Achilles Tendinopathy: Running Back to Full Load

Achilles tendinopathy is the most common lower limb tendinopathy in runners. The classic presentation is stiffness and pain around the tendon in the first few steps in the morning, improving with walking, then flaring again during or after a run. If this sounds like you, the good news is that most cases respond well to a structured loading program.

Mid-portion vs. insertional

There are two distinct types of Achilles tendinopathy and they behave quite differently. Mid-portion tendinopathy (pain 2-6cm above the heel bone) responds well to heavy slow resistance and eccentric loading. Insertional tendinopathy (pain right at the heel bone attachment) is more sensitive to compressive load - particularly the ankle in dorsiflexion - and eccentric drop exercises can aggravate it. Knowing which you have changes the program.

Phase 1: Isometric loading (Weeks 1-2)

Isometric calf holds - standing on the affected leg, rising onto the ball of the foot and holding for 45 seconds - reduce tendon pain in the short term and provide safe early loading. Perform four to five repetitions, twice daily. These can be done even on running days.

Phase 2: Heavy slow resistance (Weeks 2-8)

Progress to weighted heel raises on a step. The key is slow speed - three seconds up, three seconds down - and meaningful load. Use a backpack with weight or a dumbbell held in one hand. Aim for 3 sets of 15, progressing to 3 sets of 6 with heavier load over the eight-week period.

Phase 3: Energy storage - plyometrics and running (Weeks 8+)

Running and jumping require the tendon to store and release energy rapidly - a different demand to slow resistance work. Progress from double-leg hopping to single-leg hopping, then to skipping and bounding before reintroducing running. Return to running progressively: walk-run intervals, then easy running, then pace work.

The total timeline to return to unrestricted running is typically three to four months. Tendinopathy is slow to respond, but it does respond to consistent, well-dosed loading.