Runner’s Guide to Managing Achilles Tendonitis

sbr_hazyVol. 38, No.3, issue 382 – May/June 2012

By Mike Ryan, PT,ATC,PES

Achilles tendonitis is a common injury for runners,young and old. Achilles tendonitis or tenosynovitis is associated with the presence of inflammation, scar tissue and sometimes degenerative changes of the largest tendon in the body.

The Achilles tendon connects the two large calf muscles (Gastrocnemius and Soleus) to the heel bone (calcaneus). Its main function is to transfer power to the ankle during the push off phase of the gait cycle while both walking and running.

A decrease in the elastic qualities and a reduction of the tendon fiber strength is a common finding with athletes older than 30 years of age. The location of the inflamed tissue can be anywhere along the tendon from the calf
muscle to where it attaches to the heel bone.

Expanding on what was stated earlier, it’s important to understand that the two muscle of the “calf” merge together to form the Achilles tendon before it anchors or inserts into the calcaneus bone. The Gastrocnemius in the larger and more superficial muscle and it originates above the knee. The Soleus is the deeper and shorter muscle that does not cross over the knee joint.

Signs & Symptoms of Achilles Tendon Pain

• The onset of pain can be as fast as within minutes or a gradual increase in symptoms over a period of days or weeks.
• Symptoms such as pain, stiffness and calf weakness typically decrease with rest.
• Tenderness noted anywhere along the tendon with palpation and with activities.
• Palpable knots or lumps in the Achilles tendon are common.
• Tendon “squeaking” can often be felt with ankle motion.
• When performing a one-legged toe raises with the knee completely straight, pain in the tendon,
weakness in the calf and limited range of motion in the ankle is demonstrated.
• Swelling or thickening within the tendinous sheath is common.

Causes of Achilles Heel Pain

Achilles tendonitis is typically an overuse injury. The basic cause of an overuse injury is when a person does “too much too soon”. With that being said, other factors can contribute to inflammation of the largest tendon in
the human body:
• Altered or improper footwear for both activities and work environments.
• Changes in training surface firmness and an increase in exposure to hilly terrain.
• Rapid increase in activity volume and/or intensity.
• Insufficient recovery time between workouts.
• Various arch and foot pathologies such as fallen arches, excessive pronation, hyper-supination or poor toe alignment.
• Weak calf muscles
• Tight calves and Achilles tendons
• Stiff ankles due to arthritic changes.

Professional Treatment for Achilles Tendon Pain

• Stretching of the two calf muscles is important for long-term reduction of Achilles tendon pain.
Wall pushes should be performed with both the knees straight and with the legs bent to address both muscles and the Achilles tendon.
• Avoid the activities and footwear that are linked to the symptoms.
• Place a ¼ – ½ inch heel lift in both shoes.
• Ice your Achilles tendon and calf muscles in a moderately stretched position. Ice bags/veggie, ice cup or ice bucket will work.
• Massage of calves, arches and front of ankles to promote a decrease in Achilles tendon and ankle stress with motion.
• Improve arch and toe flexor strength with activities such as marble or rock pickups and towel curls in a seated position.
• Perform daily calf rolling treatments for the calf and peroneal tendons (lower outside of the shin) but not on the Achilles tendon itself.
• When at least 75% of the pain is eliminated with walking, initiate toe raises to strengthen the calf muscles.
• Compression of the calf during activities to maintain warmth and improve blood flow.

Questions a Pro Athlete Would Ask

A smart professional athlete with Achilles Tendonitis who wants to safely return to his/her sport will ask his sports medicine specialist the following questions:
1. What are the main factors to why I have Achilles tendon pain?
2. What does my foot/arch/subtalar joint biomechanics look like? Do they needs to be addressed with an orthotic?
3. Are my legs the same length? If not, is the difference greater than 1/4 inch?
4. Am I a candidate for a cross friction massage on my Achilles tendon or will that form of treatment be too aggressive?
5. Who is the best physical therapist in town to rehab with for my Achilles heel pain?

Mike’s Sports Medicine Tips

• Issues Above – Achilles tendon pain is probably more a result of a problem farther up the chain. Look at everything from your shoulder levels to your core strength to your sore knee for clues.
• Why Now? – What triggered the flare-up now, Detective? List the activities and factors that you changed in the last month and you may be shock to see the reason(s) looking right at you!
• Limber Time – I watch my young son stretch and bend like Stretch Armstrong. As adults, we are probably not as flexible as we need to be. Quickly stretch your shoulder, back and legs every day.
• How’s Your Sole – Compare the shoe/sneaker wear pattern. Do the soles look differ from left to right?
• Avoid Hills…For Now – As you return to your activities avoid hills for the first couple of weeks.


Mike Ryan, PT, ATC, PES is the Head Athletic Trainer/Physical Therapist for the Jacksonville Jaguars of theNFL and a 6 time Ironman triathlete. Mike is the founder of, a free sports medicine resource dedicated to keeping mature athletes healthy & active.

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