The Runner's Guide to Achilles Tendinopathy

Achilles tendon injuries plague many a runner, but Matt is here with findings from his PhD dissertation to help us understand what's going on and find the path to recovery. Matt dives into the anatomy and function of the Achilles in the gait cycle. Then he explains tendinopathy, the most common injury to that tendon, and what puts runners at a higher injury risk. Finally, he gives rehab and strength-building tips and strategies to get you on the road to running at full strength again. If you or a fellow runner have ever suffered from Achilles pain, this is the episode for you!
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[@applerunner1184]

Just wanted to let everyone know that Matt is spot on based upon my experience - I am about 15 months on from a bad Achilles problem which I picked up during a race. I could barely walk. It didn't really start improving until I was able to do single leg calf raises with a deficit. Heavy weight (I am now up to 150 lbs). 5 reps per set, 3 sets. I just smashed my half PB with zero achilles pain! It does take a while, so be patient.

[@kylestreeter6569]

What's "a while". Just curious. I've had symptoms for about 6 months and started rehab immediately. Still having symptoms and wondering when I can expect to feel normal again.

[@applerunner1184]

@@kylestreeter6569 I was running after about 3 months with symptoms. I had to tape gel pads to my heel and remove shoe heel counters to prevent friction. I was not symptom free until 9-12 months. The real progress in the rehab came from progressing to heavy single leg heel drops twice a week. I mean heavy - to failure (5-8 reps, 3 sets). Increasing the weight on a regular basis. Then I started doing the same weighted heel drops with a deficit. Start small initially and then build up over time. After a while, performing heel drops became the “medicine” for pain. I always felt better after!

[@Mattbh119]

2 yrs off n on most annoying injury / issue

[@applerunner1184]

I was running after about 3 months with symptoms. To get symptom free took about 9-12 months. Heavy weight to failure. Then with a drop. I use a smith bar at the gym and put a weight on the floor to provide a deficit. Key is to keep on progressing the weight and the deficit. Keep going beyond pain free symptoms as it is still healing when no pain. I still do it for maintenance purposes…

[@andybrown9190]

Can I ask, did you still doing running whilst carrying out your strengthening exercises.

[@waynehadley1999]

I'm 60 years old, been a runner since primary school, rugby player, swimmer, waterpolo and triathlete since 1986, sprint, 70.3 and IM distances. Over the past 8 years I've struggled with recurring achilles tendonitis, did loads of rehab, PT etc. each time, did all the usual exercises. The big change for me was switching from 10-12mm heel-toe drop shoes to 4-5mm, this is counter to the conventional wisdom that you need a higher heel-toe drop if you have recurring AT. Symptom free and mileage heading up to normal over the past 12 months. I also think the other factor to improvement came when I added plyometrics to my rehab (once I was pain free with isometric, eccentric and concentric exercises and passive stretch).

[@JHornsby89]

This is really fascinating, I injured my Achilles in 2018... Had to take time off, 6 months later did strength training. Lots of heavy KB calf raises etc. 3 months later voila! Gone!... or so I thought. I then trained and after most speed sessions my Achilles would "flare up". Couple of easy runs, gone... Fast forward 2024, in really good running shape (highest most consistent block of running in a long while). Finished my long run and bam! It's back. Well interesting to know, I never really "fixed" the tendinopathy in the first place. Back to strength training I go...

[@BowflexWorkouts]

Wow, this was so informative! I thought I had a full recovery from my Achilles Tendinopathy and backed off the rehab a few months ago & now it's flaring up again. I stopped when the pain went away. Sounds like that's a common mistake and I know better now. Thank you so much for taking the time to record this video!

[@danieljozefczyk7869]

This is so true I used to struggle with my knees in my 20s and now it's my calfs being 42 thank you this is interesting

[@runningfortherestofus7812]

That was a really great episode. I’m a masters runner who has struggled in the past with this. I’ve been doing one legged calf raises just with body weight so I’m going to try going heavier. I actually benefit more from these topics than the shoe reviews. Please keep making more of these. Question; does it help to do both straight and bent leg calf raises to work both soleus and gastroc?

[@matthewtait]

This video is fantastic, thank you!

