Why Does My Achilles Hurt When I Run?

Achilles tendon pain is a frustratingly common problem for runners.

When it first starts creeping in, it feels like a dull ache that hits after a run, and it usually doesn’t hit hard or long enough to cause alarm…

So, understandably, runners tend to gloss over it — it’s not severe enough to stop their training, so why let it, right?

For several reasons, actually.

Although the symptoms don’t start out as a pressing concern, leaving them unchecked can often worsen the initial pain into more intense, lingering problems (and eventually, injury). In the case of Achilles pain, runners typically sustain the notorious Achilles tendinitis or tendinopathy.

Let’s dig into the specifics behind why Achilles pain can strike, what it means for your running, and how you can recover from it (or, how to prevent it from happening altogether!).

What Exactly Is Achilles Tendinopathy?

The most accurate description of Achilles tendinopathy is a “degeneration” of the tendon tissue, but don’t worry — it sounds more alarming than it actually is. Degeneration of the tissue simply identifies when the quality of your tendon tissue decreases over time.

During the initial, acute stages of symptomatic pain, your body naturally responds with inflammation. (That inflammation is what defines the Achilles tendinitis phase of the pathology, during the first few days of injury.)

Unfortunately, inflammation doesn’t actually improve the healing process for the tendon. It can actually result in light scarring of the tissue, which is what leads to that degeneration in the first place.

You can almost think of your Achilles tendon as a rope or cord: ideally, it should be taut and cohesive. But as it gets worn down from constant use, it may begin to fray (i.e., decrease in quality). Simple fixes like patches or duct tape can help in the short-term, but unless you directly reinforce the rope itself, you won’t be able to achieve the same level of tightness.

The same goes for your Achilles — trying to treat the pain with surface-level fixes like stretching or icing will help to an extent, but it won’t solve the true problem. (But more on that later!)

What Are the Telltale Symptoms?

When Achilles pain first starts up, it presents as that achy pain in the calf or tendon, usually after your runs. Many runners default to stretching it out, which usually alleviates the symptoms long enough to dispel concern.

However, if you continue to run with it, the problem will worsen, and you’ll likely start to feel it during activity as well. People often report feeling the pain at the start of their runs when they’re tissues are still a bit cold or inflexible; as they warm up, the pain typically subsides, but will then return again after stopping.

You may also feel other symptoms besides pain, like stiffness or thickening in the tendon. Some people experience redness or swelling, and it can sometimes feel tender to the touch, depending on how long you’ve dealt with the issue.

In addition to feeling pain with running, you may also encounter symptoms with jump training or plyometric workouts, as these activities recruit your calves and Achilles tendon a lot.

But, managing Achilles pain is more than just knowing what the symptoms are — it’s also about knowing how to gauge them.

Can I Run Through Achilles Pain?

Now, we know that, ideally, runners would never sacrifice their training if they didn’t have to. And for the most part, if you can physically run with the symptoms, it should theoretically be okay to do so, right?

In some cases, that’s true. Sometimes running will wear out your body and leave you feeling a bit achy, and there are plenty of times where it’s okay to run through it.

But that doesn’t mean that you can ignore that pain altogether.

Managing your pain and safely running with it requires close attention to your symptoms and limitations. Keep an eye out for any of the following red flag symptoms:

If your experience matches any of these criteria, pause your training and speak with a running and movement specialist! These signs indicate that your pain is more than just a small niggle, and leaving it unchecked will only further exacerbate the problem.

Risk Factors for Achilles Tendinopathy

There are quite a few factors that could lead to Achilles tendinopathy, ranging from training habits to specific biomechanical deficits in your running form.

Most commonly, runners experience this issue as a result of overuse. This happens when you continue to train and increase your mileage without accounting for your symptoms, only further exacerbating the problem and placing it under greater strain. If you also sprint frequently or run hills without sufficient rest in between, you’re at a higher risk of Achilles injury.

You can also suffer the consequences from undertraining (that is, not actively including workouts for injury prevention). If you don’t have workouts that address Achilles tendon health in some way, there’s a much higher chance of the tissue being overworked and sustaining injury.

But how much or how little you train isn’t the only factor — your Achilles health also depends on other tissues and mechanics relevant for running.

For instance, having insufficient activation or strength in your glute muscles can have a surprising impact on the tendon.

If your glutes lack proper activation or strength, you aren’t able to achieve proper hip strategy. This affects your ability to achieve proper flexion in the hip, which consequently impacts the degree of flexion in your knee and ankle. (The interconnectivity of the kinetic chain is no joke!)

Having limited ankle dorsiflexion is a key risk factor: studies have shown a direct correlation between insufficient dorsiflexion and Achilles tendinopathy, particularly during peak knee flexion. If you don’t have enough joint flexion during this phase of your gait, your Achilles tendon ends up absorbing more impact and loading forces than it was built to handle.

But! The silver lining with common injuries like Achilles tendinopathy is that there’s LOADS of research for recovery and prevention… So let’s dive in.

How to Fix Achilles Pain in Running

Ah yes, the part you were waiting for!

