Can You Run with Achilles Tendinopathy? A Coach's Guide

Can you run with Achilles tendinopathy? It's one of the most common questions I get from runners, and honestly, it's one of the most important ones to get right. Get it wrong in one direction and you're sidelined for months. Get it wrong in the other and you risk a partial tear or, worse, a full rupture.

I've been working with injured runners for over 20 years. In that time, I've seen Achilles tendinopathy wreck marathon build-ups, end running streaks, and frustrate even the most patient athletes. But I've also seen runners manage it really cleverly, keep their fitness ticking over, and come back stronger for it. The difference between those two outcomes almost always comes down to one thing: whether they understood what their tendon was actually telling them.

The truth is, there's no simple yes or no answer here. It depends on which type of Achilles tendinopathy you have, how irritable your tendon is right now, and whether your symptoms follow a predictable pattern. Get those three things clear in your head and you're most of the way there.

Let me walk you through exactly how to figure that out.

Quick answer: Many runners can continue running with Achilles tendinopathy if pain stays below 3/10 during activity, settles within 24 hours after running, and doesn't worsen week on week. If pain spikes above 5/10, lingers for days, or gets progressively worse, you need to stop running and begin a structured rehab programme.

What Is Achilles Tendinopathy?

Achilles tendinopathy is an overuse injury affecting the Achilles tendon, the thick cord of tissue connecting your calf muscles (gastrocnemius and soleus) to your heel bone. It's the strongest tendon in the body, but also one of the most commonly injured in runners. Not a great combination.

You might see it called Achilles tendonitis, tendinitis, or tendinosis. For practical purposes, these terms all describe the same problem. "Tendinopathy" is the most accurate label, because it doesn't assume inflammation is the main driver. Research now shows that in a good chunk of cases, the real issue is structural breakdown of the collagen fibres within the tendon rather than classic inflammation. That distinction actually matters quite a lot for how you treat it.

Achilles tendinopathy accounts for roughly 10% of all running injuries, with studies reporting an incidence rate of between 9.1% and 10.9% in recreational runners. It's the second most common running-related musculoskeletal injury, sitting just behind knee problems.

There are two main types, and knowing which one you have changes pretty much everything about how you manage your running.

Non-Insertional Achilles Tendinopathy

This affects the mid-portion of the tendon, typically 2 to 6 centimetres above the heel bone. It's the most common type in runners. You'll feel pain and possibly some thickening or nodularity in that area. Tensile loading, the pulling force through the tendon when you run, is the main driver here.

Insertional Achilles Tendinopathy

This affects the very bottom of the tendon where it attaches to the heel bone. It tends to be more stubborn and slower to respond to treatment. Compression is a key factor, which is why certain exercises (like dropping the heel below a step) can actually aggravate it rather than help. If you have insertional tendinopathy, some of the standard rehab advice for mid-portion tendinopathy can genuinely make you worse. So it's worth getting a proper diagnosis before you start loading the tendon.

If you're not sure which type you have, my article on Achilles tendon warning signs will help you work out what's going on before you read any further.

Reactive vs. Degenerative: Why the Stage Matters

Beyond the location of your pain, the stage of your tendinopathy matters enormously. This is something a lot of runners miss entirely, and it's a real shame because it changes the management completely.

Reactive Tendinopathy

This is the early stage. It typically happens after a sudden spike in training load, a new pair of shoes, a change in surface, or returning from a break. The tendon reacts to the increased stress by swelling and stiffening up.

Think of reactive tendinopathy as your body's alarm system firing. The tendon hasn't yet suffered significant structural damage. Catch it here, manage it properly, and you can often keep running while the tendon settles down. Not always, but often.

Symptoms of reactive tendinopathy:

Degenerative Tendinopathy

This is the more serious, chronic stage. It involves actual structural changes to the tendon tissue. The collagen fibres lose their neat, parallel arrangement, and areas of the tendon can become disorganised, weakened, and in some cases degenerate into fatty or calcified tissue. Not pretty, and not something you want to be running hard through.

Degenerative tendinopathy is more common in older runners and those who've had a long history of Achilles problems. It takes longer to respond to treatment, and continuing to run aggressively through it carries a real risk of partial or complete rupture.

Symptoms of degenerative tendinopathy:

I've written about this in more detail in my article on running with Achilles tendonitis, which is worth reading alongside this one if you want a deeper understanding of how the injury develops over time.