[@kdub3562]

Very helpful and gained some additional info that I was not aware of

[@johnmclean9498]

Mat - huge thank you for this. This is very helpful- I will be switching to your protocol of heavier weight and low reps more frequently. Keep doing the great content - and have fun chasing the kids 👍

[@fahadghabesh3053]

Thank you for this video! It's been incredibly helpful for my Achilles tendon I can already see improvement Keep up the great work!

[@michaelhaney1357]

This was timely. My DPT helped me get through Berlin and Chicago while dealing with this. I was typical, as the issue was over a year old before we got together. Spent the last 6 weeks getting things settled down while building strength and have just started adding weights. Now I’ll try upping the weight and lowering the reps. I should start jogging in another couple weeks. Mentally, I was already resigned to not running all out until at least the summer. Thank God I can still get VO2 max and anaerobic work in on the bike. Really appreciate the in depth talk.

[@fernandezjose205]

I truly appreciate your help! As a new runner, I've been dedicated to intense training for about 5 months, achieving some notable milestones, including PRs and a half marathon. Notably, I started with a 36-minute 5k and have progressed to an impressive 19:37 5k within this relatively short period. However, during a 10k run, I experienced Achilles pain, possibly linked to my Nike race day shoes and rigorous training. As of right now the discomfort surfaces at paces below 9 min per mile, but I can manage with slow runs, walking, and calf exercises. Despite this, I can't help but worry about potential tears, given my past experience with a meniscus tear from MMA when I was younger. I'll continue to run slow and incorporate weight training exercises. Thank you for sharing your knowledge and valuable information!

[@sumguy9687]

Great info. I’m 58 and have been having achilles problems for a while now. Been concentrating on eccentric heel drops per the Alfredson protocol. Just started adding weight with a 20lb dumbbell about a month ago. Gotten back into run/walking and so far so good. Also using shoes with a higher heel drop.

[@brentg2792]

Great information, thanks. As a 47 year old ultra runner I’ve been battling high hamstring tendinopathy in both legs for last 6 months and my left achilles just started acting up. Been lifting but not with enough purpose or close enough to failure. Excited to try the heavy 3-5 sets/reps.

[@LancePeterman]

Great stuff, Matt. The calf strength training in particular was helpful. Hopefully some black friday sales on kettlebells :)

[@ahmedhentati598]

Thanks for the awesome rehab guide! Very informative video. What would you recommend as the top exercise for tibialis posterior tendinopathy please ?

[@TheCyclingCardio]

Awesome..now I need to rehaul my lower body program…my plantar fascitiis, achiles, and sacrolumbar (due to squats) is compromising my training

[@cedric_v]

What the .. Been having so much stiffness in my achilles last months but was always afraid to load heavy with the calf raises. Decided to give it a go with 13kg and the stiff is like totally gone after doing 4 sets with 5 reps. Guess weight idd was the key to all this Awesome video this !!!

[@StreamCrossingRunner]

SO helpful- I’ve been suffering from this and this is so helpful!

[@DoctorsofRunning]

Thanks for watching!

[@skateata1]

Everything in this videos makes sense. My route always included up and down hills. I also play roller derby so my ankles go through a lot. I noticed abig improvement when i added strength training to my routine and an actual warm up.

[@jeffloflin6316]

Age 63, 25 trail races over 3ish years. Yep achilles issues from the start. One is great the other in rehab. This information is very accurate. Great video!! The main reason I've made it through is my Physical Therapist, Erika, who is up to date on achilles issues.

[@SteveLinGuitar]

Thank you so much! I'm 42 and last week experienced my first Achilles tendonitis. Stumbled on your channel after watching a bunch of stuff and can't thank you enough. This was caused by badminton -- lots of footwork in lunging and jumping--lots off explosive movements. I'm very happy that the message is that all of this can be remedied and improved.

[@nznige]

im 46 and have had it bothering for me about 3 years, I was doing long distance slow trail runs and playing tennis, I think its the tennis doing it, so frustrating its stopping me running another 50km atm

[@emirgokcen1906]

This was great, thanks a lot. I have been suffering from Archilles Tendinopathy since 2018 due to high running load back then. It has never been fully healed. Long term mindset is the key as you suggested which is I did not do much. Need to stick strength training for long term.

[@davidg5584]

Thank you

[@andynth33]

great episode. is there any examples of the one leg kettle bell calf raise that you recommend?

[@treythompson3083]

This is a very informative video. I have been dealing with this issue for over a month.

[@DoctorsofRunning]

Thanks for watching! Hope this video was helpful to your recovery.

