By: Brian Wolfe, PT, DPT, OCS
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Achilles tendinopathy is one of the most common overuse injuries seen in runners. It can be frustrating because it often starts as a mild annoyance but gradually progresses into a stubborn injury that affects every run, every hill, and sometimes even your first few steps out of bed in the morning.
Unlike an Achilles tendon rupture, which occurs suddenly and is often accompanied by a “pop,” Achilles tendinopathy develops over time. Repeated stress placed on the tendon exceeds its ability to recover, leading to pain, stiffness, and decreased performance. This is why it is particularly common in runners, field sport athletes, and active adults who increase their training volume, intensity, or frequency too quickly.
The hallmark symptom of Achilles tendinopathy is pain and stiffness along the tendon, typically just above the heel bone. Many runners notice increased discomfort first thing in the morning or during the first few minutes of a run. Interestingly, symptoms often improve as the body warms up, only to return later in the day or after activity.
One of the biggest mistakes people make when treating Achilles tendinopathy is avoiding loading the tendon altogether. Rest may temporarily decrease symptoms, but it does little to improve the tendon’s capacity to handle stress. Just like any tendon injury, the key to recovery is simple:
You need to “load the tissue with the issue.”
Too often, runners focus exclusively on stretching, foam rolling, massage guns, or buying new shoes while neglecting the one thing that actually helps the tendon adapt: progressive strengthening.
While eccentric exercises became popular for Achilles tendinopathy years ago, current research suggests that the most important factor is progressive loading of the tendon over time, not simply performing eccentric exercises alone. The Achilles tendon responds best when it is gradually exposed to increasing amounts of load and stress.
Below is a simple Achilles tendon loading progression that we commonly use with runners struggling with Achilles tendinopathy.
Step 1: Seated Calf Raises
Before progressing to higher-level loading exercises, we need to build strength in the soleus muscle. The soleus sits underneath the larger calf muscle (gastrocnemius) and plays a major role in running, walking, and absorbing force through the Achilles tendon.
Seated Calf Raises
(3 sets x 12-15 reps)
Sit with your knees bent to approximately 90 degrees and perform calf raises through a full range of motion. Focus on a controlled movement and gradually increase the weight over time.
Many runners are surprised by how weak they are in this position. Improving soleus strength often reduces stress on the Achilles tendon and improves running performance.
Step 2: Eccentric Calf Raises on a Slant Board
The Achilles tendon responds exceptionally well to loading through a full range of motion. Performing calf raises on a slant board increases the range available at the ankle and challenges the tendon through a greater excursion.
Eccentric Calf Raise on Slant Board
(3 sets x 12-15 reps)
Stand on a slant board with both feet. Rise up onto your toes using both legs, then slowly lower yourself down over 3-5 seconds. Focus on controlling the descent and allowing the heel to drop below the forefoot.
The goal is not simply movement; it is progressively increasing the tendon’s tolerance to load.
Step 3: Bilateral Up, Single-Leg Down Calf Raises
As symptoms improve, we can increase the demand on the injured side.
Bilateral Calf Raise with Single-Leg Eccentric Descent
(3 sets x 8-12 reps)
Rise up onto your toes using both legs. Shift your weight onto the affected side and slowly lower down over 3-5 seconds.
This exercise increases load through the injured tendon while still allowing assistance from the uninvolved side during the lifting phase.
Don’t be afraid to add weight as you improve. One of the most common mistakes runners make is stopping at bodyweight exercises. Tendons need progressively greater loads to continue adapting.
Step 4: Pogo Hops
Running requires the Achilles tendon to store and release energy like a spring. Once the tendon is tolerating strengthening exercises well, we need to expose it to more dynamic and elastic loading.
Pogo Hops
(3 sets x 20-30 seconds)
Perform quick, rhythmic hops while staying tall and spending minimal time on the ground. Focus on using your ankles like springs rather than generating movement from your knees.
These exercises help prepare the Achilles tendon for the repetitive demands of running, sprinting, and jumping activities.
Returning to Running
The good news is that many runners can continue running while recovering from Achilles tendinopathy, provided symptoms are managed appropriately and training loads are modified when necessary.
A mild increase in discomfort during exercise is often acceptable, but pain should not progressively worsen throughout a run or remain significantly elevated the following day. As a general guideline, pain should remain mild and return to baseline within 24 hours.
If you can tolerate these strengthening exercises and your symptoms are steadily improving, you are likely ready to begin a structured return-to-running progression.
Remember, the goal is not simply to make the pain disappear. The goal is to build an Achilles tendon that is strong enough to tolerate the demands of running again.
If your Achilles pain continues to linger despite your best efforts, don’t ignore it. Tendon injuries rarely disappear on their own, but they often respond very well to the right loading program.
If you’re struggling with Achilles pain, schedule an appointment with one of our physical therapists. We’ll identify the cause of your symptoms, create a personalized rehabilitation plan, and help you get back to running without pain.
For more running injury prevention tips and exercise progressions, check out our other running-related articles and resources on Evolution Physical Therapy & Fitness.
