How to Prevent Achilles Tendon Pain When Running

Picture this: You lace up your running shoes, step outside, and start pounding the pavement with enthusiasm. The wind in your hair, the rhythm of your breath, and the steady beat of your feet hitting the ground create a sense of freedom and accomplishment. Running can be an exhilarating and fulfilling activity, providing not only physical fitness but also mental clarity and stress relief. However, Achilles tendon pain when running can quickly turn this blissful experience into an agonising one.

If you've ever experienced the discomfort of Achilles tendon pain or want to learn how to prevent it from derailing your running journey, you've come to the right place. In this comprehensive guide, we'll explore the causes of Achilles tendon pain, the importance of early intervention, and most importantly, practical strategies to keep your Achilles tendon healthy while running.

Whether you're a seasoned marathoner or just a weekend warrior, understanding how to protect and care for your Achilles tendon can make all the difference in your running experience. So, let's dive into the world of Achilles tendon health and discover how to run pain-free and with confidence.


The Achilles Tendon

The Achilles tendon, often referred to as the "heel cord," is a remarkable structure and the strongest tendon in the human body. Named after the legendary Greek hero Achilles, it's the largest tendon in our body, positioned at the back of the lower leg, connecting the calf muscles, specifically the gastrocnemius and soleus, to the back of the heel bone or calcaneus. This tendon plays a crucial role in our daily activities, especially in sports like running and jumping. It's responsible for transmitting the force generated by the calf muscles to the foot, allowing us to push off the ground and move forward efficiently. While its strength and resilience are impressive, the Achilles tendon is not invincible and is susceptible to various injuries and conditions, such as Achilles tendonitis, which can cause discomfort and limit mobility. Understanding how to care for and protect this vital tendon is essential for maintaining a healthy, active lifestyle.


What causes heel pain when running?

Heel pain while running can stem from various factors, often making it a frustrating and uncomfortable experience for runners. One of the most common culprits is plantar fasciitis, a condition characterised by inflammation of the plantar fascia, a thick band of tissue that runs along the bottom of the foot. When this tissue becomes strained or irritated due to overuse or improper footwear, it can lead to a stabbing, sharp pain in the back of your heel, especially during the initial steps of a run. Another prevalent cause of heel pain is Achilles tendonitis, which occurs when the Achilles tendon becomes inflamed or strained, typically due to overtraining or a sudden increase in running intensity. Additionally, biomechanical issues like overpronation, where the foot rolls inward excessively during each stride, can contribute to heel pain as it places undue stress on the heel and surrounding structures. Ill-fitting shoes, insufficient arch support, and running on hard or uneven surfaces are also factors that can exacerbate heel pain when running. Understanding the root cause of your heel pain is crucial for effective treatment and prevention, allowing you to continue enjoying the sport while minimising discomfort and potential injury.


What injuries can cause heel/achilles pain?

Heel and Achilles injuries are prevalent among athletes and individuals engaged in physical activities. One of the most frequent injuries is Achilles tendonitis, characterised by inflammation and pain in the Achilles tendon due to overuse or excessive strain. Runners and athletes who suddenly increase their training intensity are particularly susceptible to this condition. Plantar fasciitis, another common issue, causes stabbing heel pain due to the inflammation of the plantar fascia, the thick band of tissue along the bottom of the foot. Stress fractures in the heel bone, often seen in long-distance runners, result from repeated impact and can lead to sharp, persistent pain. Haglund's deformity, sometimes referred to as "pump bump," is a condition where a bony enlargement at the back of the heel causes friction and discomfort, often aggravated by wearing tight shoes. Additionally, heel bursitis, which involves inflammation of the bursa sac near the heel, and Achilles tendon ruptures, typically caused by sudden force or trauma, are other injuries that can affect the heel and Achilles region. Understanding these common injuries, their causes, and appropriate prevention measures is essential for athletes and active individuals to maintain their mobility and prevent prolonged downtime.


