How Milwaukee Runners Can Overcome Achilles Tendinitis and Get Back to Peak Performance

Introduction

Achilles tendonitis occurs in up to 19% of athletes year round. The Achilles tendon is responsible for storing and releasing up to 35% of our total work when running. This high workload makes this injury very common in runners and can prevent runners from performing at their highest potential. 

1 in 5 people with Achilles tendinopathy experience persistent pain. It is important to seek proper treatment if you are having Achilles tendon pain as tackling your pain earlier on can result in a more successful rehab process. 

This guide is made to give Milwaukee-area runners a better understanding of the potential causes of Achilles tendon pain, help you decide when to get professional help, and provide you with research backed rehabilitation strategies to get you back on track as soon as possible!

Understanding Achilles Tendinitis & Tendinopathy

There are 2 different types of Achilles tendinitis. The most common type is called mid-substance Achilles tendinitis. This is inflammation in the mid section of the Achilles tendon and is normally due to overuse and excessive stretching of the tendon. The second type is insertional Achilles tendinitis. People with this type of tendinopathy will likely have pain on or around the heel bone where the Achilles tendon inserts. Insertional tendinopathies are often caused by prolonged compression of the tendon, for example wearing shoes that are too tight. 

Common Causes

Achilles tendinitis is most common in males and older athletes due to the loss of tendon stiffness as we age. It is also common in runners who are performing more speed or hill work due to the higher requirement of tendon strength when training this. Other risk factors include low calf strength, previous history of Achilles tendinitis, current change or increase in training loads or recent change in footwear. 

Symptoms to Watch For

Symptoms include pain or around the Achilles tendon, ankle stiffness and difficulty with running, walking or jumping.

Rehabilitation Strategies for Achilles Recovery

So what do we do if we’re experiencing this pain?

1. Load Management & Activity Modification

• Complete rest isn’t the answer but adjusting training volume is crucial.
  • The first thing to consider is load management and activity modification. Tendons are responsible for storing and releasing energy, especially with faster running and explosive activities. Therefore, tendons do not respond well to rest. In fact, resting will only delay your progress. Finding the right balance between strengthening exercises and modifying certain activities or adjusting activity levels is key to a proper recovery. 
• Modify running intensity, frequency, and surface to reduce strain.
  • When thinking about making adjustments to your training plan, you want to think about what causes the most strain. The most strain is put on our calf muscles and our Achilles tendon when we run fast and when we run uphill. With that being said, running on even surfaces or downhill and slowing down our running speed can help reduce strain. Adjusting frequency and duration of running is also helpful. 
• Consider alternative cardio options like cycling or swimming to maintain fitness.
  • Because we may be reducing our training, it’s important to maintain our fitness and aerobic capacity. Options like cycling, swimming, rowing, and elliptical can be good options to keep up with fitness levels while decreasing load on your Achilles tendon. Keeping up with your aerobic capacity will make your transition back into full running go much more smoothly. 

2. Strengthening the Achilles & Lower Leg Muscles

As stated previously, tendons respond well to load. However, we want to gradually and methodically introduce load in order to avoid further irritation and inflammation. 

• Isometric Exercises: Static holds to reduce pain.
• Isometric exercises or static holds are a great place to start when we are trying to reduce Achilles tendon pain. Research shows that performing isometric exercises for 5 sets of 45 seconds will provide pain relief. 
  • Double leg heel raise iso
  
  
  • • Double leg soleus heel raise iso 
      

• Eccentric Strengthening: Slow, controlled heel drops to promote tendon remodeling.
  • Once the isometric exercises have done their job, you want to try to start strengthening through a full range of motion as soon as possible. Tendons respond the best to heavy, slow movements. A great exercise to start with is heel raises. The further up on your toes, the more stress on your tendon. Try to start on a step and only go up to neutral or as far as your pain will allow. It’s important to note that a 2-3/10 on the pain scale is OK. Anything past that and you are doing more harm than good!
    • Double leg heel raise on step 
• Progressive Loading: Gradually increasing resistance with weighted calf raises.
  • Ultimately, our goal is to continue to gradually increase the load that we are placing on our calf and achilles tendon to prepare you for the high demand of your activities. To do this, you can increase the range of motion, weight, or move to single leg focused calf raises. 
    • Single leg heel raise on step 
      

3. Mobility & Soft Tissue Work

• Importance of ankle dorsiflexion and calf flexibility.
  • Our ankle joint mobility also plays an important role in rehabbing achilles tendonitis. Without adequate ankle mobility, we won’t be able to move through a full range of motion at the ankle. Therefore, it’s going to be harder to strengthen your calf muscles in rehab. Ensuring that you have optimal ankle mobility will allow you to get stronger and help you be successful in rehab. 
• Foam rolling and self-massage techniques.
  • Tightness in your calf may be contributing to decreased ankle mobility. Foam rolling your calves can be a great way to decrease tension at home. Try finding one spot that is sore and sinking into that spot with the foam roller, rather than continuously rolling back and forth over your calf. 
    