[@armanimckoy2168]

Im using this info to help with skateboarding.

[@chrisconrad4521]

I’ve had Achilles tendonopathy for 2 years. In my last year of middle distance running, I had to get cortisone shots in both ankles 3 times over the year. I wish this video was made earlier but better late than never!

[@Marc-dk8vw]

Congrats Dr Matt (I know you are still working on PhD, but you will do it.)

[@intosite7279]

Really insightful! Have seen so many videos and read so many articles that mention the same exercises but always only mentioned heavy weights without specifics, which isn't helpful. 5 max reps weights is so much better indicator

[@bjornpersson1172]

Thanks for a great episode! A friend recommended it to me. I’m desperate to get back to running after two years of not running. Rest didn’t help, nor did body weight eccentric heel raises. Will definitely try this! What I don’t get is how to do them without support, with a kettle bell in each hand. Is that on flat ground then? Cause it seems hard on a step up board. Anyone, please go ahead and reply.

[@michaelcaricoo]

Jokes on you thumbnail, I always panic

[@DoctorsofRunning]

🫠

[@miroslavmiskuf3459]

cool video 👍

[@wendymackenzie7771]

@DoctorsofRunning what strength would you recommend for bilateral insertion achillies tendinopathy. TIA. Great video BTW

[@giuseppec8134]

In the context of what you discuss in the video (namely, strenghtening, load management and recovery) can you also advise on the impact of the drop in running shoes when trying to recover from Achille's tendinitis a/o tendinopathy. With the view of picking more forgiving shoes to deal with Achille pain (a/o tendinitis) I've just purchased a pair of Topo Atmos, after some deliberation against the Glycerin 21 and the Ghost Max (booth featuring a higher drop, despite the lower drop Brooks claim for the Ghost Max). My thinking choosing the Atmos is that if I need to increase the drop I can always add a heel lift to them. My choice has mostly been the result of me being no longer able to tolerate pointed shoes like those from the traditional brands. To give you some background, about a year ago I found relief from some metatarsalgia through using lower drop and foot shaped shoes (namely Topo for my running and Altra for my walkings). I got rid of my metatarsalgia, and built good resilience and strenght in my running, with few 10ks and half marathon joyfully run by following a well structured routine for a number of months and including long, speedy, tempo and recovery sessions for a total of, let's say, 40/50 miles per week. I probably abused from using my Altra Escalante 3 during a two-week holiday when I did some running (which I hadn't done before), which included some unplanned hills, and lot of barefoot walking on the beach. As a result, I believe, back from holiday, when resuming my usual running I started experiencing an increasing pain in my Achille. Although this prevented me from going back to my pre-holiday routine I have somehow managed to do some running since (let's say 4 miles three time a week) and some strenghtening routine of the like you discussed in your videos. Based on the pain, which I understand is not necessarily a good indicator, it seems to be improving. I am a mid foot-forefoot stryker, slightly overweight (85 kg and 180 cm) and 46 of age (fit and healthy). Although I had not payed attention to this before, I've realised that my most congenial drop height has always between 4-6 mm. Most recently, and following my metatarsalgia, I have developed low tolerance to higher drops (8mm+). Thanks!

[@erinmalette7276]

I do these calf raises for post tib. Would suggest loading heavy as well? Light weight high rep hasn’t helped.

[@maewalker]

This was really helpful. I'm a younger runner, and my physio thinks I might have a tendonopathy--not it's not in my Achilles (tho I have had some calf pain), it mostly tends to have some sharper pain thru my anterior medial calf/peri-shin area (which I'm not even certain has a tendon there...). Trying to find strength exercises that work for that I'm finding tricky. It's not on the shin itself, so I feel like a splint or stressie is pretty unlikely. I know I have struggled with hip strength for a long time, so maybe that's an area I need to address better too 😅

[@FeelgoodThreads]

@doctorsofrunning I’m in month 6 of rehabbing an Achilles rupture. When do you recommend I start loading heavy? Right now I’m only doing single leg calf raises with body weight.

[@Bettie_Noir]

Thank you for this. I am 56 and I have been suffering from Achilles tendinitis and Tennis Elbow for several months and the pain is awful. Does taking collagen help improve tendons in addition to the exercise? Thank you again.

[@user-wy2tj2zy3y]

Would you avoid foamrolling calfs while having Achilles tendinipathy? Thank you.

