eccentric loading, heavy-slow resistance, and the one thing we see runners get wrong.
the shape of the problem
achilles tendinopathy accounts for roughly 6–18% of running injuries. it sits at the intersection of volume, age, and capacity — and responds, almost embarrassingly well, to structured loading.
what the evidence says
two decades of good trials point in the same direction. eccentric loading (alfredson), heavy-slow resistance training (beyer), and — crucially — continued activity within symptom limits produce measurably better outcomes than rest, anti-inflammatories, or passive care.
the thing runners get wrong
complete rest. we see it weekly. two weeks off running, then back at the old mileage, and back in our clinic a fortnight later. tendons get strong by being loaded, not by being protected. the trick is the right load.
a sensible protocol
three sessions a week of heavy calf work, progressing from 15 reps at a moderate weight to 6 reps at heavy weight over 12 weeks, alongside modulated running that stays below a 3/10 pain threshold. you will get better. it will take longer than you want it to.
when it's not that simple
insertional achilles tendinopathy (at the heel itself) behaves differently from mid-portion. we'll differentiate on exam. some cases benefit from shockwave or injection, but these are adjuncts to loading, not substitutes for it.
