Written by Dr. Marc Gruner
Propel Sports and Orthobiologics
Why rest alone is not enough
Resting a sore Achilles or patellar tendon often calms the pain, but it also lets the tendon and surrounding muscles lose capacity. When running starts again, the tendon is weaker than before, and the pain comes back. This cycle is one of the most common reasons runners stay stuck.
Tendons get stronger through progressive load. The safest path back to running is to rebuild that capacity on purpose, with exercises you can measure, before asking the tendon to handle the repeated impact of running.
Stage one: calm the tendon and start loading
Early on, the goal is to settle irritability without stopping activity completely. Cycling, swimming, or walking often keep fitness up while the tendon calms. Holds such as wall sits or calf raise holds can reduce pain and begin loading the tendon gently.
A useful guide is the pain-monitoring approach: a mild ache during exercise, around three out of ten, is acceptable if it settles within a day and does not steadily worsen from week to week.
Stage two: build real strength
Next comes heavier, slower strength work: single-leg calf raises, seated calf raises, split squats, step-downs, and hip exercises, with weight added over time. Runners need far more calf and thigh strength than most people expect, because running forces are several times body weight with every step.
Before running, most people should be able to do repeated single-leg calf raises and single-leg hops on the injured side without pain and with control similar to the other leg. Hopping and skipping drills also retrain the tendon's spring-like function.
Stage three: return to running with walk-run intervals
Start on flat, even ground with short walk-run intervals every other day, so the tendon has recovery time between sessions. Increase total running time gradually, and change only one thing at a time, such as distance, frequency, or pace.
Add speed work, hills, and track sessions last, because these place the highest load on tendons. Keep up strength training twice a week even after you are running normally. Sleep, fueling well enough for your training, and steady weekly volume all help prevent the next flare.
When to see a physician
See a sports medicine physician if tendon pain has lasted more than a few weeks despite a reasonable plan, keeps returning each time you build mileage, or limits walking. Our physicians use an exam and ultrasound to confirm the diagnosis and check for a partial tear, then guide your loading plan. When progress stalls, PRP or percutaneous tenotomy (Tenex) may help alongside rehab.
Seek prompt care for a sudden pop with weakness pushing off the foot, which can signal an Achilles rupture that may need surgery. Pinpoint bone pain that worsens with each run can signal a stress fracture, and night pain, swelling, or fever with pain should also be checked quickly.
Frequently asked questions
- Is it okay to run through tendon pain?
- Mild tendon discomfort during a run can be acceptable if it stays low, settles within a day, and is not getting worse week to week. Sharp pain, limping, or pain that builds each day means the load is too high. In that case, scale back running and keep up strength work.
- Should stretching come before strengthening for a sore Achilles?
- Strengthening matters more. Aggressive stretching can irritate some tendons, especially at the heel attachment. Progressive calf strength work is the core of most Achilles rehab plans.
- Do running shoes or orthotics help tendon injuries?
- Shoes and orthotics can shift where load lands, which sometimes eases symptoms. They work best as a short-term support while strength improves, not as a replacement for rehab. Big, sudden changes in footwear can themselves irritate tendons.
What to expect at your visit
- 1.
We listen first
Your visit opens with a real conversation: how the problem started, what you have already tried, and the activity you want back.
- 2.
Exam and in-office ultrasound
A hands-on exam, then ultrasound at the exam table, often while you move, so your physician can see the tendon, joint, or nerve involved.
- 3.
A clear diagnosis and plan
You leave knowing what is wrong and what your options are, from strength-based rehab to procedures, and why we recommend each one.
- 4.
Treatment and follow-through
Most procedures happen here in the office. We coordinate with your physical therapist and check progress against the goals you set.