Is it ok to run on your Achilles if it is painful?

I would answer this by first asking another question: Is your pain changing the way that you run? For example, limping or putting more weight on the outside of your foot or the other leg due to the pain. If the answer is yes, then I would not recommend running as you risk injuring another area. Sometimes, people are not sure if their pain is changing the way that they are running and in this scenario, a pain score may be a better guideline. A lot of research uses a pain score of less than 5/10 (0=no pain, 10=the worst pain you can imagine) as a safe zone to run in if you feel comfortable to do so (Silbernagel & Crossley, 2016).

The second question I would ask is, how are you feeling the day after your run? If you are hobbling badly first thing in the morning when you get up, then your running needs at least some modulation (e.g. reducing time or intensity). If this continues for several days after a run, then I would counsel you to stop running until we settle down your Achilles and build up your strength and tolerance.

What exercises can I do to help get me back running?

The good news is that there is always something that you can be doing. Gradually building up your strength and tolerance to exercise and daily activities is crucial. There was a great paper done by Baxter et al. (2020) that looked at over 20 different exercises for the Achilles and created an index of loading. That is, they created a guideline on how to progressively increase the intensity of exercises on the Achilles. The table below shows several exercises and their corresponding loading index on the Achilles.

You should get advice from a physio who is experienced in treating Achilles tendon problems in regards to specific volumes and how often you should do your exercises. Remember, gradually building up your exercise tolerance is the key to getting back to running.

When can I go back to running?

There is a barrage of tests that can be undertaken to assess readiness for return to running and they should be individualised depending on the demands of the runner (e.g. marathon runner vs casual runner who runs 3km twice per week). However, in general I like my runners to demonstrate good calf endurance (20 single leg calf raises) and no provocation with 10 single leg hops prior to running. No provocation does not necessarily mean they must be pain free, but their pain must be stable. I define stable as less than or equal to 3/10 and no flare ups thereafter (this has often already been tested as by now they will have been doing hopping as a regular part of their weekly program). At his point, running can be reintroduced progressively. That is, a gradual increase in their running which can be done in a number of ways. I often start with a walk-run interval program (e.g. run 1 minute, walk 1 minute for a total of 20-30mins) which is built up over the coming weeks. To start with, there should be 2 days between any repeat running.

If you have any questions regarding Achilles tendinopathy or think you may benefit from physiotherapy, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

References

Baxter et al. (2020). Exercise progression to incrementally load the achilles tendon. Medicine & Science in Sports & Exercise. DOI: 10.1249/MSS.0000000000002459

Silbernagel & Crossley (2016). A proposed return-to-sport program for patients with midportion achilles tendinopathy: rationale and implementation. JOSPT 45(11)

Achilles Tendon Pain: When Am I Ready To Run?