Achilles Tendon Pain When Running: Causes, Treatment, and Recovery Timeline
- Dr. Kelsey Changsing, PT, DPT
- Jun 23
- 6 min read
Achilles tendon pain when running is commonly linked to Achilles tendinopathy, a condition that develops when the tendon can no longer tolerate the loads placed on it. Early symptoms often include pain at the start of a run that improves as activity continues.
Managing training load, avoiding sudden changes in running demands, and following a progressive strengthening program are key parts of recovery. Rest alone is often not enough because tendons need consistent loading to adapt.
Recovery timelines vary, but addressing symptoms early can shorten the rehabilitation process. Physical therapy can help identify contributing factors and guide a structured return to running.
Understanding Achilles Tendon Pain
Achilles tendon pain is one of the most common running injuries, but most cases can be successfully managed without completely stopping running.
The Achilles tendon is the thick, rope-like part connecting your calf muscle to the back of your heel. It acts like a spring to help propel you forward during activities like running.
Achilles tendon pain is usually associated with tendinopathy. It used to be thought that Achilles tendinopathy (AKA Achilles tendonitis) was from the Achilles tendon being inflamed. But updated research points to it being a tendon loading issue instead.
There are two types of Achilles tendinopathy: insertional and noninsertional. As the names suggest, insertional Achilles tendinopathy involves the lower part of the Achilles tendon where it attaches to the heel, and noninsertional Achilles tendinopathy involves the rest of the Achilles.
Early Warning Signs
Achilles pain when running is usually described as a “sharp” pain in the Achilles that is only felt while running. The pain usually goes away at rest in the initial stages.
Like most tendinopathies, when you first start having Achilles tendon pain, you might also experience the “warm-up effect”. This is when your Achilles is painful at the beginning of your run but seems to warm-up and become less painful as you keep running.
You might also feel the “warm-up effect” when taking your first steps in the morning or after sitting for a while.
Since the pain doesn’t seem to linger, it’s easy to forget about it between run sessions. But the earlier you address Achilles tendon pain, the less time it takes to recover from it.
Once the pain progresses to being “dull” and “achy” at rest, and you stop experiencing the “warm-up effect”, it can be more challenging and time-consuming to recover from Achilles pain.
Training Mistakes That Increase Risk of Achilles Tendon Pain
The biggest training mistake that increases your risk of developing Achilles tendon pain is not managing your training load properly. This includes doing too much, too soon (overloading) and having too many rest days between run sessions (underloading).
Remember that Achilles tendinopathy happens when the tendon stops being able to handle the loads put on it.
If you overload the Achilles by increasing your run volume or hill and speed work too quickly, you are not giving the tendon enough time to adapt to your training loads.
Similarly, if you only run every few weeks because you’re trying to rest your Achilles, you’re not giving the tendon an opportunity to acclimate to the demands of running. It might seem like resting the tendon is protecting it, but tendons need load to adapt. Without regular loading, the Achilles tendon won't develop the capacity needed to tolerate running.
A Note on Footwear
While running shoes on their own are not a main contributor to Achilles tendon pain, sudden changes in running shoe styles can be.
For example, switching from a traditional running shoe to a minimalist shoe can increase the amount of load placed on the feet, calves, and Achilles tendon. Making the switch too quickly can increase the demands on the Achilles past what it’s prepared to handle, leading to pain.
Treatment and Pain Management Options
The current best practice for treating Achilles tendinopathy is to improve your Achilles tendon’s ability to handle load.
As alluded to earlier, rest can actually prolong Achilles tendinopathy. It can cause you to get stuck in a cycle of temporarily feeling better after resting, but then flaring up the Achilles tendon again every time you try to return to running.
Depending on how severe your symptoms are, most runners can continue running during Achilles tendon rehab but at a lower volume and intensity. Some runners may also benefit from temporarily increasing their run cadence to reduce the demands placed on the Achilles tendon.
Achilles tendon rehabilitation can be broken down into 3 stages; the stage you start in for rehab will depend on the severity of your symptoms.
Stage 1: Decrease Pain with Isometrics
The goal of the first stage of Achilles rehab is to decrease your tendon pain enough to be able to begin progressively loading the tendon again. Most runners in this stage have too much Achilles tendon pain to tolerate the calf raises used in the next phase of rehab.
Isometrics, such as calf raise holds, are used to introduce load to the Achilles without causing too much pain. They can also help decrease pain when the Achilles tendon is especially sensitive.
Other treatments, such as dry needling, shockwave therapy, low-level light therapy, and corticosteroid shots can also help with pain in the short-term but do not help to address the Achilles tendon’s ability to tolerate load. These are best used as part of a comprehensive rehab program for long-term results and not as standalone treatments.
It’s also important to note that repeat corticosteroid shots can actually weaken tendon tissue and increase the risk of Achilles tendon rupture in the future.
Stage 2: Improve Calf Strength and Mobility
The goal of this stage is to progressively strengthen the calf muscles and Achilles tendon through exercises such as calf raises and eccentric calf raises.
If you have decreased ankle mobility because of tight calves, this stage will also work on improving calf flexibility. Calf stretches along with eccentric calf raises can help with that.
Stage 3: Plyometrics and Return to Running
This stage continues building your Achilles tendon’s load capacity for impact activities, such as running, through plyometrics.
A lot of people skip this stage, because they feel a lot better and have no symptoms by the time they reach this step. But running demands a lot more from your Achilles tendon than heavy calf raises.
Running requires your Achilles tendon to act like a spring, storing and releasing energy with every stride. Plyometrics help prepare the tendon for those demands.
How Long to Recover
The time it takes to recover depends on how soon you start rehab once symptoms appear. The earlier you address this, the less time it takes to recover.
On average, Achilles tendinopathy takes 3-6 months to fully recover because tendons take a while to adapt. Some cases may even take over a year to recover.
But if you’re able to start rehab before your Achilles tendon pain progresses, your rehab time can be much shorter.
When to See a Physical Therapist
Achilles tendon pain can be reasonably managed without help by managing your training load and progressively strengthening your calves and Achilles tendon.
However, it’s worth getting help from a physical therapist if:
You’re not sure if your pain is coming from the Achilles tendon
Your Achilles pain keeps coming back
You seem stuck in a cycle of feeling better and flaring-up the tendon again
Your Achilles pain seems to be worsening
Your Achilles pain starts affecting your daily life
A physical therapist can help determine where your pain is actually coming from and create an individualized plan to help you recover.
Achilles tendon rehab can also be a tedious process; having a physical therapist on your team can also help keep you accountable and help you stay on track.
But if you feel a sudden "pop" in the Achilles and have significant swelling or bruising in the calf, or difficulty pushing off with that foot, seek medical attention immediately. These may be signs of a more serious injury, such as an Achilles tendon rupture.
Triathlete Physical Therapy in Nevada
Achilles tendon pain doesn't have to keep disrupting your training. If you're a triathlete in Nevada struggling with Achilles pain while running, I can help you build a plan to reduce pain, improve tendon capacity, and return to training with confidence.
Schedule a virtual movement assessment below if you’re ready to return to consistent pain-free running.
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References
Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British journal of sports medicine, 43(6), 409–416. https://doi.org/10.1136/bjsm.2008.051193
Cook, J. L., Rio, E., Purdam, C. R., & Docking, S. I. (2016). Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research?. British journal of sports medicine, 50(19), 1187–1191. https://doi.org/10.1136/bjsports-2015-095422