Granted, we can’t tell you the precise exercises and reps needed for your specific recovery — those details will vary with every runner. But, there is a general prognosis for Achilles recovery, and exercises that are proven to help with Achilles health.

The Main Steps for Achilles Tendinopathy Recovery

There are five important elements that go into a thorough recovery for the Achilles tendon:

Start with pain management — and that means more than those basic stretches! For the tendon, it’s actually more beneficial to load the tissue with simple, eccentric exercises. Eccentric loading will also focus on stretching out the tissue, but it will simultaneously prompt the calf muscles and tendon to contract while under load. This ultimately builds strength into your tissues and will help gradually reduce your pain.

Use ice or anti-inflammatories as needed — as you’re in the initial stages of recovery, you want to be sure to keep any swelling at bay. (As we learned earlier, inflammation doesn’t aid the healing process, and it can interfere with faster or more effective recovery.)

Assess (and improve) your ankle mobility — unsurprisingly, if the cause of your problem is limited ankle mobility, the solution is to improve it! A lot of runners tend to overlook this aspect of training, since it doesn’t feel very dynamic or running-specific… but, ankle mobility drills don’t take long to do! You simply have to add them in regularly with the rest of your training so you can achieve and maintain ideal mobility.

Work on glute activation and strength — as a runner, this one probably doesn’t come as a surprise to you. The glutes are always highlighted as a major focus in running training, and it’s just as relevant for Achilles tendinopathy recovery! This is particularly important to supplement your joint mobility and muscular control, and it will also improve your shock absorption to offload much of the excess impact forces your tendon otherwise has to take in.

Correct any biomechanical deficiencies — this one is an important consideration. Although aspects like joint flexion and muscle strength are primary risk factors, there may also be other movement deficits at play that can affect your recovery. (Form errors may not be the biggest contributor to the injury itself, but if you don’t address them as you improve everything else, you won’t achieve the most success in your recovery.)

We know, this all sounds pretty broad… but these are the foundational elements that go into a solid recovery program. The specific exercises, timeline, and progression will be tailored to your individual case (and that’s where working with a running and movement specialist will be the most beneficial).

How to Prevent Achilles Pain and Reinjury

Running injury prevention effectively boils down to one thing: exercises!

Of course, that encompasses a lot. But, that’s sort of the point with injury prevention — you want to address as many training facets as possible to ensure that you’re thoroughly prepared to match the demands of running.

While we can’t review every workout that contributes to Achilles injury prevention, we do have a set of hand-selected options that our team likes to use for our runners. Let’s review!

Single-leg eccentric heel raises — A simple but classic drill for tendon health and strength. Eccentric heel raises are (unsurprisingly) great for eccentric tendon loading to reinforce the quality and durability of the tissue. You can also work on loading and strength for your calf muscles, as well: if you perform these with your knee straight, you’ll target the soleus muscle, and if you perform them with your knee bent slightly, you’ll target the gastrocnemius.

Glute strengthening drills — Obviously, there are many options to choose from in this category… but the key is to keep them running-specific! Focus on workouts like deadlifts, hip thrusts, or kettlebell swings: these are great for engaging and working the glutes while also prompting ample hip hinge and trunk and pelvic stability through dynamic movement.

Depth jumps — If this seems like a very specific choice, you’d be right! Depth jumps allow you to practice both tendon loading and glute strength at the same time, all in combination with plyometrics and shock absorption. But, because it has so many moving pieces, we typically suggest our runners to progress towards depth jump training. (This usually involves a variety of single-leg exercises like Bulgarian split squats and box jumps, all of which will supplement your running and injury prevention training perfectly!)

Calf stretches — Although stretching may not do much by way of eliminating Achilles pain, it goes a long way for injury prevention. Implement regular calf stretches into your routine (they can be a great addition for a cool-down!) to ensure that the tissues stay malleable and the whole muscle can elongate as needed.

And there you have it: four essential building blocks to help “bulletproof” your Achilles tendon from pain or reinjury! Combine this knowledge with the expertise of a running specialist, and you’ll be well on your way to protecting that tendon and running pain-free.

Don’t Let Achilles Pain Be Your Achilles Heel!

The bottom line is this: if you start to experience Achilles pain, you don’t have to immediately halt your running.

But you do have to pay close attention to your symptoms! Pain doesn’t have to be the end-all, be-all of training, but it’s still the primary way that your body signals you that something might be off.

So, now that you’re equipped with the knowledge of what your Achilles pain might mean (and when to truly be concerned about it), go forth and run — just don’t forget those exercises for tendon health, too!

By Dr. James Liaw DPT CSCS SCS

Dr. Liaw specializes in working with athletes of all calibers, spending the early part of his career in a sports medicine residency and creating sport-specific rehabilitation programs. He later went on to serve as the team PT for the Idaho Steelheads (Boise’s minor league hockey team) and furthered his expertise in sports rehab, injury prevention, preparticipation screenings, and return-to-sport testing. During his free time, he enjoys climbing (both in the gym and outdoors), watching sports (49er faithful), mountain biking, snowboarding, learning new things, and eating good food.

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