How to Actually Decide Whether to Keep Running

Here's the framework I use with every runner I work with. It's built around monitoring symptoms over a 24 to 72 hour window after each run, not just how you feel during the run itself. That last part is crucial, and it's the bit most runners get wrong.

The 24-Hour Rule

How your Achilles feels the morning after a run tells you far more than how it felt during the run. Tendons are slow-responding structures. They don't give you immediate feedback the way muscles do.

If your pain and stiffness the morning after a run are no worse than before you ran, and they settle within 24 hours, that's a green light to continue running with appropriate modifications. If your symptoms are notably worse the morning after, and they take more than 24 to 48 hours to settle, that's your tendon telling you the load was too much. Listen to it.

The Pain Scale Test

Use a simple 0 to 10 pain scale when you run:

Pain Level What It Means Action
0 to 3/10 Mild, acceptable discomfort OK to continue running with modifications
4 to 5/10 Moderate pain, borderline Reduce pace and distance, monitor closely
6/10 and above Significant pain Stop running, begin rehab, see a physio

The key thing to understand is that some discomfort during running is acceptable in reactive tendinopathy, as long as it follows the rules above. Zero pain isn't always the target. Managed, predictable discomfort that settles quickly is a very different thing from escalating pain that lingers for days. Those two things are not the same.

The Week-on-Week Trend

Zoom out and look at the bigger picture. Are your symptoms getting better, staying the same, or getting worse over a two to four week period? If they're improving or holding steady, you're managing the load well. If they're creeping up despite you not changing anything, the tendon is telling you it can't cope. That's when you need to pull back, regardless of how close your next race is.

When Is It Safe to Keep Running?

You can generally continue running if all of the following are true:

Here's something that surprises a lot of runners. Continuing to run, when done carefully, can actually help tendon recovery. Sounds counterintuitive, right? But tendons respond to load. Complete rest for weeks on end often makes things worse, because the tendon loses its capacity to handle load. Managed, progressive loading is part of the treatment, not a barrier to it.

When You Need to Stop Running Immediately

Stop running if any of these apply:

A sudden severe pain with a "snap" sensation needs urgent medical assessment to rule out a rupture. Don't run on it. Get it checked that day.

And if you're dealing with a progressively worsening pattern, I'll be straight with you: continuing to run is making things worse. I know that's hard to hear, especially with a race coming up. But two weeks of rest now beats six months of rehab later. I've said that to a lot of runners over the years. The ones who listened are always glad they did.

For context on how similar tendon injuries behave, my article on proximal hamstring tendinopathy covers the same load management principles and is worth a read.

How to Modify Your Running When You Have Achilles Tendinopathy

If your symptoms pass the tests above and you're cleared to keep running, you need to modify how you train. Here's exactly what I'd recommend.

Reduce Volume First, Not Intensity

This surprises a lot of runners. Research on tendinopathy suggests that volume, your total weekly mileage, is often the bigger driver of load than pace. Cut your weekly distance by 20 to 30% and see how your tendon responds over the following week before making any other changes. Simple as that.

Avoid Back-to-Back Hard Days

Tendons need recovery time between loading sessions. If you run hard on Monday, give your Achilles at least 48 hours before your next quality session. Easy running on alternate days is fine if symptoms allow, but don't stack hard efforts on consecutive days. That's a recipe for a flare-up.

Avoid Hills for Now

Running uphill dramatically increases the load on your Achilles tendon. Running downhill compresses the insertional area. Both can aggravate symptoms, especially in the early stages. Stick to flat routes until your tendon has settled, and reintroduce hills gradually once you're consistently pain-free. I know it's frustrating if you're training for a hilly race, but it's the right call.

Shorten Your Stride

A slightly shorter, quicker stride reduces the peak load on your Achilles with each footstrike. Increasing your running cadence by 5 to 10% can make a meaningful difference. You don't need to overhaul your entire technique. Just take slightly quicker, lighter steps and see how it feels.

Warm Up Properly Before Every Run

Never head out cold with an irritable Achilles. Trust me on this one. I always recommend a dynamic calf and Achilles warm-up before every run when you're managing tendinopathy. Five minutes of gentle movement makes a real difference to how the tendon tolerates the first kilometre.

Speed Work Is the Last Thing to Return

Track sessions, tempo runs, hill sprints. These put enormous load through the Achilles and they're the last things to return to your programme, not the first. Build your easy mileage back first, then gradually reintroduce faster running over several weeks once the tendon is consistently settled.

