Achilles Pain That Only Appears When Running

Achilles pain that feels worse in the morning, improves after a short run, and flares up again with hills or speed is commonly associated with Achilles tendinopathy.

Current research indicates that this condition is degenerative and load-related, rather than inflammatory. Excessive or poorly managed loading exceeds the tendon’s capacity to adapt.

Common Clinical Features

• Morning stiffness or limping on first steps

• Temporary symptom relief after warming up

• Increased pain with uphill running or acceleration

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What Helps (and What Doesn’t)

Direct tendon massage may aggravate sensitive tissue and is generally not recommended in painful stages.

More effective strategies include:

• Calf muscle belly release to reduce tensile load on the tendon

• Foot intrinsic strengthening (e.g., towel toe pulls)

• Slow, controlled heel drops to stimulate tendon remodeling and improve load tolerance

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Multiple studies support progressive loading programs as the cornerstone of Achilles tendinopathy management.

Persistent or worsening symptoms should be assessed by a physiotherapist to rule out partial tears or load management errors.

Key References (summary):– Alfredson et al., 1998– Malliaras et al., British Journal of Sports Medicine– JOSPT Clinical Practice Guidelines – Achilles Tendinopathy