Returning to Running after Achilles Tendinitis

Achilles tendinitis is a common running injury due to the repetitive stress runners place on the tendon, especially when doing speed or hill work. Just because it’s common, however, doesn’t mean it should be ignored! Rest is essential to give the injury the time it needs to heal, but here’s the strange twist when it comes to your plan for returning to running after Achilles tendinitis – complete rest will actually hurt the situation more than it will help it!

Running after Achilles Tendinitis

Rest Redefined

Achilles tendons are typically tight when inactive, so completely resting can make matters worse. This can be attributed to the fact tissues will only tear and become aggravated again and again every time you try to move, weakening the tendon as it heals.

The swelling, tenderness, and pain you are experiencing results from damage to the collagen fibers that make up the tough cord. Unfortunately, these fibers take a long time to heal (especially if re-aggravated!) and even when healing does take place, it tends to be incomplete, and let’s just say a little messy. For some reason, collagen fibers don’t heal uniformly, so instead of the smooth band of tissues that once made up your tendon, “healed” fibers look more like a bunch of scrambled noodles! So how can you address this? Well, while you do need to stop running for some time, and refrain from any activity that pulls on your tendon, you will need to “work” your Achilles with what’s called eccentric exercise.

Eccentric Exercise Explained

Prolonged inactivity may eventually alleviate your pain, but it will also make your Achilles weak, thus more prone to continued problems. Therefore, instead of complete rest, it’s important to incorporate exercise that stimulates the breakdown of your damaged tendon fibers and encourages collagen cell reproduction, so new fibers form to replace the so-called “healed” ones. In other words, instead of the collagen fibers healing into a misaligned mess, new collagen is generated in closer alignment to the smooth, healthy tendon fibers, thereby strengthening the Achilles rather than weakening it as it heals.

Fortunately, this is much easier than it sounds! You can accomplish it with one simple exercise: the eccentric heel drop.

  • Stand with your toes on the edge of a step and slowly drop your heel down. Use your other, healthy foot to raise yourself back up to your initial position and repeat. Do three sets of 15 reps twice a day.

Since the misaligned, damaged fibers are being broken down and stripped away during this process—and you must add weight over time to progressively strengthen the tendon—you will likely experience some pain with this eccentric exercise. However, keep in mind that in the long run this is a good thing – it means it’s working! Before you start, though, it’s important to determine exactly how much pain you should feel.

Finding Your Pain-Free Threshold

The first step in Achilles tendinitis recovery is finding your pain-free threshold. A physical therapist (PT) will have you rise up on your toes, which “loads” your Achilles tendons with your body weight. This is typically done via a Variable Incline Plan, or VIP, which uses equipment with varying angles, each one allowing for a specific percentage of body weight to increase or decrease the amount of physical force placed on your tendon. Every two weeks tests will be done to measure your pain threshold and adjust your training accordingly.

The forces created while running are 4-5 times your body weight, so the goal is to get your Achilles to the point where it can handle more than body weight force without pain. Eccentric exercise will help shorten your rebuilding time, and to maintain your cardiovascular fitness, we recommend using a Newton Speed Trainer, which is an unloading device that allows you to run on a treadmill at below body weight forces.

Returning to Running

Rest, massage, ice, and medication can help to relieve your discomfort, but following a recovery program of physical loading and eccentric exercising is the only true way to ensure your tendon will heal correctly and you can return to running after Achilles tendinitis without pain. Of course, any underlying conditions that could be putting you at risk for tendon injuries should be addressed as well to prevent further problems.

To have your feet assessed, and to learn what your load tolerance is, as well as how to exercise to optimize recovery time, schedule a consultation with the doctors at Austin Foot and Ankle Specialists. Contact our Austin, TX office by calling (512) 328-8900. 

Dr. Craig H. Thomajan, DPM, FACFAS, FAENS
Founder and Managing Partner of Austin Foot and Ankle Specialists