As runners, we push ourselves through countless miles—pavement, trails, track—the trials of miles. This consistency builds our strength and endurance, but it can also lead to overuse injuries, and Achilles tendinitis is one of the most common effective between 7 to 11% of runners. Achilles tendinitis develops when the tendon connecting your calf to your heel becomes irritated and inflamed. Often this pain is proceeded by an increase in activity- more miles, faster workouts, and or hills. You might notice a dull ache or stiffness at the back of your ankle, particularly when starting a run or even after long periods of sitting.

Here’s the good news: with the right approach and proper management, most runners make a full recovery, returning to regular training without long-term setbacks. Joe Norton Physical Therapy in NW Washington, DC, we’re experienced in treating Achilles tendinitis specifically for runners, using personalized techniques to get you back on your feet as quickly as possible.

What is Achilles Tendinitis?

The typical runners I see who develops achilles tendinitis is in their 30’s and 40’s training for a marathon. These are folks who are active and strong! Usually they have made a big jump in mileage, running faster workouts OR they had not been doing a lot of running and have had to ramp up training quickly. Most of these folks do not seek help right away as the pain begins insidiously. They try to stretch and massage it away. After a few weeks or months of not improvement OR worsening pain, they seek physical therapy help.

Understanding the root cause of Achilles tendonitis is essential to effective treatment. At Joe Norton PT, we identify the root cause to tailor a treatment plan. The achilles tendon is the strongest tendon in our body. It has a very big task! When running it needs to be able to tolerate up to 4 to 7 times our body weight in force!

We start by assessing the underlying factors, such as training habits, muscle imbalances, and flexibility deficits, to create a plan tailored to each runner's specific needs.

Physical therapy in NW Washington, DC, can effectively manage and treat Achilles tendinitis. Common symptoms include pain and stiffness along the Achilles tendon, especially in the morning, and pain that worsens with activity.

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Diagnosis and Evaluation

Proper diagnosis is essential for effective treatment. At Joe Norton Physical Therapy in NW Washington, DC, our PTs are specially trained in achilles tendinitis, something our running specialists see often.

Often runners with Achilles tendinitis will experience pain at the back of their heel or 1 to 3 inches above. The may feeling more stiffness and will have pain with running, jumping and walking. Frequently, these folks will have had a recent increase in training in the last 2 to 6 weeks.

This includes a thorough physical examination to assess for tenderness and swelling, as well as a functional evaluation to understand how the injury affects your daily activities and running. In some cases, imaging tests like ultrasound or MRI may be recommended to better evaluate the extent of the injury. We also work closely with local sports medicine physicians to ensure our clients receive comprehensive care.

Physical Therapy Treatment Options

Physical therapy is a cornerstone in the treatment of Achilles tendinitis. Joe Norton Physical Therapy offers a comprehensive approach to manage and alleviate symptoms. Our tailored exercise programs strengthen the calf muscles and Achilles tendon.

Step 1: Managing Discomfort

In the early stages of Achilles tendonitis, managing discomfort and reducing inflammation is crucial. While complete rest is often unnecessary, we typically recommend adjusting your training to include low-impact activities like cycling or swimming. These activities allow you to stay active without placing excessive stress on the tendon. Reducing your training volume by 50% and avoiding faster running or hills for 2 to 6 weeks may be necessary to get ahead of the pain.

Manual therapy and dry needling can effectively reduce pain and improve mobility. Research suggests that needling the calf and areas near the tendon may be more effective than eccentric exercises (https://pubmed.ncbi.nlm.nih.gov/23263998/) in the acute phase, making it a powerful tool during the early stages of rehabilitation.

Using a 1-centimeter heel lift has also proven to be a helpful adjunct for offloading the tendon especially for insertional tendinopathy cases. This approach reduces tendon strain during the muscle-tendon “stretch-shortening” cycle. For clients experiencing insertional Achilles tendon pain, a heel lift is often an essential component of treatment.

