Achilles pain is one of the most frustrating injuries a runner can face, and personally I have been there. Presence of increased tightness can be the first signs, and unfortunately it can quickly derail weeks (or even months) of your training. If left unchecked, it doesn’t just stop your runs — it chips away at your confidence, your momentum in training, and reduces your mental outlet for exercise.

In fact, Achilles tendinopathy accounts for approximately 6–17% of all running-related injuries, according to epidemiological studies in both recreational and elite runners (Lopes et al., 2012; van der Vlist et al., 2019). It often shows up in runners looking to absorb more mileage, intensity, and subsequently more training load.

A flare-up can be mentally exhausting, making you feel like you’re losing progress or unsure if you will make it to the start line of your next race.

So let’s break down the following:

• Why the Achilles gets irritated in the first place?
  
  
• How do these runners present when they come into the office?
  
  
• What's the strategy for a stronger come back?

What Causes Achilles Pain in Runners?

Your Achilles tendon is the largest tendon in your body. It’s responsible for absorbing and transferring as much as 10x your body weight in force when sprinting! The main reason we are able to run the way we can is because of our Achilles Tendon. However if this tissue is not adequately ready to store and expend these forces — it becomes overloaded.

There are 2 Common Culprits when it comes to Prevalence of Achilles Pain:

1. Training Errors

• Sudden increase in mileage or intensity
  
  
• Repeating hill sprints or speed work without a proper phasic build in your training plan
  
  
• Insufficient strength preparation

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2. Running Form Mechanics

• High vertical oscillation (too much bouncing) = more force absorbed by the tendon
  
  
• Rapid pronation of the foot caused by:
  
  
  • Excessive supination at initial contact
  • Creates a delayed and excessive inward roll → adds stress on Achilles

What About How a Runner Moves?

While running form is very important for identifying the characteristics with your foam that are contributing to your pain. We also need to examine how the body moves with control, balance, coordination, and stability Many runners that I have treated with Achilles pain at Path to Movement Health & Wellness share these key movement issues:

➤ Poor Big Toe Mechanics

During a calf raise, these runners show difficulty pressing through their big toe. This dysfunction causes poor use of the transverse arch (ball of the toes) that seemingly small issue leads to:

• Faster impact loading times (shock is poorly absorbed through the muscles of the lower leg)
  
  
• Decreased arch support
  
  
• Overloading of the Achilles and calf

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➤ Hip & Core Stability Deficits

During single leg balance both from the foot and in half kneeling we should be able to remain upright even with our eyes closed. Stability deficits caused by poor hip and core strategies are frequently seen with:

• Poor single-leg balance. Unable to stand 10sec or more with eyes closed.
  
  
• Core disengagement. Unsteadiness with movements closer to the ground (plank/bridge).
  
  
• Weak glutes and lateral hip support, Unable to stabilize during lunges, step downs and side planks.
  
  

These limit your ability to control leg motion, leading to more stress down the chain.

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How to Overcome Achilles Pain— And Perform Better Than Ever

First and foremost, you cannot just treat the pain. Of course soft tissue techniques like scraping, myofascial release, and cupping are helpful at restoring some tissue properties but this will not get you back training the way you want—We must challenge the body's capacity to adapt. 

Here’s how:

➤3D Gait Analysis

Using advanced motion capture, we break down your gait in real time and pinpoint:

• Where inefficiencies are causing strain
  
  
• How your body absorbs force with emphasis on the time it takes for you to absorb the initial impact.
  
  
• What you can adjust to improve form and reduce injury risk
  
  

➤ Dynamic Stability Training

Through targeted strength and stability training, you can restore balance and coordination between:

• Core and hips
  
  
• Foot and ankle
  
  
• Knee and pelvis
  
  

This includes drills and strategies for improving single-leg control, glute engagement, and core timing.

Watch the whole video here.

➤ Heavy Slow Resistance Training (HSRT)

Tendons respond best to slow, controlled loading, especially when irritated. A growing body of research supports HSRT as one of the most effective rehab strategies for mid-portion Achilles tendinopathy.

In a landmark RCT by Beyer et al. (2015), runners who followed an HSRT protocol (with exercises like slow calf raises performed at 3–6 rep max loads) showed significantly greater improvements in pain, function, and tendon structure compared to eccentric training alone.

Key benefits of HSRT:

• Reduces tendon pain and allows for return to an early running program
• Stimulates collagen remodeling and tendon hypertrophy
• Builds strength while avoiding reactive flare-ups

This bent knee heel raise can be a great way to implement heavy slow resistance training for Achilles pain.

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Final Thoughts

Achilles pain doesn’t have to be a season-ending injury. If you catch it early and correct the underlying cause, you’ll not only bounce back — you’ll come back a smarter, stronger runner.

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Struggling with Achilles pain?
Book a Running Evaluation and let's get you running pain-free and strong again.

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References

• Beyer, R., Kongsgaard, M., Hougs Kjær, B., Øhlenschlæger, T., Kjær, M., & Magnusson, S. P. (2015). Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: A randomized controlled trial. The American Journal of Sports Medicine, 43(7), 1704–1711. https://doi.org/10.1177/0363546515584760
  
  
• Lopes, A. D., Hespanhol Junior, L. C., Yeung, S. S., & Costa, L. O. P. (2012). What are the main running-related musculoskeletal injuries? A systematic review. Sports Medicine, 42(10), 891–905. https://doi.org/10.1007/BF03262301
• van der Vlist, A. C., Breda, S. J., Oei, E. H. G., Verhaar, J. A. N., de Vos, R. J. (2019). Clinical risk factors for Achilles tendinopathy: A systematic review. British Journal of Sports Medicine, 53(21), 1352–1361. https://doi.org/10.1136/bjsports-2018-099387