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Your Achilles tendon has a very specific way of entering a conversation. Usually first thing in the morning.
You get out of bed, take three innocent steps towards the kettle, and suddenly the back of your ankle feels like it has aged forty years overnight.
Then something strange happens. You walk around a little, it warms up, and the discomfort improves.
Excellent, you think. Fixed. Then you run that afternoon, and it comes back.
Achilles tendon pain can be frustrating precisely because it does not always behave like a straightforward injury. It may feel stiff after rest, loosen as you move and become uncomfortable again after activity. For runners and active people, that can make it very tempting to either ignore it completely or stop exercising altogether.
Neither extreme is always helpful.
What is the Achilles tendon?
The Achilles tendon is the thick tendon connecting the calf muscles at the back of your lower leg to your heel bone.
Every time you walk, run, jump or rise onto your toes, it helps transfer force from the calf to the foot.
So yes, it has a fairly busy job.
Tendons are designed to deal with load. They also adapt to the demands you place on them. Problems can develop when those demands suddenly become greater than the tendon is currently prepared to handle.
That is one reason Achilles tendon pain often appears after a change in activity rather than after one obvious injury.
Why does Achilles tendon pain happen?
A sudden increase in training is a common culprit.
Perhaps you went from running twice a week to preparing for a half-marathon. Maybe you introduced hills, speed sessions or longer weekend runs at the same time.
Perhaps you returned to exercise after a break and picked up roughly where your fitter former self left off. Your cardiovascular fitness may remember. Your tendon may have other opinions.
Other contributing factors can include changes in training surface, repeated jumping, reduced ankle or calf capacity and a workload that has increased faster than the body has adapted.
Sometimes there is no single dramatic moment. The tendon simply becomes increasingly irritated over time. This is commonly referred to as Achilles tendinopathy.
What does Achilles tendinopathy feel like?
Common symptoms can include:
- Pain or stiffness at the back of the ankle
- Morning stiffness
- Pain when beginning to walk after sitting for a while
- Tenderness when touching the tendon
- Pain during or after running
- Discomfort when climbing stairs
- Pain when rising onto your toes
- Swelling or thickening around the tendon
Some people find that Achilles tendon pain improves once they start moving.
That does not necessarily mean the problem has disappeared.
A tendon can “warm up” during activity and feel temporarily better, only to become more uncomfortable afterwards or the following morning. This pattern is useful information when deciding how much activity your tendon is currently tolerating.
Why does complete rest not always solve it?
When something hurts, resting it makes perfect sense. And in the short term, reducing painful activity can be helpful. The issue is what happens next.
If you completely stop loading the tendon for an extended period, symptoms may settle because you have removed the activity that aggravates it. But the tendon has not necessarily rebuilt its capacity to tolerate running, jumping or other demanding movement.
Then you return to your usual training.
Hello again, Achilles.
This is why rehabilitation for ongoing Achilles tendon pain often involves relative rest rather than total rest.
Relative rest means reducing or temporarily changing the activities that provoke symptoms while continuing with movement that is better tolerated.
For a runner, that might mean temporarily reducing mileage or pausing hills and speed work while maintaining fitness through an alternative such as cycling or swimming, if comfortable and appropriate.
The details depend on the injury.
So should you exercise a painful Achilles tendon?
Often, rehabilitation includes progressive strengthening. The key word is progressive.
Not “find the hardest calf exercise on the internet and prove a point”.
Strengthening exercises can gradually expose the calf and tendon to increasing load, helping rebuild capacity over time. Depending on the stage and location of the problem, exercises may include variations of calf raises performed with different loads, speeds and knee positions.
The appropriate programme varies from person to person. It is also normal for tendon rehabilitation to take time. This is not usually a three-days-and-back-to-sprints situation.
Recovery may involve weeks or months of gradually rebuilding strength and tolerance.
How do you know whether you are doing too much?
Your symptoms can provide clues.
Pay attention not only to how your Achilles feels during exercise, but also afterwards and the following morning.
Imagine you complete a run and it feels manageable. Great. But the following morning, your usual slight stiffness has turned into significant pain, and you are limping to the bathroom.
That response matters. A noticeable increase in symptoms after activity may indicate that the tendon was asked to handle more load than it could currently tolerate.
Keeping a simple training and symptom log can help.
Record:
- What activity you did
- Approximately how much
- Pain during the activity
- Symptoms later that day
- Morning stiffness the next day
You do not need to become the accountant of your own ankle. A few notes are enough to help identify patterns.
Should you stretch an Achilles tendon?
This depends on what is causing the pain and where the symptoms are located.
Stretching is often treated as the universal answer to anything that feels tight. Sometimes it is useful. Sometimes aggressive stretching simply adds more irritation. Pain close to where the Achilles attaches to the heel, for example, may respond differently to certain movements than pain higher up the tendon.
This is another reason an assessment can be useful when Achilles tendon pain is persistent. Instead of guessing whether you need more stretching, more strengthening or less running, you can establish what you are actually dealing with first.
Do you need different running shoes?
Maybe. But shoes have developed an impressive reputation for being blamed for almost everything.
Changing footwear can alter the load placed on your feet and lower legs, and supportive shoes may make some people more comfortable during recovery. But simply buying a new pair does not address every possible cause of Achilles tendon pain.
Look at the bigger picture.
Have you suddenly increased mileage? Added more hill running? Returned after a break? Changed several parts of your training programme simultaneously?
Often the recent training story is more useful than the logo on the side of your shoe.
When should Achilles tendon pain be assessed?
Consider an assessment if:
- The pain persists despite reducing aggravating activity
- Symptoms keep returning when you resume exercise
- Morning stiffness is becoming more noticeable
- The tendon appears swollen or thickened
- Running or walking is increasingly uncomfortable
- You are changing the way you walk because of pain
- You are unsure how to modify your training safely
- The problem is preventing you from returning to your usual sport
An assessment can help distinguish common tendon overload from other causes of pain around the heel and ankle.
It can also give you a more structured way to return to activity rather than alternating between doing absolutely nothing and testing the tendon with a 10 km run every second Saturday.
When could it be an Achilles rupture?
Not all Achilles tendon pain is gradual.
A rupture is different and needs prompt medical attention.
Seek urgent assessment if you experience sudden pain in the Achilles or calf, particularly if there was a snapping or popping sensation, if it felt as though somebody kicked you in the back of the leg, or if you suddenly struggle to walk, push off the affected foot or rise onto your toes.
Do not test it repeatedly to see whether it is “definitely torn”.
That experiment is unnecessary.
The goal is not simply to make the pain disappear
For an active person, the real goal is usually bigger than being comfortable while sitting at a desk. You want to walk. Run. Train. Hike. Play sport. Climb stairs without negotiating with your ankle first.
Reducing pain matters, but rebuilding the tendon's ability to deal with the activities you want to return to matters too. That usually means managing load, gradually restoring strength and progressing activity according to how the tendon responds.
Rest can be part of that process. It doesn't need to be the entire plan.
If Achilles tendon pain is lingering, repeatedly returning or getting in the way of exercise, contact Fluid Medical to arrange an assessment and discuss an appropriate treatment plan for returning to activity.
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