Common Running Injuries #6 〜Achilles Tendinopathy〜
Common Running Injuries #6
Pain Above Your Heel in the Morning? It Could Be Achilles Tendinopathy
Do you feel pain around your lower calf or just above the heel, especially when you take your first steps in the morning?
This could be Achilles tendinopathy, a very common condition among runners caused mostly by overuse.
Common Symptoms
- Pain with first steps in the morning
- Tenderness, swelling, or warmth in the Achilles tendon
- Tightness after running or jumping
- In severe cases, the tendon may feel thickened and stiff
Primary Causes
- Sudden increase in training load or hill running
- Tight or weak calf muscles
- Inadequate stretching or poor warm-up routines
- Reduced ankle mobility
- Worn-out or unsupportive footwear
Types of Achilles Tendinopathy
| Type | Characteristics |
| Acute | Involves inflammation, swelling, warmth, and sharp pain |
| Chronic | Less inflammation but increased stiffness and tendon thickening |
Physiotherapy-Based Management
Acute Phase
- Rest and ice therapy
- Taping or heel lifts to reduce tension
- Avoid stretching until inflammation settles
Chronic Phase
- Eccentric loading exercises (e.g., heel drops on stairs)
- Improve mobility in the calf and ankle
- Manual therapy or ultrasound treatment by a physiotherapist
For chronic Achilles tendinopathy, the most critical aspect of treatment is to progressively load the tendon and calf muscles to stimulate regeneration and strengthening. This approach is best exemplified by the Alfredson Protocol, one of the most evidence-based and widely-used rehabilitation methods for tendon injuries.
The protocol was developed by Swedish orthopedic surgeon Dr. Håkan Alfredson. Interestingly, it originated from his own personal case — he had chronic Achilles tendinopathy and was advised to undergo surgery. However, for the sake of research, he deliberately started eccentric loading exercises, placing repeated stress on the tendon through “heel drop” exercises.
To his surprise, the condition improved without surgery. This self-experiment became the foundation for the now-famous Alfredson Protocol.
The protocol includes:
- Heel drops on stairs, twice daily
- 3 sets of 15 reps with knee straight
- 3 sets of 15 reps with knee bent
- Continue despite mild pain
- Gradually add weight (e.g., holding dumbbells)
This approach is based on the concept that controlled mechanical loading encourages tendon remodeling and regeneration. Rather than avoiding all pain, the key lies in treating through load — the core philosophy behind the Alfredson Protocol and modern sports physiotherapy.
Prevention Tips
- Choose well-cushioned running shoes
- Warm up and stretch your calves thoroughly
- Monitor training intensity and volume
- Post-run recovery with ice, stretching, or massage