Can Physical Therapy Help Runners with Achilles Tendon Pain?
Absolutely! Runners that find themselves dealing with Achilles tendon pain should 100% look for a running specialized physical therapist to help manage and resolve their pain so that they can safely return to running.
If you’re a runner in Atlanta dealing with stubborn Achilles pain, you’re not alone. Achilles tendinopathy is one of the most common injuries we see at Tempo Physical Therapy & Performance, especially in runners increasing mileage or training for a big race.
Keep reading as we (running specialized PTs) answer the most common runner questions about Achilles tendinopathy rehab including causes, treatment timelines and how to safely return to running.
What is Achilles tendinopathy?
Achilles tendinopathy is a condition where the Achilles tendon (the thick cord connecting your calf muscles to your heel bone) becomes irritated over time. It’s often caused by the repetitive loading of running when someone goes beyond their capacity, such as ramping up mileage, speed or hill work without enough recovery.
There are two main types:
Midportion Achilles tendinopathy: pain 2–6 cm above the heel
Insertional Achilles tendinopathy: pain right at the heel bone
It is important to note what kind of achilles tendinopathy pain you are dealing with as a runner because the treatment/recovery looks slightly different between the two main types. That is why it is key to work with a running specialized physical therapist to ensure proper healing.
What does Achilles tendinopathy feel like?
Every runner has a slightly different experience but common symptoms runners report:
Stiffness and pain during the first few steps in the morning
A tender, sometimes thickened tendon
Pain that eases as you warm up, but worsens after a run
Discomfort when going up stairs, doing calf raises or sprinting
What causes Achilles tendinopathy in runners?
Several factors can contribute:
Training errors: sudden mileage increases, introduction of speed or hill workouts
Weak calf muscles or poor eccentric control
Reduced ankle mobility or limited dorsiflexion
Running form mechanics: excessive heel striking or poor load distribution
Previous calf or Achilles injuries
Along with most running injuries, Achilles tendinopathy develops when there is an imbalance between a runner’s capacity and the demand they are placing on their body. At Tempo PT, we consult runners in Atlanta all the time to make sure they are not putting themselves at risk for developing Achilles tendinopathy.
How do you diagnose Achilles tendinopathy?
At Tempo PT in Atlanta, diagnosis starts with a thorough runner’s evaluation that involves a look into training routines, injury history and running specific strength and mobility assessments. We examine:
Tendon tenderness and thickness
Calf strength and endurance
Ankle range of motion
Running gait mechanics using slow-motion video analysis
Imaging (like ultrasound or MRI) is rarely needed unless symptoms don’t improve with rehab. Most runners will see improvements with an individualized plan of care from a running specialized PT.
What are the best exercises for Achilles tendinopathy rehab?
The cornerstone of any treatment plan for a runner with Achilles tendinopathy is progressive loading: strengthening the tendon over time to restore its ability to handle running forces.
Here’s what that typically includes:
Isometric calf holds (early phase)
45-second holds, 4–5 sets daily to reduce pain and maintain strength.
Eccentric calf raises (mid-phase)
Slowly lower your heel below a step, 3 sets of 15 reps, 1–2x daily.
Progressively add weight in a backpack or use a Smith machine.
Heavy slow resistance (advanced phase)
Seated and standing calf raises with controlled tempo and added resistance.
Plyometrics and return-to-run prep (final phase)
Hops, skips and gradual reintroduction of running drills once pain-free.
Pro tip: Runners with insertional Achilles tendinopathy tend to be more bothered by compressive forces so their rehab exercises should take this into account.
How long does Achilles tendinopathy take to heal?
Recovery can vary depending on severity and how long the issue has been present:
Mild cases: 4–6 weeks
Chronic cases: 3–6 months of progressive loading
Consistency matters most! Skipping rehab phases or returning to running too early often leads to flare-ups.
When can I start running again?
You can usually start a run-walk progression once:
Pain is minimal with daily activities
You can perform 20+ single-leg calf raises pain-free
You tolerate hopping or light plyometrics without pain
At Tempo PT, we also use 3D running gait analysis to help determine readiness and guide a safe, individualized return-to-run plan. No two runners are alike. We take into consideration a host of factors to make sure we are making the best decisions for your specific needs as a runner.
Should I stop running completely with Achilles tendinopathy?
Not always. In many cases, you can modify running instead of stopping completely. We will sometimes have our runners try the following as they recover from Achilles tendinopathy:
Shorten runs
Avoid hills and speedwork
Cross-train with cycling or pool running
A running specialized physical therapist can guide load management so you maintain fitness while allowing the tendon to heal.
What mistakes do runners make during Achilles rehab?
The biggest pitfalls:
Doing too much stretching (which can compress the tendon)
Relying only on rest or massage
Ignoring calf and glute strength deficits
Not progressing exercises heavy enough to stimulate tendon remodeling
Rehab should be strategic loading, not just rest and ice. Our team of therapists at Tempo PT & Performance are experts in helping runners avoid these common rehab mistakes.
Do shoe inserts or heel lifts help?
Heel lifts can temporarily reduce strain on the tendon, especially early in rehab or for insertional cases, but they’re not a long-term fix. The goal is always to rebuild the tendon’s strength and resilience through proper loading.
Can physical therapy help Achilles tendinopathy?
Absolutely! At Tempo Physical Therapy & Performance, our approach for runners includes:
Manual therapy to reduce stiffness and improve mobility
Progressive strengthening tailored to your training cycle
Running gait retraining to reduce Achilles load
Return-to-run testing and individualized plans
Our goal isn’t just pain relief; it’s helping you run stronger, longer and with confidence.
Where can runners in Atlanta get help for Achilles tendinopathy?
If you’re a runner in Sandy Springs, Buckhead or the surrounding Atlanta area dealing with Achilles pain, our team at Tempo PT specializes in running-specific rehab and 3D gait analysis.
We’ll help you:
Identify what caused your pain
Rebuild tendon strength
Return to running safely
Book a FREE consultation call with our team of experts to finally get rid of your Achilles pain for good! You deserve to run without pain!
Written By: Dr. Morgan Kamau
