Return to running after Achilles injury

Trying to return to running after Achilles injuries often leads to frustration and false starts!

Regardless of how slowly you rebuild your volume, it’s common that any running after Achilles episodes can cause the pain to come back.

The trick to a successful return to running is to plan your training with the Achilles in mind – not just avoiding it but actually getting controlled pressure on it during the run.

It’s also worth understanding why mild Achilles symptoms during running can actually be a GOOD thing!

We’ll cover both parts of this topic – the expected Achilles response to returning to running and how to structure your training for successful running after Achilles injury.

Types of Achilles injury

There are several types of injuries that can cause Achilles pain, and they each need a different approach to training and running.

For the Achilles tendon itself, you can have non-inflammatory reactions (known as “Achilles tendinopathy“), partial tearing of the tendon structure or a tendon rupture (complete tear with loss of all tendon function).

To add to that list, there are other conditions like an inflammation of the bursa underneath the Achilles tendon (called “Retrocalcaneal Bursitis“), non-inflammatory issues where the tendon meets the heel bone (called “Achilles Enthesopathy“) and even an irritation of the growth plate (called “Sever’s Disease”).

Knowing which pathology is causing your symptoms is rather critical – it determines whether you’re injury will react poorly to strong forces, bouncing or stretching, just to name a few.

For example, deficit heel raises (lowering your heels over a step and raising up again) can be great for Achilles Tendinopathies and even some partial Achilles tears.

However if you use them for larger partial tears, Achilles Enthesopathies, Retrocalcaneal Bursitis or Sever’s Disease, you’ll actually make the symptoms worse!

We’ll make reference to specific pathologies in the design of our training program below.

If you don’t know your diagnosis, I strongly recommend that you make a quick visit to your Doctor or Physiotherapist and get a firm diagnosis as it dictates how you’ll adjust your running plan going forward.

Effect of Achilles injury on running technique

The Achilles tendon can be considered like a huge spring at the back of the ankle.

Its job is threefold:

1. to absorb force on ground contact,
2. store that force during ground contact, and
3. release that force as you push off.

When there’s pain on Achilles loading, the brain adjusts small aspects of the running stride to reduce the symptoms.

For example, it won’t push off as much on the sore Achilles – this reduces the speed of energy release from the Achilles.

You’ll also find there’s a tendency to avoid forefoot landings (typically associated with faster running) as it makes the Achilles stretch and store energy as you land.

Both of those adjustments will lead to slower running, but…

If you run too slow and your cadence (steps per minute) reduces too much, there’s increased ground contact time and more stretch on the Achilles, leading to an accidental increase in tendon loading.

The other consideration is that the brain will often call on the uninjured side to do more (assuming that both Achilles aren’t effected), but that overloads the other side. This can lead to new injuries on the good side or, as it fatigues, a sudden shift in load back to the injured side.

How to modify your running technique to reduce Achilles loading

As mentioned in the section above, slowing down can reduce some aspects of Achilles loading but may accidental increase other aspects.

So here are some tips on tweaking your running technique for returning to running after Achilles tendon injuries:

1. Select shoes with a higher heel-toe offset (learn about what that is and other features of running shoes here)
2. Keep your cadence on the higher side – that isn’t necessarily 180 steps per minute (as you’ll often hear quoted) as it depends on your pace
3. Avoid excessive forward trunk lean – looking well out in front of you can help, rather than watching your feet
4. Think about running quietly/softly – the loudness of your impact directly correlates to the spike in force through your body, so less noise = less force spike
5. Take regular short walk breaks – muscle fatigue leads to longer strides and more Achilles loading so take a short 30-60sec walk break at set intervals to avoid a “tired” running technique

Program changes for running after Achilles injury

Here are the aspects of a typical running program and how they relate to running after Achilles injury:

Frequency of sessions

Let’s start with the best one – you need to run MORE OFTEN to recover an Achilles injury!

Yup, you read that right. More frequent running sessions (eg. 6 sessions/week vs 3 sessions/week) reduces the time between runs and offsets some of the stiffness and sensitivity issues that happen with rest days.

You still need to manage loading so you can’t take 3 x 10k each week and make it 6 x 10k each week.

As an example, if you go from running 3 x 10k each week and swap that for 6 x 5k each week, you can preserve your weekly distance while massively improving the recovery rate of your Achilles injury.

Speed sessions

Unfortunately there’s no way of hitting top speed without putting lots of load on the Achilles.

So your best compromise is to lengthen your speed intervals. If you can’t hit top speed, make your 200m intervals into 800m intervals so they require a less-than-max pace.

The other consideration here is that one of the biggest Achilles loads is experienced during acceleration. Comparing the two, 4 x 800m would only have 4 acceleration phases compared to 8 x 400m which would have 8.

Long runs

Long runs are slower so they naturally have less spiking of Achilles loads (as you land or push off), but there is more loading overall and it increases with fatigue (as mentioned above).

So the safest way to cover your long run is to keep it fairly flat (ie. avoid hills) and add short walk breaks at set intervals.

And while this may not sound like the sexiest option (runners having to walk, WTF!!!), it’s better than only covering half the distance or flaring the injury up again. It’s also a viable option to complete longer races before you’re back to 100% (popularised by Olympian Jeff Galloway).

Vertical/hill sessions

Running uphills can be problematic as the forward lean adds more stretch to the Achilles, and the incline needs more power to generate speed.

That combination can make uphill running one of the worst sessions for a recovering Achilles tendon.

A safer option would be stairs – you still get your vertical but the stairs limit the issue of overstride, taking away the stretch risk.

For stair running, try to land with your foot completely on the step (rather than toes on and heel off).

Sample running program (with explanations)

This program would be an early (building) phase program that I’d use for one of my mid-pack 10k runners. It would vary each week but this gives an overview of the rationale behind the design.