Author
Ellesse Newman
MSK Physiotherapist
Training for a Race? Don’t Ignore Achilles Pain
Whether you’re training for your first 5K or preparing for your next marathon, Achilles pain can quickly disrupt your progress. It often starts as mild stiffness first thing in the morning or a slight ache during the first few minutes of a run. Many runners dismiss it as “just a niggle”, hoping it will settle on its own. Unfortunately, that’s not always the case.
A large prospective study found that around 1 in 25 recreational runners developed Achilles tendinopathy over a five-month period.¹ Recognising the early signs and seeking advice when symptoms persist may help prevent a minor problem from becoming more difficult to manage.
The Achilles tendon is the largest and strongest tendon in the body, connecting your calf muscles to your heel bone. Every time you walk, run or jump, it stores and releases energy to help propel you forwards.
Achilles tendinopathy occurs when the tendon is no longer able to tolerate the demands placed upon it. Rather than resulting from one specific injury, symptoms usually develop gradually over time and are often influenced by several factors.
What does Achilles tendinopathy feel like?
Symptoms vary from person to person, but common features include:
If these symptoms sound familiar, it’s worth addressing them early rather than hoping they’ll disappear.
There is rarely one single cause. Instead, Achilles tendinopathy is thought to develop when the demands placed on the tendon exceed its current capacity to tolerate and recover from loading.Factors that may contribute include:
Busy professionals often balance training around long working days, commuting and family commitments. When recovery doesn’t keep pace with training, the tendon may become less able to tolerate repeated loading.
Common misconceptions
“I need to stop running completely.”
Not necessarily. Many runners with Achilles tendinopathy can continue running with appropriate modifications to their training. The goal is to reduce excessive tendon load—not always to stop running altogether. A physiotherapist can help you adjust your training while your tendon recovers.²
“If my Achilles feels better once I’ve warmed up, it’s fine.”
This is known as the warm-up phenomenon. Tendon pain commonly eases as you continue moving, but that doesn’t necessarily mean the tendon has recovered. If pain consistently returns after your run or is worse the following morning, it may be a sign the tendon is still being overloaded.
“Stretching is all I need.”
Stretching may help some people, particularly if calf flexibility is limited, but it’s unlikely to be enough on its own. Current clinical guidelines recommend progressive tendon-loading exercise, alongside appropriate load management, as the cornerstone of rehabilitation for midportion Achilles tendinopathy.²
What does Achilles tendinopathy feel like?
Achilles pain isn’t always a short-lived problem.
Research has shown that around one-third of runners with newly developed Achilles tendinopathy still reported symptoms one year later.³ While many continued to run, persistent symptoms highlight the importance of recognising Achilles pain early and addressing it appropriately.
When should you seek advice?
Consider seeing a physiotherapist if:
Early assessment can help identify the factors contributing to your symptoms, guide an appropriate rehabilitation programme and support a safe return to running.
Achilles pain is one of the most common injuries affecting runners, but it doesn’t have to mean the end of your training. Recognising the early signs, modifying your training appropriately and starting the right rehabilitation early can often help you continue working towards your running goals while reducing the risk of longer-term symptoms.
If you’re training for your next event and Achilles pain is beginning to interfere with your progress, seeking professional advice early can help you return to running safely and confidently.
Lagas IF, Fokkema T, Bierma-Zeinstra SMA, Verhaar JAN, van Middelkoop M, de Vos RJ. How many runners with new-onset Achilles tendinopathy develop persisting symptoms? A large prospective cohort study. Scandinavian Journal of Medicine & Science in Sports. 2020;30(10):1939–1948. doi:10.1111/sms.13760.
Chen W, Cloosterman KLA, Bierma-Zeinstra SMA, van Middelkoop M, de Vos RJ. Epidemiology of insertional and midportion Achilles tendinopathy in runners: a prospective cohort study. Journal of Sport and Health Science. 2024;13(2):256–263. Doi:10.1016/j.jshs.2023.03.007.
Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL. Achilles pain, stiffness, and muscle power deficits: midportion Achilles tendinopathy revision 2024. Journal of Orthopaedic & Sports Physical Therapy. 2024;54(12):CPG1–CPG32. Doi:10.2519/jospt.2024.0302.
