14: Achilles Tendinopathy in Runners - Can I Keep Running?

A 41-year-old female runner and experienced half-marathoner develops mid-Achilles tendon pain, morning stiffness, and a noticeable bump along the tendon. Symptoms improve after warming up but return with longer runs, leaving her caught in the common cycle of pushing through pain, resting without progress, and uncertainty about what actually helps. She wonders if her tendon, “hurts at the start but warms up, is that okay?”In this episode of Interdisciplinary Case Miles, Dr. Sara Raiser (MD) , Kelsey Pontius, and Dr. Kate Mihevc Edwards (PT) discuss the clinical presentation of Achilles tendinopathy, why it often becomes chronic, and why complete rest is rarely the solution.Key topics include:Tendon loading principles and why tendons require progressive strength workBiomechanical contributors such as foot control, dorsiflexion limits, hip extension, and proximal weaknessThe role of perimenopause, estrogen changes, and life stress in tendon vulnerabilityNutrition foundations for tendon healing, including energy availability, collagen synthesis, and carbohydrate supportPractical considerations around footwear, heel-to-toe drop changes, and carbon-plated shoesIf you’re enjoying these conversations, please follow the podcast and take a moment to rate or review it. Sharing it with a runner, coach, or healthcare provider helps us reach the people who can make the biggest difference in athletes’ lives.This podcast is for runners at every level, the coaches guiding them, and the healthcare professionals who care for them. We believe interdisciplinary care leads to better outcomes  and stronger runners.00:00 – Welcome to Interdisciplinary Case MilesHosts introduce the evidence-informed case format.02:05 – Case Presentation: Mid-Achilles Pain in a Half-Marathon RunnerMorning stiffness, crepitus, tendon thickening, and pain that fluctuates during runs.05:10 – Why These Cases Are ChallengingThe warm-up effect, post-run soreness, and training “push-through” patterns.08:20 – Medical Evaluation PrioritiesTraining changes, hormonal factors, surgery history, and load management.12:30 – Tendons Require More Than RestWhy conservative care emphasizes strength, mechanics, and progressive loading.16:10 – Foot Posture and the Kinetic ChainRigid vs flexible feet, arches, glute engagement, and core contribution.20:05 – Achilles Mechanics: The “Wringing Out” EffectHow pronation and poor control increase tendon stress.24:40 – Running With Tendinopathy: Pain Monitoring GuidelinesWhen continued running can be appropriate and how to track symptom response.28:10 – PT Interventions: Eccentrics, BFR, and Load ProgressionStrength-based tendon rehab and improving blood flow.32:45 – Nutrition for Tendon HealingEnergy availability, collagen synthesis decline with age, and micronutrient support.37:20 – Collagen Supplement Timing and Practical UseWhy collagen works best 30–60 minutes before tendon loading.41:10 – During-Run Fueling and Injury RiskCarbohydrate needs, glycogen depletion, fatigue-related mechanics breakdown.45:30 – Chronic Tendon Changes Take TimeWhy tendinopathy develops over years and requires patience in rehab.48:10 – Proximal Drivers: Low Back, Hip Extension, and Glute FunctionHow upstream issues overload the Achilles.52:20 – Footwear Considerations and Heel-to-Toe Drop ShiftsCarbon-plated shoes, shoe rotation, cushion effects, and transition errors.57:30 – Final TakeawaysSara: Tendon recovery takes time but allows continued activityKelsey: Fueling protects long-term tissue healthKate: Rest alone fails tendons need load and strength adaptation1:01:30 – Closing and Case Submission InfoBecome a supporter of this podcast: https://www.spreaker.com/podcast/interdisciplinary-case-miles--6623567/support.If you enjoyed this episode, don’t forget to follow and subscribe so you never miss a case.Have a question or a case you'd like us to explore on the show? We’d love to hear from you. Reach out anytime at [email protected].