Pain in the Achilles tendon does not automatically mean several weeks without running. Continuing exactly the same programme while the pain climbs each week is not a good plan either. The aim is to match running and strengthening load to the tendon’s current capacity.
Midportion and insertional tendinopathy are different
“Tendinopathy” is more useful than “tendinitis” for many longer-lasting cases. Pain can be in the middle of the tendon or at its insertion on the heel. That distinction affects exercise selection: compression against the heel in deep ankle dorsiflexion can matter more for an insertional problem. A sudden snap and loss of push-off require urgent assessment for a possible rupture.
Loading usually matters more than complete rest
The 2024 midportion Achilles guideline puts progressive tendon loading at the centre of care. A review comparing loading programmes did not find one universally superior exercise format. Eccentric exercises, mixed exercises and heavy slow resistance are possible approaches, chosen according to the person and the response.
A recent randomised trial in insertional tendinopathy found better results when a programme initially limited tendon compression, including deep dorsiflexion, while loading was progressively rebuilt. That finding should not be applied unchanged to all Achilles pain.
Can running continue during rehabilitation?
Often yes, with temporary adjustments. Look for recent changes in mileage, hills, intervals, fast sessions or return after time off. Keep the dose that produces a manageable response during the run and afterwards, then gradually increase. Pain the following morning and changes in function are useful signals. A substantial or persistent increase means modifying the plan.
There is no universal pain number or week-by-week progression that fits every runner. Our article on building running volume explains why training changes should be considered together.
The calf needs more than pain relief
- Strengthen with the knee straight and bent to train calf and soleus.
- Progress load, endurance and contraction speed to match the running task.
- Reintroduce springing, hills, fast running and jumping gradually as capacity returns.
Symptoms can improve before the tendon has recovered full sporting capacity. Sports physiotherapy in Basel and endurance physiotherapy can help plan the return to running. Book an appointment.
Frequently asked questions
Can I keep running with Achilles tendinopathy?
In many cases, yes, if load is adjusted and the tendon’s response during and after running is monitored. The type of tendinopathy and current capacity matter.
Are eccentric exercises mandatory?
No. Different progressive strengthening programmes can work, including eccentric exercise and heavy slow resistance.
How long does recovery take?
There is no fixed timeline. Pain can settle before the tendon is ready for sprints, hills and jumps; progress those loads according to function.
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