Achilles Tendon Pain in Runners: What Denver PTs Recommend Instead of Resting

If you’re a runner in Colorado, chances are you’ve felt that nagging ache just above your heel. Maybe it started as tightness in the morning. Maybe it flared up after a few hill repeats. Either way, Achilles tendon pain is one of the most common overuse injuries we see at Rise Rehab and Sport Performance in Denver.

And here’s the kicker: resting it rarely solves the problem.

Yes, you might feel a little better after taking time off. But if you jump right back into training without addressing the root causes, the pain almost always returns.

In this post, we’ll break down what causes Achilles tendon pain in runners, why rest alone isn’t enough, and what Denver-based physical therapists actually recommend to get you back on the trail or road—stronger than before.

What Is Achilles Tendinopathy?

The Achilles tendon connects your calf muscles (gastrocnemius and soleus) to your heel bone. It plays a major role in walking, running, and absorbing ground reaction forces.

Achilles tendinopathy refers to pain, dysfunction, and thickening of the tendon due to repetitive overload. It's often mislabeled as "tendinitis," but true inflammation is rarely the primary issue.

Two Common Types:

• Midportion Achilles Tendinopathy: Pain is located 2–6 cm above the heel.

• Insertional Achilles Tendinopathy: Pain is right where the tendon attaches to the heel bone.

Both can affect runners, but treatment differs slightly depending on location.

Why Rest Doesn’t Fix It

Rest can temporarily reduce symptoms, but it doesn’t resolve:

• Tendon capacity deficits

• Biomechanical inefficiencies

• Strength and loading impairments

In fact, complete rest may decondition the tendon further, making it even less tolerant to load when you return.

The better solution? Load it—progressively and intelligently.

Tendons respond to mechanical loading. The right rehab plan helps remodel the tissue, improve its strength, and restore your ability to run without pain.

Common Causes in Runners

Achilles tendon pain usually develops from a combination of training errors and mechanical factors. Here are some key contributors:

1. Sudden Increases in Volume or Intensity

Your tendon needs time to adapt. Rapid mileage spikes, added hill work, or speed training can exceed its current capacity.

2. Poor Ankle Mobility or Dorsiflexion Stiffness

Limited ankle range of motion increases strain on the Achilles and forces compensations up the chain.

3. Weak or Underactive Calf Muscles

The gastrocnemius and soleus help absorb force with every step. If they’re not strong or well-conditioned, the tendon takes more of the load.

4. Poor Running Mechanics

Overstriding, poor cadence, or excessive forward lean can increase the eccentric load on the Achilles.

5. Footwear Changes

Switching to minimalist shoes or worn-down heels can alter tendon loading significantly. Gradual transitions are key.

What Denver PTs Recommend Instead of Rest

So what should you actually do? At Rise, we approach Achilles rehab through targeted loading, mobility, and full-chain strengthening.

1. Eccentric and Heavy-Slow Resistance Training

One of the gold standards for tendon rehab.

Example: Heel Drops (Eccentric Focus)

• Stand on a step with heels hanging off

• Raise up with both feet

• Slowly lower with affected leg only (3–5 seconds)

• 3 sets of 12–15 reps

Modify angle and depth depending on whether it's midportion or insertional.

Example: Heavy-Slow Calf Raises

• Use a barbell or dumbbells

• 3 seconds up, 3 seconds down

• Start with double leg, progress to single leg

• 3–4 sets of 6–8 reps

This loads the tendon while encouraging remodeling and hypertrophy in the calf complex.

2. Restore Ankle and Foot Mobility

Restricted dorsiflexion increases stress up the chain. Try:

• Banded ankle mobilizations

• Deep calf stretch in standing or half-kneel

• Toe mobility work for better push-off mechanics

3. Isometric Loading for Pain Modulation

Great in early phases when symptoms are high.

Wall Calf Isometric Hold

• Stand in a staggered stance against the wall

• Raise heel of rear leg slightly and hold

• 30-45 seconds x 3–5 rounds

Reduces tendon pain while maintaining load tolerance.

4. Strengthen the Posterior Chain

Tendons don't work in isolation. Train the system:

• Romanian deadlifts

• Hamstring bridges or curls

• Step-downs

• Lateral hip work (e.g., banded sidesteps)

All of these help reduce overreliance on the Achilles.

5. Modify Running, Don’t Eliminate It

Most runners can keep running with modifications:

• Reduce volume, not eliminate it

• Avoid hills temporarily

• Switch to softer surfaces

• Increase cadence (try 5–10% boost)

Loading the tendon with low-intensity running can be beneficial, as long as symptoms stay mild and recover within 24 hours.

Bonus: A Sample Progression

This is a simplified outline and should be individualized, but here’s a general idea:

Week 1–2:

• Isometrics for pain relief

• Light mobility work

• Double-leg heel raises

Week 3–5:

• Eccentric heel drops

• Add load to calf raises

• Begin posterior chain work

Week 6–8:

• Single-leg heavy-slow calf work

• Return to running drills

• Plyometrics (e.g., pogo hops, bounding)

The Takeaway

If you’re a runner with Achilles tendon pain, resting isn’t your best option.

Instead, address the real problems:

• Tissue load tolerance

• Calf and posterior chain strength

• Ankle and foot mobility

• Running mechanics

Physical therapy can guide you through the right progressions so you recover faster, stay stronger, and get back to running confidently.

At Rise Rehab and Sport Performance, our Denver-based PTs specialize in helping runners resolve Achilles issues without giving up the sport they love.

Ready to rebuild your stride? Book your discovery call today!