4. Footwear 

• Improper shoes can contribute to Achilles issues.
  • Shoes that have a rigid heel counter could be playing a role in your Achilles tendon pain, specifically if you are experiencing insertional tendinopathy. The heel counter is a U-shaped piece of either plastic or cardboard that wraps around your heel. It provides stability and support. However, if it’s too rigid or just not the right fit for you, it may be time to look for another shoe. 
• Recommendations for supportive footwear or orthotics.
  • When reducing strain on the achilles, a good, temporary option is a heel lift, foot inserts, or wearing a high-drop or rocker-soled shoe. Making these small adjustments have been shown to reduce loads on the achilles by 10-15%. 

5. Advanced Rehab & Performance Optimization

• Plyometric drills to rebuild explosive strength.
  • Towards the end stages of your rehab, it’s important to challenge the elastic properties of the achilles tendon. Like stated earlier, the achilles tendon is responsible for storing and releasing up to 35% of our energy when running. Therefore, we need to train those elastic properties in order to prepare for the demands of running. Plyometrics are the key to training our tendons in this way. Plyometrics are defined as exercises that include the full stretch-shortening cycle. Examples of these include different variations of pogo hops, depth drops, and squat jumps. 
    
    
    
    
    
• Speed and agility work to ensure full recovery.
  • When thinking about the demands of running, typically runners are only moving in one direction. Therefore, you want to train in that specific direction. However, specifically for trail runners or court athletes, there is a high demand for tolerance in multiple directions. It’s important to add in lateral and rotational components of training as well as more challenging workouts like hills and speed days.
• Strength and conditioning strategies to prevent recurrence.
  • As with anything, if you don’t use it, you lose it. The same goes for managing your achilles tendonitis. It’s crucial to continue to progress your strength and conditioning in order to prevent future occurrences. 

Training Around Achilles Tendinitis: How to Keep Running Without Making It Worse

One of the biggest fears for runners dealing with Achilles Tendinitis is losing fitness. The good news? You don't necessarily have to stop running entirely! With the right approach, you can often continue training while managing symptoms and progressing through rehab.

1. Modify, Don’t Eliminate Running

Like we stated earlier, stopping all activity can actually make the tendon weaker and prolong recovery. Instead, focus on reducing the load on the Achilles while maintaining as much of your running routine as possible.

• Reduce Volume & Intensity: Instead of high-mileage weeks, focus on shorter, controlled runs. Avoid speed work and hill training, as these increase tendon stress.
• Switch to Softer Surfaces: Running on grass, trails, or treadmills can help reduce impact forces.
• Incorporate a Run-Walk Strategy: If pain is persistent, use a structured approach like 3 minutes running/1-minute walking to allow for tendon recovery.
• Adjust footwear: as described above, temporarily running in a high-drop or rocker soled shoe will help temporarily decrease tendon stress.

2. Adjust Running Form & Biomechanics

Certain running mechanics place more stress on the Achilles. Making small adjustments can allow you to continue training with less strain.

• Increase Cadence: Increasing your cadence by only 10% can make a huge impact on Achilles forces.
• Shortened Stride Length: Over-striding puts excessive tension on the Achilles tendon. A shorter, quicker stride can help. 
• Avoid Excessive Toe Push-Off: If you tend to rely on a strong toe-off, try running with a more even foot strike to offload the Achilles.

3. Monitoring Symptoms & Knowing When to Pull Back

While you can keep training, it's crucial to monitor symptoms and adjust accordingly. 

• Use the Pain Scale: A mild level of discomfort (2-3 out of 10) during or after running is typically okay, but pain above this means you need to modify or rest.
• Watch for Morning Stiffness: If Achilles stiffness worsens in the morning, it may be a sign you need more recovery.
• Tendon Response Time: Pain that lingers for more than 24 hours post-run suggests overloading and a need for further adjustments.

Final Thoughts: Train Smart, Not Reckless

As explained in this article, with the right modifications, most runners with Achilles tendinitis don't need to stop running altogether. The key to successful rehab is strategic adjustments that allow the tendon to heal while maintaining fitness and progressively loading the Achilles tendon and calf muscle. However, if symptoms persist despite modifications, it's important to consult a performance physical therapist to develop a structured rehab plan that will get you back to your goals.

When to Seek Professional Help

If you are not having success on your own, we find that the best results are experienced when you are assessed and treated for your specific needs by a Doctor of Physical Therapy.

If you are in pain and need support, we are here to help you understand what is causing your pain, get you out of pain and get back to the things you love pain-free. If you would like to learn more, call us to book an injury consultation call or a visit with one of our Doctors of Physical Therapy today!