How to Manage Achilles Tendon Injuries for Runners

Dec 20

Achilles tendon injuries are common running injuries that occur when the tendon connecting the calf muscles (the gastrocnemius and soleus) to the heel becomes irritated and, in some cases, inflamed.

While rest and stretching might sound like the best advice, these approaches have the potential to make the condition worse!

Let’s go through what you can do instead so that you’re back to healthy, happy running as quickly as possible.

Achilles Tendonitis vs Achilles Tendinopathy: What’s the difference?

The most common term we hear historically for Achilles injuries is Achilles tendonitis. However, you’ll typically hear doctors, physios, and healthcare professionals call it Achilles tendinopathy. Here’s the difference:

Tendinopathy is a degeneration of the collagen protein that forms the tendon. It’s a general term that includes microscopic degeneration and can be linked to:

Overtraining or rapid increases in mileage or intensity, commonly referred to as training error.

Running in shoes with a low heel-toe drop

Weak calf muscles or tight lower legs.
Poor running form or biomechanical issues.
Aging
Stress (physical, mental and emotional!)

Tendonitis is a form of tendinopathy that involves an inflammatory response in the tissue.

We now know that most Achilles injuries are cases of tendinopathy without true tissue inflammation, so you’ll likely hear it referred to more often as Achilles tendinopathy instead of tendonitis.

Either way, the treatment is often fairly similar, so there is no need to stress whether you fall into the Achilles tendonitis subset!

How to recover from Achilles tendinopathy

To recover from Achilles tendon injuries, you need to focus on reducing pain and gradually rebuilding strength. Here’s a simple guide to help you manage this injury and get back to running pain-free.

1. Modify Your Running and Activities

Keep your pain level at 3 out of 10 or less on a pain scale, where 0 is no pain and 10 is the worst pain you’ve ever experienced.

We’re not afraid of a bit of discomfort with tendons. Tendons respond well to load, and we’ve repeatedly proven that avoiding all loading isn’t a good long-term solution, as you only get weaker and less tolerant to load.

Of course, you also don’t want to create a chronic cycle by pushing too hard. Use that pain scale as a guideline, and also note that you should be back to your baseline for pain within about 24 hours after activity.

Avoid high-impact activities or pushing through pain. Focus on low-impact exercises like swimming or cycling to maintain fitness while your tendon heals. Gradually add run-specific strength training to build a tolerance to the demands of running before fully diving in.

If you want to dive a little deeper into the decision to run, modify, or rest, check out this resource.

2. Avoid Stretching the Calf and Achilles Tendon

Stretching can worsen Achilles tendon injuries by compressing and irritating the tendon and surrounding tissue. Instead of stretching, focus on strength and mobility exercises that don’t strain the Achilles.

3. Limit Movements with Excessive Dorsiflexion

Dorsiflexion (bending your foot upward) can compress the tendon and make the pain worse.

Avoid exercises like:

Deep squats

Lunges where the knee extends far past the toes

These are usually great movements in a runner’s strength program, but if your Achilles is irritated, modify or skip them temporarily to avoid worsening the injury.

4. Strengthen the Calf Muscles

Strong calf muscles (gastrocnemius and soleus) are key to recovering from Achilles tendonitis.

Start with isometric heel raises:

Lift your heel slightly off the ground and hold for 20-30 seconds. Repeat several times.
For a few more great options, check out this post.

Isometrics have been shown to reduce pain while allowing you to begin loading the tissue and building motor control, which is essential to long-term success.

Progress to slow heel raises:

Lift your heel up and lower it slowly, but avoid dropping it below the step at first to prevent strain.

The slow lowering is key here, making this an eccentric exercise. Eccentric exercises (where the muscle lengthens while contracting) promote tendon healing and improve the brain's ability to control the muscle-tendon unit. Much research shows that tendon injuries involve a lack of coordination between the nervous system and the muscle-tendon unit, which is particularly important to successful rehab!

Gradually build speed and intensity:

As you improve, you can gradually speed up the movement as you retrain the nervous system to control movements at a higher cadence. You can also add in more explosive movements, like bounding, and plyometrics where you focus on getting off the ground as quickly as possible or being springy!

5. Choose the Right Shoes

Wearing shoes with a higher heel drop (where the heel is slightly raised compared to the toes) can reduce strain on the Achilles tendon.

This helpful short-term fix allows you to keep moving while your tendon heals. However, don’t forget that without also building the capacity to tolerate loads (strength!), this solution alone will almost always fail.

You will find your way to recovery!

Achilles tendon injuries don’t have to sideline you for long. By modifying your activity, avoiding stretching, strengthening your calves, and making temporary changes like adjusting your footwear, you can recover and get back to running stronger than ever.

If you’re struggling with Achilles tendon pain or other running injuries, consider working with The Runner’s Academy. Our team of run-focused healthcare providers, personalized coaching and strength training programs can help you stay injury-free and achieve your running goals.

For more tips on returning to running after injury, check this out!

TRA Team