Achilles Tendinopathy: Why Rest Alone Often Doesn’t Fix Achilles Pain

That first step out of bed hurts!

You walk around for a few minutes and it starts to loosen up. You might even find that your Achilles feels better once you’ve warmed up during exercise — only for the stiffness to return later that day or the following morning.

Sound familiar?

You may be experiencing Achilles tendinopathy.

It’s a common problem in runners and active adults, and one of the first things people often try is simply resting until the pain disappears.

Unfortunately, rest alone doesn’t always solve the problem.

What is Achilles tendinopathy?

The Achilles tendon is the large tendon connecting your calf muscles to your heel.

Every time you walk, run, jump or push through your foot, the Achilles has to tolerate and transfer force.

Achilles tendinopathy is a condition involving pain and reduced function of the Achilles tendon, often associated with changes in how much load the tendon is being asked to tolerate.

Common symptoms include:

• Pain or stiffness around the Achilles

• Morning stiffness

• Tenderness when touching the tendon

• Pain during or after running

• Discomfort with calf raises

• Stiffness after sitting for a prolonged period

• Symptoms that initially improve once you’ve warmed up

Some people also notice that the tendon feels thicker than the other side.

Why has my Achilles suddenly started hurting?

One of the first questions we often ask isn’t:

“What have you done to your Achilles?”

It’s:

“What changed?”

Achilles problems commonly appear following a change in activity or training load.

Perhaps you’ve:

• Increased your running mileage

• Started running more frequently

• Added hill running

• Introduced sprinting or interval sessions

• Returned to exercise after a break

• Started playing a new sport

• Increased your gym training

• Suddenly done much more walking than usual

Sometimes it’s not one dramatic change.

Several smaller increases in activity can add up.

Your cardiovascular fitness may be perfectly capable of handling the additional exercise, but your tendons still need time to adapt to increased loading.

Why doesn’t resting my Achilles fix it?

If something hurts, stopping the activity seems logical.

Temporarily reducing an aggravating activity can absolutely be appropriate.

The problem comes when rest becomes the entire rehabilitation programme.

Imagine your Achilles currently struggles to tolerate running.

You stop running for six weeks.

The pain settles because you’ve removed the activity that was aggravating it.

But during those six weeks, you haven’t necessarily improved your calf strength or increased the amount of load your Achilles can tolerate.

You then return to your previous running volume.

The symptoms return.

This can create a frustrating cycle:

Run → Achilles hurts → Rest → Feels better → Start running again → Achilles hurts again

The missing piece is often progressive rehabilitation.

Should you stretch a painful Achilles?

People with Achilles pain are frequently told they have tight calves and need to stretch more.

But stretching isn’t automatically the answer.

In some cases — particularly when pain is close to where the Achilles attaches to the heel — repeatedly forcing the ankle into a deep stretch can aggravate symptoms.

Rather than assuming the tendon simply needs to be stretched, it’s useful to establish what the tendon can currently tolerate and where its limitations are.

How do you rehabilitate Achilles tendinopathy?

There’s no single exercise programme that’s right for everyone with Achilles pain.

Rehabilitation should reflect your symptoms, current strength, activity level and what you’re trying to return to.

However, progressively strengthening the calf and Achilles complex will commonly form an important part of rehabilitation.

A programme might progress through stages such as:

Isometric calf holds

↓

Double-leg calf raises

↓

Single-leg calf raises

↓

Heavier calf strengthening

↓

Faster and more explosive exercises

↓

Hopping and jumping

↓

Return to running or sport

Not everyone needs exactly this progression, and how quickly you move through it will depend on your individual presentation.

Someone who wants to comfortably walk the dog has very different physical requirements from someone preparing for a marathon or returning to football.

Don’t forget the soleus

When people think about strengthening their calves, they often think about straight-knee calf raises.

But there’s another important muscle we need to consider: the soleus.

The calf complex includes both the gastrocnemius and soleus, and both contribute significantly during walking and running.

That’s why Achilles rehabilitation will often include calf exercises performed with both a straighter knee and a bent knee.

For runners in particular, developing good calf and soleus capacity can be an important part of preparing the lower leg for repeated running loads.

Can you keep running with Achilles tendinopathy?

Sometimes, yes.

Having Achilles pain doesn’t automatically mean you need to stop running completely.

A better question might be:

“How much running can my Achilles currently tolerate?”

For one person, temporarily stopping running may be appropriate.

For another, reducing weekly mileage might be enough.

Someone else might tolerate easy running but need to temporarily remove hills, intervals or sprinting.

The aim is often to find an appropriate level of activity and then gradually build from there as the tendon becomes more capable.

How long does Achilles tendinopathy take to recover?

Tendons generally don’t change overnight.

Some people notice improvements relatively quickly, while longer-standing Achilles problems may require rehabilitation over several months.

That doesn’t necessarily mean you’ll be unable to exercise throughout that period.

A good rehabilitation programme should aim to keep you as active as your symptoms safely allow, while progressively rebuilding the strength and capacity required for your chosen activity.

When should you get Achilles pain assessed?

Consider getting your Achilles assessed if:

• The pain keeps returning whenever you exercise

• Morning stiffness is becoming more noticeable

• Symptoms are progressively worsening

• You’ve reduced your activity but the problem isn’t improving

• You’ve noticed a loss of calf strength

• You’re struggling with single-leg calf raises

• You’re unable to return to running or sport

• You’re unsure how much exercise you should be doing

What about an Achilles rupture?

A sudden sharp pain or snapping sensation, particularly if followed by immediate weakness or difficulty pushing through the foot, is different from typical gradual-onset Achilles tendinopathy.

This requires prompt assessment to rule out a significant Achilles injury or rupture.

Achilles Pain Treatment & Rehabilitation in Biggleswade

At MEHAB Injury & Wellness Clinic in Biggleswade, we work with runners, gym-goers, sportspeople and members of the general public experiencing Achilles and other lower-limb problems.

An assessment isn’t simply about finding the painful area.

We want to understand:

Why is your Achilles struggling with its current demands, and what does it need to be able to do next?

Depending on your presentation, your rehabilitation may involve:

• Injury assessment

• Strength and movement testing

• Calf and soleus strengthening

• Training-load modification

• Exercise rehabilitation

• Physiotherapy

• A progressive return-to-running or return-to-sport programme

The goal isn’t simply to make your Achilles feel better for a few days.

It’s to build its capacity so you can get back to doing what you want to do.

Struggling with Achilles pain?

If your Achilles pain keeps disappearing with rest and returning every time you exercise, it may be time to find out why.

Book an initial assessment with the MEHAB team in Biggleswade.