Achilles tendinopathy

Achilles tendinopathy is a blanket term that describes an achilles tendon injury. It is a condition that encompasses both Achilles tendonitis (inflammation of the achilles tendon) and Achilles tendinosis (damage to the tendon itself), is a troublesome and often painful disorder affecting the Achilles tendon. Unlike acute inflammation seen in tendonitis, tendinopathy involves a degenerative process in which the tendon undergoes structural changes over time. It is typically characterized by persistent pain and stiffness in the Achilles region, especially upon initiating physical activity or after prolonged periods of rest. This condition can be caused by various factors, including overuse, inadequate rest, improper footwear, biomechanical issues, or even age-related wear and tear. Achilles tendinopathy can limit one's ability to engage in physical activities, particularly those that involve running and jumping. Effective management often involves a combination of rest, targeted exercises, stretching, and sometimes, medical interventions such as physical therapy or even surgery in severe cases. Early recognition and appropriate treatment are crucial for a successful recovery and a return to an active, pain-free lifestyle. It is important to note that if left untreated, any type of achilles tendon damage could possibly lead to an achilles rupture if not managed correctly; and as a large tendon... that's not what you want to happen!


Stress fractures

Heel stress fractures, a relatively common injury among runners, are tiny cracks or fractures that occur in the heel bone, also known as the calcaneus. These fractures typically develop due to repetitive impact forces, which are common during activities like running, especially on hard surfaces. Runners who increase their training intensity too rapidly, wear inadequate footwear, or have biomechanical issues that alter their running gait are more susceptible to heel stress fractures. The pain associated with this injury often starts as a dull ache in the heel and may progress to sharp, localized pain, particularly during weight-bearing activities. Ignoring these symptoms can lead to more severe fractures and a longer recovery period. Early diagnosis through imaging techniques like X-rays or MRIs, along with rest, modification of running routines, and proper footwear, is essential for managing heel stress fractures effectively and ensuring a quicker return to pain-free running.


Heel bone spurs

Heel bone spurs, also known as calcaneal spurs, can be a source of discomfort and pain for runners. These spurs are bony growths that develop on the underside of the heel bone, typically in response to chronic inflammation or stress on the plantar fascia, the thick band of tissue that runs along the bottom of the foot. Runners who engage in high-impact activities, especially on hard surfaces, may be at an increased risk of developing heel spurs. The pain associated with this condition often feels like a sharp, stabbing sensation in the heel, particularly during the initial steps of a run. It can be exacerbated by inadequate footwear, overuse, or biomechanical issues that affect the way force is distributed through the foot. Managing heel spurs when running usually involves proper footwear, orthotic inserts, stretching exercises, and in some cases, anti-inflammatory medications or physical therapy. Runners should pay close attention to any persistent heel pain and consult a healthcare professional for an accurate diagnosis and personalized treatment plan to ensure a more comfortable and pain-free running experience.


Soleus muscle strain

Soleus muscle strains are a common occurrence, especially among athletes and runners. The soleus muscle, located in the calf, plays a crucial role in plantar flexion, which is the movement that allows you to point your toes downward. Strains in the soleus muscle typically result from sudden or excessive force, such as a rapid change in running pace or intensity, pushing off forcefully during sprinting, or repetitive use during activities like long-distance running. These strains can vary in severity, with symptoms ranging from mild discomfort to sharp, debilitating pain in the lower calf. Rest, ice, compression, and elevation (RICE) is often recommended as an initial treatment strategy, along with gentle stretching and strengthening exercises. Proper warm-up routines and gradual increases in training intensity can help prevent soleus muscle strains and keep runners on track with their fitness goals.


Plantar fasciitis

Plantar fasciitis is a well-known and often unwelcome companion for many runners. This condition involves the inflammation of the plantar fascia, a thick band of tissue that runs along the bottom of the foot, connecting the heel bone to the toes. Runners, due to the repetitive impact and strain on their feet, are particularly prone to developing plantar fasciitis. The hallmark symptom is a sharp, stabbing pain in the heel, usually most pronounced with the first few steps in the morning or after prolonged rest, but it can also intensify during or after running. This condition can be caused or exacerbated by various factors, including overuse, improper footwear, poor running mechanics, and tight calf muscles. Treatment often involves a combination of rest, targeted stretching exercises, supportive footwear or orthotics, and in some cases, physical therapy. Runners should prioritize early intervention to manage plantar fasciitis effectively, as it can significantly disrupt training routines and hinder running performance.


