If your Achilles feels stiff and sore for the first few steps out of bed, or you’ve noticed an ache building at the back of your heel partway through your run, you’re dealing with one of the most common overuse injuries we see in Perth’s running community. It shows up often among the recreational and distance runners we work with here in Subiaco – from newer runners ramping up mileage in our Tuesday night Perth Run Collective sessions through to seasoned athletes deep in a marathon block.
The good news: Achilles tendinopathy responds very well to the right treatment. The less good news: “resting it and hoping” is usually the slowest way to get better, and often the way it becomes a recurring problem.
What Is Achilles Tendinopathy?
Achilles tendinopathy is an overload injury to the tendon that connects your calf muscles to your heel bone. Despite the old name “Achilles tendinitis,” it’s rarely a simple inflammatory problem – it’s a tendon that hasn’t been able to keep up with the load being asked of it, and the tendon tissue itself starts to change and weaken as a result.
It generally shows up in one of two places: at the mid-portion of the tendon, a few centimetres above the heel, or right where the tendon attaches to the heel bone (insertional tendinopathy). The two respond to slightly different loading strategies, which is one reason a proper assessment matters before you start a rehab program off the internet.
Why Runners Are Especially Prone
Tendons adapt to load slowly – much more slowly than your cardiovascular fitness does. That mismatch is exactly what we see go wrong. A sudden jump in weekly kilometres, a return to hill sessions, a change in footwear, or simply stacking training weeks without enough recovery can all outpace what your Achilles is conditioned to handle. We’ve written before about training load error and why it often leads to running injuries – Achilles tendinopathy is one of the most common places that error shows up.
Calf strength and capacity plays a big role too. Runners who spend most of their week sitting at a desk, and only load their calves during running itself, often don’t have the tendon or muscle capacity in reserve to absorb a training spike.
Signs Worth Getting Checked
- Morning stiffness or pain in the Achilles that eases as you warm up, then returns after activity
- A dull ache or sharp twinge a few kilometres into a run that wasn’t there at the start
- Tenderness or a thickened, “lumpy” feel when you pinch the tendon
- Pain that’s worse on hills, stairs, or push-off during sprint efforts
- Symptoms that have been nagging for more than a week or two, rather than settling on their own
None of these mean you need to stop running altogether – but they do mean it’s time to get it looked at rather than push through and hope.
Why “Rest and Wait” Often Backfires
It’s tempting to stop running completely and wait for a sore Achilles to settle. The problem is that tendons need load to heal – complete rest lets pain settle temporarily, but it doesn’t rebuild the tendon’s capacity, so the same niggle tends to return as soon as you resume training. This is very similar to what we see with plantar fasciitis and other heel pain in runners: the tissue needs a graded reintroduction of load, not an absence of it.
A Physio-Guided Loading Plan
What actually works is a structured, staged loading program, adjusted as your tendon’s tolerance improves:
- Stage 1 – Isometrics: Sustained, low-movement calf holds to settle pain and maintain some capacity early on
- Stage 2 – Isotonic strength: Heavy, slow calf raises through range to rebuild the tendon and muscle’s capacity to take load
- Stage 3 – Energy storage: Hopping and bounding drills that teach the tendon to store and release load efficiently, the way it needs to when you run
- Stage 4 – Return to run: A gradual, monitored reintroduction of running volume and intensity, guided by how the tendon responds
The exact starting point and progression speed depends on your specific presentation, which is why we build these programs individually rather than handing out a generic sheet. Our exercise rehabilitation programs are built around exactly this kind of staged loading, and where footwear, cadence, or running mechanics are contributing to the load on your Achilles, a gait analysis can help pinpoint what to adjust.
When to See a Physio
Get it assessed by one of our sports physiotherapists if your Achilles pain has been present for more than a couple of weeks, if it’s affecting how you run, or if it’s limiting the training you can do in the lead-up to a race. Early assessment usually means a shorter, simpler rehab program – left too long, Achilles tendinopathy can take months to settle rather than weeks.
If you’re carrying a niggling Achilles into your next training block, or a race on the calendar has you wondering whether to push through, book an appointment with our team and let’s get a plan in place before it becomes a bigger problem.
