Back in 2007 when I first stared treating running injuries as a newly qualified therapist, I wasn’t clear on when runners with achilles tendonitis should stop running to let the tendon heal, and when they could continue to run. Subsequent years of experience in treating achilles tendon injuries has taught me this:
In many cases of achilles tendonitis you will be able to continue running, as long as your achilles pain follows a predictable pattern of easing within days of running. If your symptoms begin to worsen over time, you must rest from running to allow time for your achilles tendon to heal properly.
In this article, I’m going to answer the inevitable question that most runners will have following a diagnosis of achilles tendinopathy:
“Is it OK to keep running with achilles tendonitis?”
Note: Achilles tendonitis is a more widely used term for what we should really be referring to as achilles tendinopathy (here’s why). For the sake of this article, I’ll be referring to achilles tendonitis, as it’s the more widely used term in the running community!
The answer to this question is different for each runner and can be found by assessing the severity, irritability and nature of your achilles pain. It’s most important to identify the pattern that your achilles tendonitis symptoms take in the next few days after you run.
Let me explain…
Build Strength to Prevent Achilles Pain >>
Free Workouts [PDF]
Running with Achilles Tendonitis
Tendinopathy (tendon injuries) can be broadly categorised as either being in a reactive or degenerative stage.
Identifying and understanding which stage your achilles tendon injury is in will play a huge role in determining:
- if you can continue to run through your achilles tendonitis without doing further damage to the tendon tissue
- how you need to manage your achilles tendon, and what treatment you may need
Take a moment to consider which of the following descriptions your achilles tendon pain sounds most like…
Reactive tendinopathy
Also sometimes referred to as “early dysrepair”. They typically occur in response to a sudden acute increase in training load (mix of volume, frequency and intensity of your running).
If you have a reactive achilles tendinopathy, you will most likely feel pain when you begin running, which will then ease as the run progresses. You will then experience achilles pain after your run which should ease throughout the following few days.
These achilles tendonitis symptoms should follow a predictable pattern, with your achilles pain getting no worse than 3/10 on a pain scale, where 10 is the worst pain you can imagine.
Degenerative tendinopathy
Also sometimes referred to as “late dysrepair”. This type of achilles tendon injury is more commonly seen in older runners, and occurs in response to chronic overtraining.
Degenerative achilles tendinopathy is a more serious injury as it involves structural changes to the achilles tendon tissue. These structural changes limit the tendon’s capacity to tolerate load.
In addition to the more sustained achilles pain that tends to get worse over time, rather than following a predictable pattern of flaring-up then easing after running, you may also notice thickening of the achilles tendon tissue.
If left untreated, a degenerative achilles tendon is at more risk of total rupture as the condition advances.
Key point: It is vitally important to appreciate the fact that a case of achilles tendinopathy can begin in the reactive stage, and over time move into the degenerative stage.
The following simple guidelines will help you to decide whether or not you should run with achilles tendonitis…
When is it OK to run with achilles tendonitis?
If your achilles tendon is in the reactive stage of tendinopathy, and is following a predictable pattern of flaring-up then easing after running, continuing to run should be possible.
While you are able to keep your achilles pain to a level of 3/10 or below, and your achilles symptoms continue to subside quickly in the first day after running, you should be able to adapt your training plan to accommodate this pattern.
However, if your achilles pain begins to become more severe, and/or it takes longer than usual for your pain to ease after running, you MUST NOT ignore these signals.
These are warning signs that you are pushing your injured tendon too hard and that you are edging towards the degenerative stage of achilles tendinopathy.
That’s not something you want. Trust me!
If that happens, be sure to take two weeks rest from running and seek advice from your physio.
Here’s a great video from physio Maryke Louw that will help to explain further:
Pushing through achilles tendinopathy symptoms which seem to be worsening ultimately leads you into the degenerative phase of achilles tendinopathy, which will be harder for you to recover from.
When must you stop running with achilles tendonitis?
You must take a break from running, and speak to your physio in the following situations:
- Your achilles pain exceeds 3/10 on a pain scale
- The achilles tendonitis symptoms seem to be getting more severe over time
- It seems to be taking longer for your painful flare-ups to ease after running.
- You notice thickening of your achilles tendon tissue
These are all signs that you are moving towards the degeneration phase of achilles tendinopathy.
At this point, your best option is to rest from running and focus on achilles rehab exercises than your physio will give you.
There are some examples of such exercises and self-treatment techniques later in this article…
When your physio gives you the green light to start running after achilles tendonitis, be sure to take it slowly. Remember, overload of the achilles tendon was part of the issue in the first place.