Achilles tendon injury healing times

The healing time for an Achilles injury can vary widely depending on the type and severity of the injury, as well as the individual's age, overall health, and adherence to rehabilitation protocols. Minor Achilles strains or inflammation may improve with rest, ice, and anti-inflammatory treatments in a matter of weeks, typically within 2 to 6 weeks. Moderate Achilles injuries, such as partial tears or tendinopathy, may require several months of rest, physical therapy, and gradual reintroduction to activity. In more severe cases, like complete Achilles tendon ruptures, the healing process can be longer, often ranging from 6 months to a year, sometimes requiring surgical surgical procedures to make a full recovery and return to sports activity. It's essential to follow a healthcare professional's advice and diligently engage in rehabilitation exercises to support the healing process. Rushing the recovery can lead to reinjury, while patient and thorough healing can help ensure a stronger, more resilient Achilles in the long run.


How to prevent achilles pain

Preventing Achilles pain is crucial for maintaining an active and pain-free lifestyle. To achieve this, it's essential to prioritise a proactive approach to your fitness routine. Begin by gradually increasing the intensity and duration of your physical activities, whether you're a runner or engage in other sports. Adequate warm-up and stretching exercises, with a focus on the calf muscles and Achilles tendon, can improve flexibility and reduce the risk of injury. Wear the best running shoes with good arch support is vital, and often the best way to protect your achilles from the forces it is subject to while running. Ensuring that your shoes are suitable for your specific activity and regularly replacing worn-out pairs. Listening to your body and allowing ample time for rest and recovery between workouts is equally essential. Additionally, strengthening exercises that target the calf muscles and Achilles tendon, such as eccentric heel drops, can help build resilience and reduce the risk of injury. By combining these preventive measures, individuals can significantly reduce the likelihood of Achilles pain and enjoy their physical activities without the hindrance of discomfort or injury.


The importance of footwear to prevent achilles injuries

The importance of correct footwear when running cannot be overstated, as it plays a crucial role in preventing injuries and ensuring a safe and enjoyable running experience. Here are several key reasons why choosing the right running shoes is essential:

  1. Shock Absorption: Running generates significant impact forces with each stride. Proper running shoes are designed with cushioning and shock-absorbing materials in the midsole to reduce the stress on your joints, particularly your knees, hips, and ankles. Without adequate shock absorption, the repetitive impact can lead to overuse injuries and joint problems.

  2. Support and Stability: Running shoes provide essential support and stability for your feet and ankles. They are engineered to control pronation (the inward rolling of the foot) or supination (the outward rolling of the foot) to maintain proper alignment. Overpronation or supination can lead to biomechanical issues and increase the risk of injuries like plantar fasciitis, shin splints, or Achilles tendonitis.

  3. Comfort and Fit: Ill-fitting or worn-out shoes can cause blisters, calluses, and hot spots, making running uncomfortable and painful. Correctly fitted shoes with ample room for your toes help prevent these issues. A snug but not too tight fit also ensures that your foot remains stable within the shoe, reducing the risk of friction-related injuries.

  4. Injury Prevention: Running in shoes that are not suitable for your foot type or running style can lead to a range of injuries, including stress fractures, shin splints, Achilles tendon problems, and more. By selecting shoes that match your individual needs, you significantly reduce the likelihood of these injuries.

  5. Optimal Performance: Proper footwear enhances your running performance. When your feet are comfortable and adequately supported, you can run more efficiently, maintain good form, and potentially run longer distances, helping you achieve your fitness goals without setbacks.

To ensure you're wearing the right running shoes, consider visiting a specialty running store where experts can analyse your gait, foot shape, and running style to recommend the most suitable footwear. Investing in high-quality running shoes tailored to your specific needs is an investment in injury prevention and long-term running enjoyment.


