What to Do When Your Achilles Tendon Hurts

Woman in pain holding her calf.

Do you ever wake up with pain in your Achilles tendons? Or, perhaps when you climb stairs or start your workout? If so, then there is a good chance that, like many runners, you are suffering from what is known as Achilles tendinosis. Achilles tendon injuries – in addition to runner’s knee and shin splints – are one of the most common problems runners experience.

Where do Achilles tendon problems come from?

There are several factors that can lead to Achilles tendon problems. The main function of the Achilles tendon is to bend your foot downwards at the ankle (plantar flexion). This movement is essential for pushing off when walking or running. When you run, your Achilles tendon has to withstand forces several times your own body weight hundreds of times per run. One common cause of Achilles tendon problems is increasing your training volume too much or too quickly. Another reason can be poorly fitting shoes (especially the heel cap). Overly stiff shoes, hip misalignments and overpronation (where the foot rolls inward) can also cause problems. Furthermore, extreme shortening of the calf muscles can also contribute to Achilles tendon issues.

Woman in pain holding her calf.

Typical symptoms

Runners typically feel a painful stiffness of the tendon. The area above the heel is usually extremely sensitive to pressure. The pain often appears upon arising in the morning. At the beginning of a run, the pain can be quite intense. It gets better as the run goes on, before increasing in strength again after the run or in the evening.

Pain that persists for weeks or even months can lead to chronic Achilles tendinosis. At this stage, the tendon has probably already thickened. This chronic inflammation leads to long-term pain. As any stretching of the tendon is very painful, the body reacts by hardening and shortening the calf muscles. This in turn stretches the tendon further and keeps the cycle of pain going.

Pain-free thanks to eccentric strength training

If you have been suffering from Achilles tendon problems for some time, then you should definitely take a break from running. Continuing to run while in pain is not going to make you any stronger or faster. Plus, you run the risk of doing major damage to your Achilles tendon, which can interrupt your training for months. Besides the usual treatment for inflammation, eccentric strength training (lengthening of specific muscles under load) can help ease the pain or even completely eliminate it.

A study published in the British Journal of Sports Medicine demonstrated the positive effects of eccentric strength training. The study examined 26 patients who suffered from Achilles tendinosis. The patients followed a twelve-week training plan in which they did eccentric calf muscle strengthening exercises twice a day. The result was that most of the test subjects were completely pain-free by the end of the program.

But keep in mind that eccentric strength training is only advisable if the tendon is not already showing signs of major damage.

Eccentric strengthening exercises

The inventor of a well-known eccentric training program for Achilles tendon problems is the Swedish doctor Hakan Alfredson. He recommends a daily exercise program for twelve weeks. This includes eccentric calf raises twice a day (3 sets of 15 repetitions), once with your knee straight and the other with it slightly bent to work each of your calf muscles (gastrocnemius and soleus muscles) evenly.

Starting position:

Stand on a step with the balls of your feet on the edge. Lift both of your heels and rise up onto the balls of your feet.

Woman doing eccentric strengthening exercises for her calfs.

How to perform the exercise:

Lift one leg. Lower the heel of your supporting leg in a slow and controlled manner. Go down as far as you can and then use your other leg to help you return to the starting position. Repeat this movement 15 times and then switch legs. You can increase the intensity by wearing a weighted backpack or holding a barbell.

Woman doing eccentric strengthening exercises for her calfs.

Woman doing eccentric strengthening exercises for her calfs.

Note: Do not attempt these exercises on your own without first being diagnosed and receiving proper instructions from an orthopedic specialist or physiotherapist.

In general, a combination of stretching, flexibility and strengthening exercises is the most effective way of avoiding common runners’ problems. Plus, it will keep you running longer and pain-free.



Herwig Natmessnig As a former professional athlete (whitewater slalom), Herwig lives for fitness. Whether in competition or just for fun, he can never turn down a challenge. View all posts by Herwig Natmessnig »