Achilles Tendonitis

Jeff Albertson
Jeff Albertson

By Jeff Albertson

As winter settles in and runners take to the treadmill, sports medicine professionals will see a spike in Achilles tendonitis. One reason is that running on a treadmill increases load to the Achilles tendon. Also, runners tend to ‘mix it up’ on a treadmill (more hills, speed work, etc.) to keep from getting bored.

If you use the treadmill more during the winter, be aware, and try an ‘ounce of prevention.’
What is it? Achilles Tendonitis (AT) describes inflammation and pain in the tendon that connects the calf muscles to the heel.

Fifty percent of runners will experience AT pain at some point in their careers. And, for some, it can become a reoccurring nightmare.

The injury can be traumatic. However, typically, the irritation is an accumulation of microtrauma. The body’s natural healing mechanisms are unable to keep up with the daily wear, resulting in micro-tearing and pain. This dysfunction occurs without significant inflammation and thus, is often referred to as tendinosis or tendinopathy (‘itis’ means inflammation).

What does it feel like? Common sites of pain are the mid-portion of the tendon, just above the heel, and at the insertion onto the heel bone.

Initially, pain is most obvious in the morning and at the beginning of activity (before ‘warming up’).  The ability to ‘run through’ the pain is common and often leads to a delay in seeking help.

With progression, the athlete will experience pain during and/or after activity.

How to diagnose it? An evaluation with a sports physical therapist includes examination of the foot and ankle, a detailed movement assessment (e.g. ability to walk/run, squat, stand on one leg, etc.) and an in-depth account of the onset and training history.

A proper clinical assessment can effectively rule out a tendon rupture, and x-rays or MRIs are typically not necessary.
What to do? To avoid developing AT, gradually ‘phase’ into activities that increase loads to the Achilles tendon (e.g. treadmill running, hill work, speed work, and barefoot or ‘minimalist’ shoes).

Avoid ‘ramping up’ running volume suddenly (* specific recommendations provided in our blog)

Stretch your calves 60-90 seconds minimum – after running.

Change your running shoes every ~ 300-400 miles or 4-6 months—whichever is sooner.

Incorporate reduced impact training and strength training into your routine.

If you feel symptoms of AT, be proactive. Remember, by the time you are feeling these symptoms, a sub-clinical accumulation of micro-trauma likely started weeks-months ago. It is not a new injury, it is an injury that has reached its ‘tipping point’ and has now become symptomatic. It is unlikely to resolve on its own. Rest may result in resolution of symptoms. But if you wish to return to prior training intensities, the underlying cause must be addressed.

Seek help from a Sports Physical Therapist familiar with treating running athletes.

• See our blog for prevention strategies, self-treatment videos, information on running form, and an exhaustive review of current research and treatment options.

As always, please email me with any thoughts questions or ideas for future articles.

Jeff Albertson is a sports physical therapist and the Director of Physical Therapy at VASTA Performance Training and Physical Therapy. See for information on services or for more tips on remaining injury free.

Jeff and his family live in Charlotte.