Achilles pain typically starts as stiffness in the tendon first thing in the morning or at the start of exercise, easing as you warm up and returning afterwards. The tendon may be thickened and tender to squeeze. It is usually a tendinopathy rather than an inflammation, which is why the older name tendonitis is gradually being replaced.
If the problem were inflammation, rest and anti-inflammatories would fix it. They do not, and that is the single most useful thing to understand about tendon pain.
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Why loading is the treatment
Tendons adapt to load and de-adapt without it. A tendon that hurts has usually been asked to do more than it was conditioned for, and the answer is a carefully graded programme that loads it enough to stimulate adaptation without provoking a flare. Some discomfort during the exercises is expected and acceptable, which is counterintuitive and is why tendon programmes need supervising rather than handing over on a sheet.
Progress is measured in months. Three to six is common, and stopping when the pain eases is the usual reason it recurs.
Managing it while you keep training
Most runners do not need to stop entirely. Reducing volume, avoiding hills and speed work for a period, and keeping the loading programme going usually beats resting completely and then returning to the same mileage.
Warning signs
A sudden sharp pain in the back of the ankle, often described as being kicked or hit, with difficulty pushing off or standing on tiptoe, may be a rupture and needs urgent medical assessment rather than a physiotherapy appointment. If you have taken fluoroquinolone antibiotics recently, mention it, as they carry a small increased risk of tendon problems.
Frequently Asked Questions
Should I rest my Achilles tendon?
How long does Achilles tendon pain take to settle?
Can I keep running?
How do I know if I have ruptured it?
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