While loading is a critically important aspect of all tendon rehab, increases in loading need to be applied gradually to give your body (and the tendon specifically) time to adapt.
Feel free to use this free return to running training plan to guide your training as you return to running after achilles tendonitis:
Return to Running After Achilles Tendinopathy >>
Free Download [PDF]
How to Modify Your Running Plan for Achilles Tendinopathy
If you’ve come to the conclusion that what you’re dealing with is a reactive achilles tendinopathy, and that you want to continue running while receiving regular physio treatment, there are a few things to consider.
In most cases a few tweaks to your running training plan will make it much easier to accommodate the flare-up and easing cycle that a reactive tendon will display in response to running.
For example, if you’re currently running 5-days per week, you may want to consider reducing your weekly running frequency to 3-days per week and incorporating 2-days of low-impact cross training such as cycling, rowing or aqua-jogging.
Doing so will allow you to avoid running on consecutive days. This will allow your achilles tendon to recover more effectively between runs, so that you’re not compounding the effect of loading it on back-to-back days.
Generally speaking, I find that achilles tendinopathy clients who switch to doing their intense workouts (track interval sessions, or mile reps for example) on the bike/rower tend to be able to maintain their fitness well.
This will leave you to focus on continuing to progress your weekly long run and other easy midweek runs with lots of recovery time in between runs.
What Can You Do for Faster Recovery from Achilles Tendinopathy?
As with most running injuries, there are plenty of ways you can help yourself on the road to recovery.
Of course, it’s always important to consult a physiotherapist. However here are some options you may want to consider.
1. Achilles Tendon Rehab Exercises
When it comes to exercises for achilles tendonitis, eccentric heel drops off a step have become the staple of many exercise-based rehab programmes.
Learn more about this achilles rehab protocol in the following video:
The goal with these heel drops is to progressively load the achilles tendon to stimulate the body’s own helping response.
It’s important to understand that this particular achilles rehab exercise will probably cause some pain. This is normal, but be sure to monitor the situation as the pain shouldn’t get worse over time.
Again, if in doubt, ask your physio!
Build Strength to Prevent Achilles Pain >>
Free Workouts [PDF]
2. Soft Tissue Techniques for Achilles Tendinopathy
A simple self-massage treatment you can do at home is to work on the tissue health of your calf muscles. After all, tight calves can be part of the underlying problem when it comes to achilles tendonitis.
Here’s a simple calf foam rolling video you can follow at home:
You don’t need to foam roll the painful area of your achilles. Instead focus your attention on the calf muscles of the lower leg.
3. Running Shoes for Achilles Tendinopathy
The internet is full of conflicting advice when it comes to deciding on the best running shoes for achilles tendonitis. Different voices suggest everything from “barefoot style” running shoes, through to maximalist options like Hokas.
Ultimately you need to find a shoe that’s comfortable for you… which I know sounds like a massive cop-opt!
However, the “comfort filter” has been proposed as a more valid way of selecting running shoes from an injury prevention perspective, compared to the traditional means of selection based on support levels.
There’s a good argument for choosing a shoe with a significant heel-to-toe drop (10-14mm), as this drop will help to reduce loading of your achilles tendon, particularly into ankle dorsiflexion.
Even if you feel more comfortable in zero-drop running shoes, it is still possible to insert heel lifts to achieve the same effect in the short term, as this video explains:
Improve Your Running Technique to Prevent Achilles Tendinopathy
Your running technique can also play an important role in why your achilles tendon was overloaded in the first place.
As described in the video below, your achilles is affected by much more than simply how your foot strikes the ground. Your running posture, tightness around your hips and where you derive your propulsive “push” from as you run will all affect the loading of your achilles and calf complex as you run.
In my experience, there are two common running techniques which place excessive demand on the calf complex and achilles tendon:
- Aggressive forefoot running: While this is completely appropriate for sprinting and middle distance running, many long distance runners who adopt a pronounced forefoot running style tend to suffer from chronically tight calves and achilles tendon injuries.
- Poor hip mobility and glute function: Much of the propulsive force which drives us forward when we run should come from the big hip extensor muscles, your gluteus maximus and hamstrings. When hip mobility into extension is poor, and these key muscles are weak or inhibited, we revert to pushing-off at the ankle, using our plantar flexor muscles (calves). This places an increased load on the calf muscles and achilles tendon, which over time can result in calf injuries and/or achilles tendinopathy.
It is possible to change your running technique over time, with a focused approach. In fact, doing so when you’re coming back from injury and not focused on preparing for an event is a great time to do so!
The article linked below further details the link between tight hips and calf / achilles injuries in runners, and gives you detailed steps for how to fix these problems in your running form:
