Achilles Tendon Pain: Causes and What Helps

By Nova Physical Therapy, an outpatient physical therapy clinic in North Hollywood, CA | Published October 2026

It started as stiffness at the back of your heel when you got out of bed. Now the tendon aches at the start of your runs, eases as you warm up, and then flares the next morning. Some days it hurts going up stairs or rising onto your toes.

Achilles tendon pain is common in runners and active adults, and it often builds slowly. The encouraging news is that the right kind of exercise is one of the best-supported treatments in all of physical therapy. This article explains why the Achilles hurts, what "tendinopathy" means, whether you need to stop running, how physical therapy helps, and which signs mean you need urgent care.

The short answer

Most Achilles tendon pain that builds over time is called Achilles tendinopathy, an overload problem in the tendon rather than a simple inflammation. The APTA's 2024 guideline gives its only top-grade recommendation to tendon loading exercise, done at the highest load you can tolerate at least three times a week, and says complete rest isn't needed (guideline summary; Chimenti et al., JOSPT 2024). A sudden pop at the back of the ankle, with trouble pushing off or standing on your toes, can mean a tendon rupture and needs urgent care. In California, you can see a physical therapist without a referral.

Why does my Achilles hurt?

The Achilles tendon connects your calf muscles to your heel bone. It handles large forces every time you walk, run, jump, or climb stairs. When load increases faster than the tendon can adapt, or when the tendon has less capacity than your activities demand, it can become painful.

Common features of midportion Achilles tendinopathy include (guideline summary):

• Pain in the tendon a few centimeters above where it attaches to the heel
• Pain with activities that load the tendon, like running, hopping, or stairs
• Tenderness when you squeeze the tendon
• Morning stiffness, or stiffness after sitting
• Sometimes a thickened area in the tendon

Things that may raise your risk include age, running and other sports, calf strength and endurance, body weight, and a sudden jump in training (guideline summary). Pain right at the back of the heel bone is a slightly different problem, called insertional Achilles tendinopathy, and is managed a little differently.

Is it tendinitis or tendinopathy?

You'll hear both words. "Tendinitis" suggests inflammation. Research shows that longer-lasting tendon pain usually involves changes in how the tendon tissue is organized and how well it handles load, not just inflammation. That's why clinicians now use the broader term "tendinopathy."

The difference matters for treatment. If the core problem is that the tendon can't handle the load you're asking of it, the solution is to gradually build its capacity, not just rest and wait.

Should I stop running?

Usually not completely. The 2024 guideline says complete rest isn't indicated, and that staying active within your pain tolerance, using your symptoms to guide progress, is the way forward (guideline summary).

A practical approach many clinicians use:

• Keep pain mild during activity, and make sure it settles by the next morning
• Cut back temporarily on hills, speed work, and jumping, which load the tendon most
• Cross-train with cycling or swimming if running is too painful
• Don't stretch aggressively if it flares the tendon; strength usually matters more
• Return gradually as the tendon tolerates more

Tendons recover slowly. The guideline describes successful recovery over about 6 to 12 months for many people, with return to their main activities and only mild, tolerable symptoms (guideline summary).

How can physical therapy help?

The 2024 APTA guideline recommends (guideline summary; Chimenti et al., 2024):

• Tendon loading exercise (strongest recommendation): calf exercises such as heel raises, progressed from holds to slow heavy lifting to hopping, done at least three times a week
• Education combined with loading, about tendon pain and how to manage activity
• Stretching or hands-on treatment when ankle stiffness is part of the problem

The guideline advises against low-level laser therapy for this condition. Heel lifts may temporarily reduce strain on the tendon for some people.

A physical therapy evaluation may include:

• Where the pain is and what brings it on
• Calf strength and endurance, including single-leg heel raises
• Ankle motion and how you walk, hop, and run
• Your training history and goals
• Screening for a tendon tear or other problems that need a physician

A typical plan may include:

• A progressive calf and tendon loading program
• Guidance on running volume, speed, and hills while you recover
• Strength work for the hips and legs
• A step-by-step return to running, jumping, or sport
• A home program you can keep doing on your own

Physical therapy doesn't guarantee a specific result or timeline. Questions about injections, imaging, or procedures are best directed to your physician. For more on why shockwave isn't a routine add-on for Achilles pain, read our post on shockwave therapy.

At Nova Physical Therapy in North Hollywood, sports injury rehab is one of our core services, and every plan starts with an evaluation so treatment fits what we find.

When is Achilles pain an emergency?

Get urgent medical care if you have:

• A sudden pop, snap, or feeling like you were kicked in the back of the ankle
• Trouble pushing off when walking, or being unable to rise up on your toes on that side
• A visible gap or sudden swelling and bruising above the heel

These can be signs of an Achilles tendon rupture, which needs prompt evaluation.

See a physician promptly if you have:

• Calf swelling, warmth, or redness, especially after surgery, travel, or a period of immobility, which could be a blood clot
• A hot, red, swollen heel or fever
• Pain that's constant, including at rest or at night
• Numbness or tingling in the foot
• Pain in several tendons or joints at once
• Symptoms that aren't improving despite consistent rehab

We screen for these signs during every evaluation and refer you to a physician when findings call for medical assessment.

Do I need a referral for physical therapy in California?

Not to get started. California allows direct access to physical therapy. A physical therapist can evaluate and treat you without a referral for up to 45 calendar days or 12 visits, whichever comes first. After that, a physician or podiatrist needs to sign the plan of care for treatment to continue. Your insurance plan may have its own referral rules, so check your coverage.

Frequently asked questions

Should I rest my Achilles completely?
Usually not. The 2024 guideline says complete rest isn't needed. Staying active within a tolerable level of pain, along with progressive loading exercise, works better for most people.

What exercises help Achilles tendinopathy?
Calf and tendon loading exercises, like heel raises progressed over time, have the strongest support. A physical therapist can set the right starting point and progression.

How long does Achilles tendinopathy take to heal?
It's often slow. Many people improve meaningfully over several months, and the guideline describes recovery over about 6 to 12 months for many.

Is it okay to run with Achilles pain?
Often, yes, at a reduced level. Pain during running should stay mild and settle by the next morning. Avoid hills and speed work until the tendon tolerates more.

Should I stretch my Achilles?
Stretching can help if ankle stiffness is part of the problem, but strengthening is usually more important. Aggressive stretching can sometimes flare symptoms.

Do heel lifts help Achilles pain?
Heel lifts may temporarily reduce strain on the tendon for some people, but they work best alongside a loading program.

Do I need a referral to see a physical therapist?
No, not to start. California allows direct access within the limits described above.

About Nova Physical Therapy

Nova Physical Therapy is an outpatient physical therapy clinic in North Hollywood, California, led by a Doctor of Physical Therapy. We help people recover from sports injuries, back and neck pain, work injuries, auto accident injuries, knee pain, and shoulder problems, and we also work with balance problems and rehab after surgery. Patients come to us from North Hollywood, Burbank, Studio City, Toluca Lake, Valley Village, and across the San Fernando Valley. Learn more about Nova or see our services.

Schedule an evaluation

If Achilles pain is slowing down your runs or your day, an evaluation can help you build a loading plan that fits your tendon and your goals.

Nova Physical Therapy
4795 Vineland Ave #E, North Hollywood, CA 91602
Call (818) 639-3402 | Book an appointment online

Disclaimer

This article is for general education only. It is not medical advice, a diagnosis, or a treatment recommendation for any individual. Heel and ankle pain have many causes, and only an in-person evaluation can determine what is right for you. No treatment guarantees symptom resolution, and results vary. Physical therapists evaluate movement and function within their scope of practice and refer to physicians when findings warrant. Physical therapy in California is regulated by the Physical Therapy Board of California.

References

1. Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision – 2024. J Orthop Sports Phys Ther. 2024;54(12):CPG1–CPG32. Link
2. Physical Therapy First. 2024 Clinical Practice Guideline for Midportion Achilles Tendinopathy (summary). Link