Think About Your Running Surface

Soft grass or trails tend to be kinder to an irritable Achilles than concrete or tarmac. If you can access softer surfaces for your easy runs during this period, use them. It's a small change that can take the edge off things quite noticeably.

The Rehab Work You Need to Do Alongside Running

This is where most runners go wrong. They either stop running and do nothing, which leads to a deconditioned tendon, or they keep running and do nothing, which leads to a worsening injury. The right answer is to keep running at a modified level and do the rehab work. Both, together. That's the bit people don't want to hear, but it's the bit that actually works.

Start with Isometric Calf Exercises

Isometric exercises involve contracting the muscle without movement. They're brilliant for reducing Achilles pain in the early stages because they load the tendon without the compression or tensile stress of dynamic movement.

The simplest version: stand with both feet flat on the floor, rise up onto your toes and hold for 30 to 45 seconds. Do this 4 to 5 times. Progress to single leg as symptoms allow. Research shows isometric loading can reduce tendon pain within minutes, which makes it a useful tool before a run too. Worth a try.

Heavy Slow Resistance Training: The Core of Tendon Rehab

Once the acute irritability has settled, typically after one to two weeks of isometrics, you need to progress to heavy slow resistance (HSR) exercises. This is the evidence-based cornerstone of Achilles tendinopathy rehab, and it's non-negotiable if you want to make lasting progress. I can't stress that enough.

The classic exercise is the eccentric heel drop, but for mid-portion tendinopathy specifically, a combination of eccentric and concentric loading (heavy slow resistance) produces better results than eccentrics alone.

Here's a basic progression for mid-portion Achilles tendinopathy:

  1. Double leg calf raise on flat ground: 3 sets of 15 reps, slow and controlled (3 seconds up, 3 seconds down)
  2. Single leg calf raise on flat ground: 3 sets of 12 reps, same tempo
  3. Single leg calf raise on a step (heel drop below step level): 3 sets of 10 to 12 reps (for mid-portion only, not insertional)
  4. Add load (backpack with weight, or a dumbbell): progress when 3 sets of 12 reps feel manageable

My article on soleus strength exercises for runners goes into more detail on how to target the soleus specifically, which is often the weaker of the two calf muscles in runners with Achilles problems.

For insertional tendinopathy, avoid dropping the heel below the step level. Keep all calf raises on flat ground or with a slight heel raise to reduce compression at the insertion point.

Don't Neglect the Soleus

Most runners focus on the gastrocnemius, the big, visible calf muscle. But the soleus is actually the primary load-bearing muscle for the Achilles tendon during running. It works hardest at slower speeds and when the knee is bent. And it's almost always the weaker of the two.

To target it specifically, do your calf raises with a bent knee. Sit on a chair, place a weight on your thigh, and do slow heel raises from that position. It sounds simple, and it is. But this is one of the most underused exercises in Achilles rehab, and adding it in can make a real difference.

Sort Out Your Ankle Dorsiflexion

Restricted ankle dorsiflexion, the ability to pull your foot upward toward your shin, is a significant risk factor for Achilles tendinopathy. When your ankle can't move freely, your Achilles tendon has to work harder to compensate. More load, more irritation.

Here's a quick test. Stand facing a wall, place your toes 10 centimetres from the wall, and try to touch your knee to the wall without lifting your heel. Can't do it? Your dorsiflexion is limited. My guide on how to improve ankle dorsiflexion has a simple mobilisation that works really well and takes less than five minutes a day.

Calf Stretching: With Caution

Stretching is a bit of a controversial area in Achilles tendinopathy, to be honest. For mid-portion tendinopathy, gentle calf stretching can help maintain tissue length and reduce morning stiffness. For insertional tendinopathy, aggressive stretching into dorsiflexion can compress the tendon at its insertion and make things worse. So it's not a blanket recommendation.

If you do stretch, keep it gentle. My super targeted calf stretch shows how to vary the stretch to hit different parts of the lower leg without overloading the tendon.

Running Technique Changes That Make a Real Difference

Your running form can either stress or protect your Achilles tendon. A few targeted adjustments can make a meaningful difference, and they don't require you to completely overhaul how you run.

