthotics, or heel lifts may be advised to reduce strain and improve biomechanics.
If discomfort persists, cross-training with pool running, cycling, or elliptical workouts helps maintain fitness while easing tendon load. Address risk factors like tight calves, high blood pressure, poor running form, or worn-out shoes with your physiotherapist to aid recovery and prevent recurrence.
Treatment includes physical therapy, stretching, orthotics, and, rarely, surgery. The goal is to promote healing, reduce pain, and restore your ability to run and play sports without discomfort. A thorough assessment and structured plan will help you manage Achilles tendon pain effectively and return stronger.
Preventing Future Achilles Tendon Issues
Prevention is always better than a cure. To minimise the risk of Achilles tendon pain:
- Warm up properly before running, focusing on calf and ankle mobility drills
- Strengthen your calves and lower limbs to improve tendon resilience
- Gradually increase training loads (no more than 10% per week)
- Wear appropriate, supportive shoes with adequate heel support
- Include cross-training activities such as cycling or swimming to reduce repetitive strain
Early management of minor injuries in the Achilles area is key to preventing tendon damage. Preventing an Achilles heel injury requires addressing minor symptoms early and following a comprehensive prevention plan.
Applying ice and elevation can help reduce swelling, and exploring different treatment options with your physio can address underlying issues before they become chronic. If you experience recurring injuries, seek professional advice to develop a prevention plan.
If you’re prone to recurring Achilles issues, consult our experienced physios for a biomechanical assessment and prevention strategy. Learn more about our physiotherapy services.
Why Choose MGS Physiotherapy?
At MGS Physiotherapy, we believe sports injury physio is for everyone, not just elite athletes. Our approach means:* Customised treatment plans for you
- Hands-on manual therapy to reduce pain and increase mobility
- Personalised exercise programs to strengthen and prevent future injury
- One-on-one care with experienced sports physios who will help you achieve your recovery goals
We want to get you back to running and daily activities stronger and with confidence.
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