[@markuscg1]

I have issues with my Achilles. I wanted to be in your study but didn’t qualify due to some other hip issues. 😢 I’ve noticed that a certain statin (which many of us over 50 are on) caused my Achilles tendon and plantar fascia to get really tight and cramp quite a bit when at rest. I know statins can cause myopathy but surprised at the issues I was having. I’m trying a different statin now.

[@emf6621]

I've struggled with Ach. Ten. (AT) for more than a year now. I have reduced my running and done many heel raises, but the tendon keeps getting sore to the touch after activity. I'd be very interested to hear how you'd interpret that symptom - soreness in one spot when the tendon is palpated.

[@zacharysmith5982]

Hi Matt! You specified 3-5 reps 3-5 sets for the heavy lifting movements, but I’m wondering: what would you prescribe for the Plyometric movements? I know you said explosive, quick recoil jumping is best, but what sets/reps would you program? Thanks!

[@harry800]

Would you recommend seated calf raise or standing

[@parkernovakovic9806]

What heavy eccentric / weightlifting exercises should I do for posterior tibialis tendinopathy?

[@yourloved6741]

I have been running about 4 years and just developed what looks like a lower bursitis and tendonitis. I have not been diagnosed but it’s the lower part of my heal. I don’t have any pain but it’s red and irritated. My question is this, should I only do Eccentric on the ground??? Or, slow Concentric & eccentric? Up & down. I read that going up could cause irritation to bursitis?? Thanks for incredibly video! Going to start to strengthening ASAP.

[@sjm2347]

Any single exercise / 20 min session recommendation for IT band? Is the rec for fascia similar? My IT band went from tight to totally unable to run in mile 23 of a road 50k. Four weeks later and still pain, even just walking sometimes. Past PT for issues always put me on the 3x10 rep low/no weight stuff, which takes an hour, but at least included calf raises, single-leg squats, RDLs - also a lot of glute work. 🤷‍♂️

[@adamdonahue4617]

Best shoes for this?

[@sublimity59]

Hi thanks for the great video. One important question - do I run on the same day as strength training? If so, before or after the strengh training?

[@DoctorsofRunning]

Recommend checking our strength training episode for these answers: kzbin.info/www/bejne/d6Oxn6qpg86Yi9ksi=e0tygO6H2bzb14qg

[@gdm9488]

Got minor tendinopathy pain and doing calf raises and can do slow running with low pain, I've been dealing with it a month or so, so early in healing. I know you mentioned no faster running early on but how much would a 10k race in a couple of weeks set you back? Mid-late 20s m

[@chrisconrad4521]

What should I do on the days between weight calf raises?

[@angelakle6576]

I have a really bad flat foot on the left. Could that mess with my achilles tendon? It hurts on the inside of the back of my ankle when I get up from my couch. I am overwight.

[@ivankrga8817]

@DoctorsofRunning Pros and cons of calf stretching for people with Achilles tendinopathy?

[@DoctorsofRunning]

Unless your calf muscle is actually limited in its flexibility, stretching not recommended for Achilles Tendinopathy

[@ivankrga8817]

Thanks for the feedback.@@DoctorsofRunning

[@jvizzle3141]

Incredibly helpful (and hopeful) video - I’m committing to putting in the work to finally put this issue to bed … You mentioned your grip: I’d highly recommend a quality weightlifting strap (versa gripps are really great) to remove your grip as a limiting factor in your calf training … There’s a time and place for grip training, but it shouldn’t impede your target muscle training! Straps are a staple in bodybuilding because back training is otherwise almost always grip-limited…

[@Bypassrunner13]

As someone with tendinopothy and a haglunds. I still run ultras on it but have been told I need to wear orthotics. I’d rather stay on a program of strength and avoid the orthotics. Do you feel that I do in fact need to wear a corrective measure for this ?

[@m.topfer]

Do you have some tips for stability when doing calf raises and having weights in both hands? Currently my setup is heavy backpack (30-40kg) with 10kg dumbbells but I have hard time with front-back stability when I'm trying to go down very slowly and controlled. Thus I prefer to use just one dumbbell and use the other hand for stability. But I didn't try many times to use both dumbbells - probably it is just a matter of training (and also heavier dumbbells instead of backpack might help - lower center of gravity). Could you be more specific about follow up exercises regarding plyometrics? I can quite easily get back to running (trail running, cca. 70km/w mileage, decent speed ~3:30min/km, no problem with speedwork) but I'm having really hard time to get from there to be able to do team sports with sudden changes in directions - like ultimate frisbee. What would be some demanding exercises that could make me ready for such sports?