Best exercises to prevent achilles pain when running

Preventing Achilles pain in runners is essential for maintaining a healthy and enjoyable running routine. Here's a detailed paragraph on how to achieve this:

Achilles pain prevention starts with a gradual and smart approach to training. Avoid sudden increases in mileage or intensity, and instead, aim for a progressive training program that allows your body to adapt gradually. Proper footwear is crucial; ensure that your running shoes provide adequate arch support and cushioning, replacing them when they show signs of wear. Pay attention to your running form, as poor mechanics can place excessive stress on the Achilles tendon. Incorporate a thorough warm-up routine before each run, focusing on calf and Achilles stretches. Strengthening exercises, such as eccentric heel drops, calf raises, and regular calf stretches, can help fortify the Achilles tendon and surrounding muscles. Cross-training with low-impact activities like swimming or cycling can reduce the strain on your Achilles while maintaining your cardiovascular fitness. Lastly, prioritize recovery by getting sufficient rest between runs, incorporating rest days into your training plan, and utilising ice and massage to alleviate any soreness or inflammation. By combining these strategies, you can significantly reduce the risk of Achilles pain and keep running pain-free.

Strengthening the Achilles tendon is crucial for preventing injuries and maintaining overall lower limb stability. Here is a list of some of the best exercises to strengthen the Achilles:

  1. Eccentric Heel Drops: Stand on a step or a curb with your heels hanging off the edge. Slowly lower your heels below the step's level, then raise them back up using both feet. Perform this exercise in a controlled manner, emphasising the lowering phase. You can progress to single-leg eccentric heel drops as your strength improves. Starting just by using your body weight as resistance is the best approach. You can then add training load later on as you progress.

  2. Calf Raises: Perform both straight-leg heel raises (or heel lifts) and bent-knee calf raises to target different parts of the calf muscles. You can do these exercises on a flat surface or with an incline (e.g., on a calf raise machine) for added resistance.

  3. Resistance Band Ankle Plantarflexion: Sit on the floor with your legs straight and loop a resistance band around the ball of one foot. Hold the ends of the band with your hands and flex your ankle, pointing your toes downward against the resistance of the band.

  4. Toe Taps: While sitting on a chair or bench, tap your toes on the ground or a small object (like a rolled-up towel) in front of you. This exercise targets the eccentric strengthening of the Achilles.

  5. Towel Scrunches: Place a small towel on the floor and use your toes to scrunch it up toward you. This exercise helps strengthen the muscles that support the Achilles tendon.

  6. Bent-Knee Wall Stretch: Stand facing a wall with one foot behind you and the other foot closer to the wall, both feet flat on the ground. Lean forward, bending your front knee while keeping your back heel on the ground. This stretch helps improve ankle mobility and flexibility.

  7. Calf Stretches: Regularly stretch your calf muscles by performing classic calf stretches against a wall or using a calf stretching device. Stretching can improve Achilles tendon flexibility.

  8. Balance Exercises: Engage in balance and stability exercises like single-leg stands or standing on an unstable surface (e.g., a balance board or foam pad). These exercises help improve proprioception and overall lower limb stability, indirectly supporting the Achilles.

Remember to start with proper form and gradually increase the intensity of these exercises to avoid overloading the Achilles tendon. If you have a history of Achilles injuries or any existing issues, consult a healthcare professional or physical therapist for guidance on a safe and effective strengthening program.

In conclusion, Achilles tendon pain when running can be a challenging obstacle for athletes and fitness enthusiasts, but understanding its causes and effective treatment strategies can make all the difference. Whether it's due to overuse, improper footwear, biomechanical issues, or sudden increases in training intensity, recognising the root causes of Achilles pain is crucial. Equally important is early intervention, which can help prevent minor discomfort from turning into a more severe injury. Incorporating a combination of rest, targeted stretching and strengthening exercises, proper footwear, and in some cases, professional guidance such as physical therapy, can effectively treat Achilles tendon pain. By prioritising prevention, addressing the causes, and following a well-structured rehabilitation plan, individuals can not only recover from Achilles pain but also enjoy a pain-free and fulfilling running experience in the long term. Remember, a healthy Achilles is key to staying on track with your fitness goals and continuing to embrace the joy of running; warm up correctly and manage your training load if you want to keep any running injury at bay whilst remaining as an avid runner!

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Arun Gray sports therapist strength and conditioning coach skegness

The author

Arun Gray is a sports therapist and strength & conditioning coach with over 15 years experience in the industry. He also has a personal history with chronic shoulder and back pain along with a range of other sporting injuries.

Arun writes about common injuries and aims to help people understand and manage their pain to prevent having to rely on national healthcare.

Read more about Arun