Foot Strike Pattern

There's loads of conflicting advice online about this. Here's the thing: forefoot striking increases the load on the Achilles tendon compared to heel striking. If you're a forefoot striker dealing with Achilles tendinopathy, shifting slightly toward a midfoot strike can reduce tendon load significantly. Conversely, if someone tells you to switch to forefoot striking to fix your Achilles, be cautious. That advice can make things worse. Read my full breakdown of proper running foot strike for more on this.

Cadence and Stride Length

As I mentioned earlier, a slightly higher cadence with a shorter stride reduces peak Achilles load. Aim for around 170 to 180 steps per minute if you're currently running at a lower cadence. Even a 5% increase makes a measurable difference, and it's one of the easiest technique tweaks to do.

Hip Extension and Glute Activation

Weak glutes force the calf and Achilles to compensate during the push-off phase of running. Not ideal. Improving your glute strength and activation can meaningfully reduce the load your Achilles has to handle. My four essential glute exercises for runners are a good starting point, and you can do them alongside your calf rehab work without any conflict.

What Your Shoes Are Doing to Your Achilles

Footwear can make a real difference, especially in the short term. Often it's the quickest win available to you, so it's worth looking at this early.

Heel Drop

A shoe with a higher heel-to-toe drop (8mm or more) reduces the stretch on the Achilles tendon during running and walking. If you've been running in zero-drop or minimalist shoes, switching to a more traditional running shoe during your recovery period makes sense. Don't make the switch back to minimal footwear until your Achilles is fully settled, and even then, make the transition gradually.

Heel Raises

A simple 5 to 10mm heel raise inside your shoe can provide immediate relief by reducing the load on the tendon. You can buy adhesive heel raises cheaply from most pharmacies. Use them in both shoes to avoid creating a leg length discrepancy. Easy fix.

Avoid Flat Shoes and Barefoot Walking

Walking around in flat shoes or barefoot puts your Achilles under sustained stretch. During a flare-up, wear shoes with some heel elevation from the moment you get out of bed in the morning. It's a small habit change, but it takes the edge off things considerably.

What About Racing with Achilles Tendinopathy?

I get asked this a lot, especially in the weeks before a marathon or a big race. Here's my honest answer.

If your symptoms are mild, following the predictable pattern I described, and you've been managing them well for several weeks, racing is a reasonable decision. You go in with eyes open, you accept the risk, and you make sure you have a solid recovery plan for afterwards. That's a fair trade-off for some runners.

But if your symptoms are worsening, unpredictable, or you're already limping in training... racing is likely to cause significant damage. A partial tear during a race is a very different injury to manage than a grumbling tendinopathy. Recovery from a partial tear can take six months or more. That's a long time out.

Be honest with yourself about where your symptoms sit on that spectrum. If you're in doubt, speak to a sports physio before race day, not after. My article on marathon training mistakes to avoid covers some relevant ground on how I think about load management in the build-up to a race.

How Long Does Recovery Actually Take?

This is the question everyone wants answered. I won't pretend there's a tidy answer, but here's what the evidence and my experience suggest:

Stage Typical Recovery Timeframe Notes
Reactive (early stage) 4 to 8 weeks With load management and rehab
Mid-portion (established) 3 to 6 months Consistent rehab required
Insertional 4 to 9 months Slower to respond, needs specialist input
Degenerative (chronic) 6 to 12+ months May need additional interventions

The runners who recover fastest are the ones who start the right rehab early, manage their running load intelligently, and don't try to rush back to full training too soon. Patience genuinely pays off with tendons. It's one of those injuries where the more you push, the further away the finish line gets. You might also find it useful to read about how long gluteal tendinopathy takes to recover, since a lot of the same principles apply to tendon rehab across different body regions.

Other Treatments Worth Knowing About

Shockwave Therapy

Extracorporeal shockwave therapy (ESWT) has decent evidence behind it for chronic Achilles tendinopathy that hasn't responded to exercise rehab alone. It works by stimulating the tendon's healing response. It's not a magic bullet, but for stubborn cases it's well worth discussing with a sports medicine specialist.

Platelet-Rich Plasma (PRP) Injections

PRP involves injecting a concentration of your own platelets into the tendon to stimulate healing. The evidence is mixed, to be honest, but some runners with chronic, degenerative tendinopathy do respond well. It's typically used when exercise rehab has failed after three to six months, not as a first port of call.

Cortisone Injections: Proceed with Caution

Cortisone injections are sometimes offered for Achilles tendinopathy, but I'd urge real caution here. While they can provide short-term pain relief, research suggests they may actually weaken tendon tissue over time and increase the risk of rupture. They're generally not recommended for Achilles tendinopathy by most sports medicine specialists. If you're considering this route, have a frank conversation with your doctor about the risks before you commit.

