Do you ever wake up with pain in your Achilles tendon? Perhaps it aches when you climb stairs or start your workout? If so, there is a good chance that you, like many runners, suffer from Achilles tendinitis.

In addition to runner’s knee and shin splints, Achilles tendon injuries are one of the most common problems runners experience.

Table of contents

• What Is the Achilles Tendon?
• What Are Achilles Tendinitis Symptoms?
• What Is Achilles Tendinosis?
• What Are The Causes for Achilles Tendon Pain?
• Achilles Tendinitis Treatment
  • Eccentric Strength Training Reduces Pain
• Other Benefits of Achilles Tendon and Calf Exercises
  • 4 More Calf Exercises That Help With Achilles Tendinitis

What Is the Achilles Tendon?

The Achilles tendon, which is also called the “calcaneal tendon,” is a band of connective tissue which connects the calf muscles to the calceneus (the bone that juts out at the bottom of your heel).

What Are Achilles Tendinitis Symptoms?

Runners who suffer Achilles tendinitis feel stiffness in the calf, through the ankle, and into the heel. The area above the heel is usually extremely sensitive to pressure. Most people experience the highest level of pain when they wake in the morning. At the beginning of a run, the pain can be quite intense. The pain usually subsides as the run continues, but then spikes again a few hours afterwards. 

What Is Achilles Tendinosis?

Achilles tendon pain that persists for weeks or even months can lead to Achilles tendinosis, a chronic pain. Chronic tendinitis pain is caused by:

• A thickening and stiffening of the Achilles tendon.
• Chronic inflammation in the area.

While most runners are inclined to “stretch the pain away,” stretching is actually contraindicated because:

• The inflamed and triggered muscles react by hardening and shortening when any motion is detected in the area.
• A shortened calf muscles pulls on the hard and tight Achilles tendon.

So, the cycle of pain persists.

What Are The Causes for Achilles Tendon Pain?

There are several risk factors that can lead to Achilles tendon problems. The main function of the Achilles tendon is to extend the ankle (plantar flexion). This movement is essential for pushing off when walking or running. When you run, your Achilles tendon pushes against the force of your own body weight and gravity. That’s like lifting a barbell several times your own weight, hundreds of times in a row!

Know Your Anatomical Terms

We commonly say “point your toes” or “flex your foot,” but these are not anatomically correct terms. The proper term for “pointing the toes” like a ballerina is plantar flexion. This movement is a function of the ankle (not the toes). When the “foot is flexed” like a kickboxing push-kick, the proper term is dorsiflexion. Again, dorsiflexion is an action of the ankle, not “the foot.”

The most common causes of Achilles tendon problems are:

• Increasing your training volume too much or too quickly
• Poorly fitting shoes (especially the heel cap)
• Overly stiff shoes
• Hip misalignment
• Pronation (where the foot rolls inward)
• Chronically tense calves
• Lack of time spent barefoot
• Lack of ankle mobility

Achilles Tendinitis Treatment

Eccentric Strength Training Reduces Pain

If you have been suffering from Achilles tendon problems for some time, then you should definitely take a break from running.

Continuing to run while in pain is not going to make you any stronger or faster. Plus, you run the risk of doing major damage to your Achilles tendon, which can interrupt your training for months. Try eccentric strength training: lengthening of specific muscles under load. It can help ease the pain or even completely eliminate it.

A study published in the British Journal of Sports Medicine demonstrated the positive effects of eccentric strength training. The study examined 26 patients who suffered from Achilles tendinosis. The patients followed a twelve-week training plan in which they did twice daily eccentric strengthening exercises for the gastrocnemius and soleus. The result was that most of the test subjects were completely pain-free by the end of the program.

Muscles of the Calves

The two muscles of the calf are called the gastrocnemius and soleus.

But keep in mind that eccentric strength training is only advisable if the tendon is not already showing signs of major damage. If you are experiencing constant and extreme distress in the region, avoid any running and standing exercise for at least 15 days.

Eccentric Strengthening Exercises

Hakan Alfredson, a Swedish doctor, is the inventor of a well-known eccentric training program for Achilles tendon pain. Here are the basics of his program:

• Daily eccentric strength training for a duration of 12 weeks.
• Exercises include twice daily calf raises at 3 sets of 15 repetitions. Conduct one set with your knee straight and the other with it slightly bent. By flexing and extending your knee, you’ll work both the gastrocnemius and soleus. 

Here is a description and images of Dr. Alfredson’s famous calf training exercise.

Step 1: Set the position

Start by standing on a step or stair with the balls of your feet on the edge. Plantar flex until heels are elevated well above toes.

Step 2: Single leg exercise

Lift one leg. Slowly dorsiflex the standing heel until it’s lower than the stair or step. Once it’s as low as possible, bring both feet to the step. Return to the start position (both feet on the step with ankles plantar flexed). Repeat this movement 15 times on one side; then, switch legs. You can increase the intensity by wearing a weighted backpack or holding weights.

In general, a combination of stretching, flexibility, and strengthening exercises is the most effective way of avoiding common runners’ problems before they start (including Achilles tendon problems). Plus, it will keep you running longer and, hopefully, without pain.

Other Benefits of Achilles Tendon and Calf Exercises

Exercises like those described above not only aid with Achilled tendinitis but also help create a more stable lower half. They’re a type of mobility training. When joints are mobile, they can move easily through their entire range of motion. And, they can do so quickly, against resistance. 

By training the ankles to plantarflex and dorsiflex with control under resistance and against gravity, we train them to do in other situations: like running, strength training, when chasing your kids around the house, etcetera. Mobile joints are effective and strong joints! 

4 More Calf Exercises That Help With Achilles Tendinitis

1. Standing Calf Raises

Start standing with your feet hip-width distance and toes pointing forward. Keep your core engaged and your chest up. To perform the exercise, lift your heels as high as possible and squeeze your calves. Hold for a breath before slowly lowering heels back to the ground. For more burn, you can go faster, or you can pulse the heels above the ground.

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2. Dynamic Calf Stretch

Begin this bodyweight exercise by standing with your core engaged and chest wide. Assume a lunge position with one leg forward. Both heels should be comfortably grounded. Pull gently out of the lunge, extending the front knee until you feel the ankle relax. As you exhale, shift your weight forward over the front ankle. Go as far as you can with your heel on the ground (and stop if you experience knee pain). Repeat 6-12 times, then switch legs.

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3. Inward Calf Raises

Start inward calf raises by standing with your feet hip-width distance, toes medially rotated (turned inwards, like a duck). Perform a calf raise in this position by lifting your heels as high as possible, holding for a squeeze at the top, and then slowly lowering.

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4. Outward Calf Raises  

Begin outward calf raises by standing with your feet hip-width distance. Externally rotate your feet so the toes turn outward to the sides. Perform calf raises in this position.

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