Blog 2: The Overuse Injuries Playbook
Part 2: Achilles Tendinopathy: Why Your Achilles Hurts and How to Fix It Before It Gets Worse
Welcome to Part 2 of The Overuse Injury Playbook. I'm Dr. Keirstyn, a chiropractor and endurance coach. In this series, we're breaking down the most common injuries that sideline athletes. In Part 1, we covered plantar fasciitis. Today, we're tackling the stubborn pain in the back of your heel: Achilles tendinopathy.
It often starts as a minor annoyance. A bit of stiffness in your lower calf first thing in the morning that works itself out after a few steps. Then you start to notice a sharp, localized pain on the back of your ankle during the first mile of your run. You might try to ignore it, hoping it will just go away. But with Achilles issues, ignoring it is the worst thing you can do. Soon, the pain is there for the whole run, and it's barking at you when you walk up the stairs.
This isn't just random bad luck. Achilles tendinopathy is a classic overuse injury, and it develops when the load on the tendon exceeds its capacity to heal. It's a sign that something in your training, your mechanics, or your recovery is off balance.
What Is Achilles Tendinopathy?
Your Achilles tendon is the thick, strong cord that connects your calf muscles (the gastrocnemius and soleus) to your heel bone. It's responsible for plantar flexion, the "push-off" motion you use when you run, walk, or jump. Tendinopathy means the tendon has started to break down at a cellular level. It's not just inflamed (that's tendinitis, an acute condition), it's degenerating. The collagen fibers become disorganized and weak, making the tendon less able to handle load and more susceptible to further injury.
The pain is typically located right on the tendon, a few centimeters above the heel bone (mid-portion tendinopathy) or right where the tendon attaches to the heel (insertional tendinopathy). It feels stiff and sore in the morning and often hurts at the beginning of a run, eases up during, and then hurts more afterward.
Why Your Achilles Is Taking a Beating
This injury is a direct result of asking the tendon to do more work than it's prepared for. Here are the most common culprits I see in the clinic:
Sudden Training Jumps: The classic mistake. You get excited and ramp up your mileage too fast, or you throw in a bunch of hill repeats or speed work without building up to it. Your muscles adapt faster than your tendons, and the Achilles pays the price.
Tight or Weak Calves: Your calf muscles absorb a huge amount of force during a run. If they are weak or chronically tight, that load gets transferred directly to the Achilles tendon. The tendon isn't meant to be the primary shock absorber.
Changes in Footwear: Switching to a shoe with a lower "heel-to-toe drop" can put more strain on the Achilles if you're not used to it. Even running in old, worn-out shoes that have lost their support can change your mechanics and overload the tendon.
Running Mechanics: Overstriding (landing with your foot way out in front of your body) or having a very bouncy, inefficient stride can dramatically increase the peak load on your Achilles with every single step.
What Actually Fixes Achilles Tendinopathy
First, you have to stop doing what's irritating it. That doesn't always mean complete rest, but it does mean significantly reducing or stopping the activities that cause sharp pain, like running. Pushing through the pain will only make the tendon degeneration worse.
Here's the framework for getting it right:
Load Management: The first step is to calm the tendon down. This means backing off running and any other high-impact activities. You can often cross-train with activities like swimming or cycling (if it's pain-free) to maintain fitness.
Targeted Strengthening: This is the most critical piece. The goal is to build the tendon's capacity to handle load again. The gold standard exercise is the eccentric heel drop. For mid-portion tendinopathy, you'll do these on a flat surface or off a step. For insertional tendinopathy, you'll do them on a flat surface only to avoid compressing the tendon at the heel. The key is to perform the lowering phase slowly and controlled.
Calf and Posterior Chain Work: You need to address the muscles that support the tendon. This includes stretching and soft tissue work for the gastrocnemius and soleus (your calf muscles) and strengthening your glutes and hamstrings. A weak posterior chain often leads to compensation patterns that overload the lower leg.
Manual Therapy: In the clinic, I use soft tissue techniques like myofascial release and instrument-assisted work on the calf muscles to reduce tension and improve tissue quality. We also assess and address any restrictions in the ankle or foot that might be contributing to the problem.
Gradual Return to Running: Once you can handle load without pain and have built up sufficient strength, you can begin a very gradual return-to-run program. This usually starts with short walk/run intervals and slowly builds back up over several weeks. This is not the time to rush.
Final Word
Achilles tendinopathy is a frustrating injury because it can linger for months if it's not managed correctly. The key is to respect the pain, address the underlying causes (training errors, weakness, mechanics), and be patient and consistent with your rehabilitation. It won't get better overnight, but with the right approach, you can rebuild a resilient tendon and get back to running without that nagging pain in your heel.
Up next in Part 3, we'll break down shin splints: what they are, why they happen, and how to get rid of them for good.
Struggling with that nagging pain in your Achilles or wondering if it's something you can keep running on? Book an assessment with me, Dr. Keirstyn, at Endurance Therapeutics. Let's figure out the root cause and build a plan to get you back to training with confidence.
📍 Endurance Therapeutics | Oakville, Ontario
📞 905-288-7161