Achilles Pain in Runners: Why It Happens and How to Get Back to Training
Stiff, painful Achilles after running? It's almost always tendinopathy, not a tear. Here's the modern, evidence-based way to fix it without losing your fitness.
Achilles pain is the most common lower-limb complaint we see in runners. It usually creeps in over weeks rather than appearing suddenly — stiffness on the first few steps in the morning, an ache during the early kilometres of a run that warms up, then soreness afterwards.
Tendinopathy vs tear — they're not the same
A true Achilles rupture is sudden, dramatic, and usually feels like being kicked in the back of the leg. Tendinopathy is a gradual, load-related overuse problem in the tendon itself. Almost all running-related Achilles pain is tendinopathy and does not require imaging in the first instance.
Why it happens
The tendon is being asked to do more work than it can currently tolerate. The trigger is almost always a change — a sudden mileage jump, more hill or speed work, a new pair of shoes with a lower heel drop, a return after a break, or a change of surface.
The treatment that actually works: progressive loading
The single most evidence-based treatment for Achilles tendinopathy is a structured calf-loading programme — heavy, slow heel raises performed several times a week. Rest alone makes the tendon weaker and the problem comes back.
A simple starting protocol
- Heel raises on a flat floor: 3 sets of 12, every other day
- Progress to single-leg heel raises once pain-free
- Then add a small weight (rucksack) and progress to a step
- Pain during the exercise up to 4/10 is acceptable, provided it settles within 24 hours
What else helps
- A temporary 6–10 mm heel raise inside your shoe offloads the tendon
- Switch to higher heel-drop running shoes for a few weeks
- Reduce volume by 30–50%, keep some running going — total rest delays recovery
- Gait analysis to identify why the tendon is being overloaded
When to get assessed
If pain persists beyond 2–3 weeks of sensible self-management, if you're getting recurrent flare-ups, or if the pain is at the very back of the heel rather than in the tendon itself (a different condition called insertional tendinopathy that needs a tweaked approach), get a proper assessment.
Need this looked at in person?
Book a £70 30-minute appointment at our Aylesbury clinic — assessment, diagnosis and a personalised treatment plan.