[@applerunner1184]

Yeah - I had the same issue. I got the most benefit by 1) increasing the weight and 2) adding a deficit. My solution for 1) was to go to the gym and perform the calf raises using a bar with weights - the bar is attached to a frame at each end so stability is not an issue for me. I use a weight on the floor to provide a deficit.

[@angelakle6576]

ok it is hurting when i get up and then if i walk on it, it isnt hurting if i walk.

[@Ginguredrunner]

What do you suggest for someone that has arthritis in both big toes (which makes calf raises difficult sometimes). I'm also wondering if you think it's ok to keep running if you wake up in the morning with stiffness? The pain is there but not unbearable.

[@davidpruden1736]

I had both my big toes fused due to arthritis. I now run in stiff carbon plated shoes as they protect my toes and can roll over the top of my big toes (as opposed to ankle rolling out to get around the big toe). Best thing ever from my perspective, and means you can get back to running and calf raises without much issue.

[@danbuhuera376]

I’ve been BATTLING partial Achilles tear since NYC half this year. Averaging 25 MPW for the past 2 years. It really is up and down. I’m seeing a great running PT now who has me strength training again, doing a lot for the calf muscles too. Recently I had a run where I felt nearly normal. It was amazing. Battling constantly cramping QL and crookedness from l54 l5s1 also. The MRI report for my Achilles was horrifying. Multiple partial tears, tendinitis, PTT, a goddamned mess. I really think that with proper PT, properly resting, less alcohol, I will be able to come out of this sometime in 2024. Or I will just have to stop running for a while and totally focus on rehab and strength. Either way, forward I have a conspiracy theory that the new fat midsoles when paired with plates make our feet react differently and increase chance of injury. I have nothing to base this on other than instinct lol. I enjoy your videos a lot. Thank you.

[@danbuhuera376]

Ok now that I’m 30+ mins into the video a huge huger thank you. I feel like this video was made for me 😂 I just started doing single leg deadlifts, bought some kettle bells, and started aggressively hopping on both feet, slowly loading hard, as part of my warm up. A question for you - SHOULD I load my bad tendon more when running? I think I’ve been avoiding loading it a lot while running, which likely has contributed to imbalances and other issues in dealing with. I’m naturally a strider but over the past few years have focused more on 180 cadence, shorter strides. I can run both ways. Shorter choppier strides feels like a bit better running economy, but I am more naturally inclined for longer strides, loading the calf more. Since the Achilles started hurting, I’ve avoided longer strides and avoided chasing that “bow” / momentum feeling (not sure how to describe this) that makes me feel like I’m a kid again / bouncing around. However, based on this video, I’m thinking I should rethink this. Overthinker here.

[@davidannett1616]

Thank you so much. Ive been struggling with this since 18 when i started college running. Here i am at 31 and still have bad flare ups. What do you think about a sleeping sock to keep it in a stretch position? About grastin? Strength is on the menu, but i want to train between now and then too!

[@angelakle6576]

And what do you mean by, "loading this thing"?

[@sunnek]

44yrs old.not a runner.occasionally play football and cricket.have had issues with knees recently developed Achilles tendinitis.how do I treat it.pain is severe.therapist is giving ultrasound,IFT and laser treatment.should I wear orthotics.but mostly wear flip flops.how do strengthen muscles?what exercise should I do.pls help .in lot of pain but have to go around with usual work and travel.

[@girtsstromcinskis1173]

Hi i have stiffnes in archellies when i run but, when i do calf rases with one leg it is sharp pain in archelles, wath should i do? It all started a few days ago

[@applerunner1184]

I had a bad achilles issue caused by a heel spur (see my post above) and I am now fully recovered. You need to start easy and slowly increase the load. Start with two leg calf raises, then do single leg, then single leg with weight, then single leg with weight and deficit. Then rinse and repeat with more weight. Stick with it and be patient - it takes up to 9 months to fully recover. One thing that I did for a while was to tape gel pads to the back of my heel to prevent the shoe counter from rubbing against the heel. For some shoes, I even had to cut out the heel counter.

[@evadebruijn]

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