Experiencing Achilles pain while running goes right along side IT Band pain and knee pain in terms of common issues from “too much, too fast and too soon”—the cardinal sins of any runner.
Fortunately, just like the other two injuries it can be resolved with a little bit of knowledge and a few changes to your routine (and possibly gear!).
What Causes Achilles Pain While Running (Tendonitis)?
Runners are prone to Achilles tendon injuries because of the constant pushing off we do with each stride. The more and faster we run, the more susceptible we are to injury. Speed and uphill training can aggravate the Achilles thanks to the additional strain placed on the tendon.
When the Achilles is overworked, the tendon tightens and causes inflammation, voila la Achilles tendinitis.
Signs of Achilles tendonitis include:
- A stiffness which goes away as you warm up
- Pain and swelling close to the heel
- Limited ankle flexibility
- Redness along the tendon
- A burning sensation along the tendon
- Scar tissue build up (this will feel like lumps)
- A cracking or popping sound with ankle movement
With rest and proper care (which I get into below) most runners can usually recover from Achilles tendinitis fairly quickly. Left untreated, however, it will lead to more severe injuries, such as tearing or rupturing.If you hear a pop followed by intense pain in the back of the ankle and lower leg then you’ve pushed this inflammation too far and now have a major injury to recover from, a torn Achilles.
You likely won’t be able to walk normally after this occurs.
Often, Achilles tendon ruptures require surgery, but this is not always the case. None the less, we’re not going in to that here because you’re going to be a SMART runner and stop pushing through pain.
Can You Keep Running with Achilles Pain?
Errr maybe, but should you…well let’s consider what’s happening here.
Every time we push off the ground during a run, the force can amount to 500-600 pounds of pressure. The Achilles tendon takes the brunt of that force, meaning like our knees or IT Band, tightness, poor form and overuse are going to quickly take their toll.
- The Achilles tendon is the largest tendon in our body and comprised of a thick band of tissue that connects the calf muscles to the heel bone.
- This tendon is responsible for every step we take, whether walking or running.
- It also permits us to point our toes, push off our feet, jump up and down, and stand on our tip toes.
Basically anything we do with movement can be credited to the Achilles tendon.
No wonder it can get so cranky so easily. A sore Achilles in the morning is often the first sign that you need to hold up and pay attention before it becomes something more.
If you’re already experiencing Achilles pain, then stop running until you can complete the toe raise exercise listed in step 3 without pain.
Returning to Running After Achilles Injury
Whether you want to prevent an Achilles injury or are trying to comeback to running after tendonitis, these are the tips that will get you there.
Following is a three step plan to help prevent Achilles tendon pain from running, meaning you won’t resolve it once only to have it reappear on you again later.
Step 1: Reduce Swelling and Inflammation
If you’re in the midst of a major flare, then DO NOT run.
You need to first allow the swelling to subside and help your body to cull the inflammation. As recently reported, do not ice the area, unless you’re in pain and need some numbness!
Try these tips for reducing inflammation, which I used after knee surgery and I remain a big fan of compression socks. If the medical community loves them for healing, why wouldn’t we take advantage too!
And like those other common injuries I mentioned, once you’ve reduced swelling get moving and start with step 2 and 3. Continued rest won’t resolve the issue. Graphic from Road Runner Sports
Step 2: Implement Smart Training
First up is to stop the things which got you in to a mess.
Jumping mileage too quickly, adding in too much speed work or skipping out on rest days which is when our body truly rebuilds from the hard work. After that, make sure you’re doing these things as well:
- No barefoot time for you. You want to keep everything supported while you fully recover.
- Warm up. Exercising on tight, cold, or fatigued calf muscles transfer too much of the load onto the Achilles. A quick dynamic warm up will get that muscle ready to run with less risk of injury.
- Cross train with lower impact activities while returning to running.
- Vary running surfaces. Hard surfaces can aggravate it more, so consider more trails – but do not run on the treadmill as one study showed this actually required a 12% higher load on the Achilles.
- Regular foam rolling will help keep your muscles flexible and supple, which means less pulling on tendons!
- Rotate your running shoes to help eliminate muscle imbalances which can affect your stride and cause pain.
While we’re on the topic of shoes, there are some things to consider if you’re running in to Achilles issues.
In general, I’m a fan of the lower heel drop for most runners, but the best running shoes for Achilles pain are actually those with a slightly higher heel drop because it reduces stress.
Running Shoes to Help Achilles Pain
Additionally, you may benefit from a stability shoe if your foot is falling inward as that will further stress the Achilles.
- 10-12mm heel drop
- Or try adding a heel lift to your existing shoes if you love the fit
- Stability shoe
- Cushioned heel collar
- Brooks Ravena and Asics Gel Nimbus are often recommended
Once you’ve resolved your issue and are completing all the things below, I recommend moving to a lower heel drop as you can. There’s enough research to show it’s key to good running form, preventing heel striking and other injuries.
Step 3: Achilles Stretch and Strengthening Exercises
Now that you’ve culled the initial pain, it’s time to keep working on your Achilles. We want to keep this injury from recurring with my favorite thing PRE-HAB…though if you’re currently injured this is re-hab, but keep doing it long after the pain goes away!
To stretch or not to stretch? While some experts recommend stretching to help heal an Achilles injury, other sources suggest that the pull on the muscles can worsen the injury. This for me is a two pronged issue:
- See what feels good to you. If stretching hurts, STOP.
- Remember that often what we need to do is loosen the muscles AROUND the tight one.
Use a foam roller to loosen those calf muscles and a massage ball to loosen the plantar fascia in your feet. Notice we aren’t rolling right on the injury, but instead working the muscles around it to ensure that nothing else is pulling on it.