Soft Tissue Work

Sports massage and foam rolling of the calf muscles can help reduce tension in the musculotendinous unit and improve blood flow to the area. It won't fix the tendon on its own, but it can reduce discomfort and help your rehab exercises feel more effective. Focus on the calf belly rather than directly on the tendon itself.

Keeping Achilles Tendinopathy from Coming Back

Once you've had Achilles tendinopathy, you're at higher risk of it returning. The good news is that with the right habits in place, it's very manageable long term.

Follow the 10% Rule

Never increase your weekly mileage by more than 10% from one week to the next. Most Achilles flare-ups I see are caused by runners doing too much too soon, often after a period of illness, holiday, or injury. If you've had time off, returning to running after a break needs to be gradual. This is not the time to try to claw back lost fitness in a hurry.

Keep Up the Calf Strength Work Year-Round

Don't stop your calf strengthening exercises the moment your pain goes away. I see this all the time. Tendon strength takes months to build and is easy to lose. Include heavy calf raises in your strength training year-round, not just during injury periods. Think of it as maintenance, not treatment.

Manage Training Load Spikes

Sudden changes in training load are the biggest risk factor for Achilles problems. This includes increases in mileage, adding speed work, changing surfaces, or switching to a new type of shoe. Make changes one at a time, and gradually. That applies to everything.

Address Your Biomechanical Risk Factors

Poor ankle mobility, weak glutes, and a high-arched or low-arched foot can all increase Achilles load. Working with a running coach or physio to identify and address your specific risk factors is the best long-term investment you can make. My 10-minute ankle strengthening routine is a great place to start if you want something practical to get on with straight away.

Frequently Asked Questions

Can I run with Achilles tendinopathy if I have no pain?

Yes, if you have no pain during or after running and your symptoms aren't worsening week on week, you can continue running. But make sure you're still doing your rehab exercises. The absence of pain doesn't mean the tendon is fully healed. Tendons can be structurally compromised without causing significant pain, so don't use pain as your only guide.

Is it OK to run through Achilles pain?

It depends on the level and pattern of pain. Pain below 3/10 that settles within 24 hours is generally acceptable. Pain above 5/10, pain that worsens during a run, or pain that lingers for more than 48 hours means you should stop running and seek professional advice.

Should I stretch my Achilles tendon if it hurts?

For mid-portion Achilles tendinopathy, gentle calf stretching is usually fine. For insertional Achilles tendinopathy, aggressive stretching into dorsiflexion can make things worse by compressing the tendon at the heel. Keep stretching gentle, and avoid any position that reproduces your pain.

How do I know if my Achilles is getting worse?

Watch for these warning signs: pain during running that increases rather than settles as you warm up, symptoms that take longer than 48 hours to settle after each run, and an overall trend of worsening pain week on week. Also watch for any sudden sharp pain, swelling, or inability to push off your toes, all of which need urgent assessment.

Can I cross-train instead of running with Achilles tendinopathy?

Absolutely, and I often recommend it. Swimming and cycling are low-load options that maintain cardiovascular fitness without stressing the Achilles. Pool running (aqua jogging) is particularly useful as it mimics running mechanics without the impact. Avoid rowing machines and the elliptical if they reproduce your Achilles pain.

The Bottom Line

Can you run with Achilles tendinopathy? In many cases, yes. But it has to be a smart, monitored approach, not a "grit your teeth and push through it" strategy. Those two things are very different.

Use the 24-hour rule. Track your pain on a scale. Watch the week-on-week trend. Modify your training load. Do your calf strengthening work consistently. And be honest with yourself about whether things are actually improving.

Achilles tendinopathy responds well to the right treatment. The runners who struggle most are the ones who either stop everything and wait, which doesn't work, or who ignore the warning signs and keep hammering the miles, which makes things significantly worse. The sweet spot is in the middle: managed, progressive loading alongside targeted rehab. That's the approach that gets runners back to full training fastest, and it's the approach I come back to every single time.

If you're unsure where your symptoms sit, or things aren't improving after two to three weeks of self-management, please see a sports physiotherapist. A proper assessment will save you months of frustration. And before your next run, it's worth reading my guide on Achilles tendon warning signs so you know exactly what to look out for.