Step 2: Strengthening and Kinetic Chain Work

As symptoms improve, the focus shifts to building strength and ensuring the rest of your kinetic chain—trunk, hips, and knees—is functioning optimally. Calf strengthening is one of the most effective treatments for Achilles tendonitis, starting with slow, controlled heel raises and lowering exercises. Gradually, these exercises progress to include full ankle range of motion, single-leg variations, and added resistance. It is important to be able to perform a single leg heel raise with 30 to 50% of your body weight before moving on to “step 3”. There exercise progressions promote healthy tissue adaptation and enhances the tendon’s endurance, preparing it for the demands of jumping and running.

We also address any imbalances in the hips, ankles, or core to ensure the entire kinetic chain works efficiently, reducing unnecessary strain on the Achilles tendon. Limited ankle mobility and weaknesses in the quads, hip abductors, and extensors often accompany Achilles tendinopathy due to compensatory movement patterns triggered by pain. Exercises such as lunges, marching drills, and single-leg deadlifts engage the entire kinetic chain, reinforcing movement patterns essential for running.

Step 3: Gradual Return to Running

With the tendon feeling stronger and symptoms under control, we can start easing back into running. Progressing gradually is key—starting with shorter, slower runs and gradually building distance and intensity. Each runner's return-to-run plan is individualized, but we always focus on listening to the body and not pushing too quickly.

Pain during running is not uncommon and will likely happen at some point. As long as the pain is <3/10 and not concerning, then green light to continue as you are very safe. If the symptoms are between 3 to 5/10 this is a yellow light to proceed with caution. It is appropriate to continue running here as long as the pain is not disconcerting, and clears up in the next 24 hours. Any pain >5/10 is a red light. Stop and walk for a few minutes. If the symptoms clear, then resume. However, if the pain comes back then call it a day. Take 2-3 days off and reduce the level in the program. 

Step 4: Staying Injury-Free

Preventing a recurrence of Achilles tendonitis is just as important as treating the initial condition. At Joe Norton PT, we focus on education and proactive strategies to help you avoid future episodes. Staying consistent with strength and mobility exercises, along with incorporating cross-training, is crucial for maintaining tendon health.

Research shows that 25–40% of individuals with Achilles tendinopathy continue to experience calf and tendon strength deficits (https://doi.org/10.1016/j.ptsp.2022.05.002). This is why we strongly encourage runners to complete all stages of physical therapy and maintain a strengthening routine 1–3 times per week for the rest of their lives.

We also assess running form and mechanical factors that could contribute to excessive strain on the tendon. However, I believe that factors like training loads and muscle imbalances often play a more significant role than footwear in the development of tendon issues. By addressing these key areas, we can help you build resilience and reduce the risk of future injuries.

The Role of Physical Therapy in Recovery

Physical therapy plays a critical role in the recovery from Achilles tendinitis. At Joe Norton Physical Therapy, our personalized approach ensures effective and lasting results.

Each patient receives a customized plan tailored to their specific needs. We provide continuous support and adjustments to the treatment plan as needed. Additionally, we empower patients with the knowledge to manage their condition independently.

Achilles tendinitis can be a debilitating condition, but with the right treatment and preventive measures, recovery is possible. At Joe Norton Physical Therapy in NW Washington, DC, we are committed to helping you achieve a pain-free and active lifestyle.

Contact us today to schedule an appointment and start your journey to recovery.

Contact Joe Norton Physical Therapy in NW Washington, DC, today to schedule your appointment and take the first step towards recovery from Achilles tendinitis.

TL;DR:

What is Achilles tendinitis?

Achilles tendinitis is an overuse injury of the Achilles tendon, causing pain and stiffness.

How can physical therapy help with Achilles tendinitis?

Physical therapy can help by providing tailored exercise programs, manual therapy, dry needling, taping and other modalities to reduce pain and promote healing.

What are common symptoms of Achilles tendinitis?

Common symptoms include pain and stiffness along the Achilles tendon, especially in the morning, and pain that worsens with activity.

What are the risk factors for Achilles tendinitis?

Risk factors include age, training errors, and medical conditions like obesity and hypertension.

How can I prevent Achilles tendinitis? Prevention strategies include wearing proper footwear, incorporating regular calf strengthening exercises, and gradually increasing activity levels.