Eccentric Strength Training
This is a form of exercise that lengthens certain muscles under weight load. They are often slowed down movements which will train the muscles and tendons differently.
Stand on a step with your heels hanging off and switch the weight to one leg. Slowly lower your body and then use your other leg to help you return to the starting position. The help is especially important on the injured side. Do three sets of 15 on each leg twice daily, incorporating both the straight leg and bent knee versions.
Creating a stronger calf is going to help as well, so once the drops cause no pain it’s time to start with raises.
Standing flat footed raise up on to the ball of your feet and hold for a few seconds before lowering back down. As always three sets of 15 reps is a good baseline.
Drawing the alphabet with your foot is another great way to increase total ankle strength and flexibility, which is going to help prevent injury.
Once you’ve eliminated pain while doing the heel drops and calf raises, you can start to up the ante a bit. Try doing skaters to help improve your total foot, ankle and leg strength. These can be a great warm up or addition to your strength day.
Get additional ankle exercises for runners here >>
Step 4: Return to Running
Now that you’re starting to move through a full range of motion and are no longer dealing with sharp pain you can start running again. That does not mean pick up where you left off.
In fact, it means doing what I call test runs and utilizing tools like Lever to reduce the impact of your running.
When elite athletes return to workouts after an injury, Achilles or otherwise, they often utilize tools that reduce their body weight. In the past this meant an AlterG which is insanely expensive and only available in Dr’s office, but now we have Lever Movement system for at home.
I use this and a large number of athletes from the everyday to elite have started using it at home as well. Specifically for Achilles recovery this is going to reduce the amount of force the tendon needs to absorb with each stride.
By reducing this amount, you can ease your body back in to running with less chance of re-aggravating the Achilles.
Too many runners try to jump back in to normal training and quickly end up in pain again. Whether you feel in a hurry because you have a race or simply can’t wait to get going, this is a smart way to get started.
Checkout the full Lever Movement System >>
Lever Movement Discount Code: Runtothefinish for 20% off
Good news, you’ll continue to get usage out of this even after injury. It’s great for increasing mileage or even getting in a few more speedy miles to help the legs feel the turnover without a big jump in HR.
- If you’ve been off running for more than a month, you might choose to start with all Lever runs. Take off the maximum amount of weight and then each week take off less weight.
- If you’re just trying to avoid a full blown injury you might try substituting Lever for a couple of runs each week. Play with the weightload to find what gives you the most relief while still being a good workout.
Along with the Lever runs, you’ll want to start seeing how outdoor runs feel. The goal in these runs is to really dial in to how things feel and STOP before you’re in any pain.
For most runners this means starting back with a run/walk. Use those intervals to allow the body to adapt to the force again and take the pressure off any expectations.
You can over time continue to increase the run intervals based on signals from your body, most notably lack of pain or soreness.
Bonus: Taping an Achilles Injury
K Tape, or Kinesiology Tape can be kinda magical for injuries, including Achilles tendinitis (I mean it’s the only thing that allowed me to run after my knee injury!).
The tendon notoriously has poor blood flow, which is one reason it is so susceptible to overuse and stress injuries. Kinesio Tape lifts the skin away from the muscle, stimulating circulation and helping alleviate pain.
There are a few different ways you can tape for Achilles pain.Aresports provides a few examples of how to tape!
Example Achilles Taping
- Sit in a chair and cross the injured leg over the other, resting it just above the heel.
- With your heel flexed, anchor the tape starting in the bottom center of your foot and stretch the tape over the back of the heel, stopping about a ⅓ of the way up your calf.
- Rub the tape to create a strong bond.
- Fold a second strip in half and round the corners and cut it at the fold so you have two pieces.
- Take the first piece and tape it around the point of pain.
- If you have pain higher up in the calf, apply the second strip at that point in the same manner.
You can also try out some of these ankle braces for runners. Sometimes that can provide a little additional support and relief.
How Does the Achilles Tendon Get its Name?
As the Greek mythology goes, Achilles’ mother, Thetis wanted to make her son immortal, so she dipped him in the River Styx. However, the strong current meant that she held onto him by his heels, so his feet never touched the water. Thus his feet remained the one weak part of his body.
Achilles grew to be a strong warrior, defeating the leaders of nearby kingdoms. Paris, the brother of a man killed by Achilles set out for revenge, directing a poisoned arrow right into his heel, killing Achilles shortly after.
The first recorded connection with Achilles to the tendon occurred in 1693 by Dutch anatomist Philip Verheyen.
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Glad to see something on achilles injuries. I have suffered from achilles tendonosis in both feet since about 2005. I actually had not yet started running but I was a highland dancer for years and think the damage built up slowly. What I found was no movement made movement harder so I believed I needed to just push through it. I saw a sports medicine specialist in 2007 and he gave me some stretches and told me that surgery would likely help but that no one would want to operate on my achilles. I did the stretches for a while and then on and off but really just accepted that it would always be this way. Funny that this came up today because all afternoon my left tendon was throbbing in pain, reminding me that I really need to do something about it. Thank for the research!
Thank you! I’ve been dealing with this for a couple of months as I train for a marathon. I’ve found that the heel drop exercise definitely helps. Another exercise I like to do at night and in the morning, while lying in bed, is to take a yoga strap or towel and put it around the ball of my foot. I gently pull the strap (and my toes/foot) towards me, slightly stretching my Achilles. Hold for a few seconds and repeat on the the other side, if you’re lucky like me and have stiffness on both sides :) When I do this consistently, I can actually walk down stairs without having to go sideways! #yikes
oh thanks for sharing that move!! will definitely help others!
I have been reading your posts for I think years now. I feel like we are old friends that just live far apart. Thanks for the article, health and wellness are most important things in life. :-) Keep spreading a word of awareness.