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 work
• Biomechanical contributors such as foot control, dorsiflexion limits, hip extension, and proximal weakness
• The role of perimenopause, estrogen changes, and life stress in tendon vulnerability
• Nutrition foundations for tendon healing, including energy availability, collagen synthesis, and carbohydrate support
• Practical considerations around footwear, heel-to-toe drop changes, and carbon-plated shoes

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00:00 – Welcome to Interdisciplinary Case MilesHosts introduce the evidence-informed case format.
02:05 – Case Presentation: Mid-Achilles Pain in a Half-Marathon Runner
Morning stiffness, crepitus, tendon thickening, and pain that fluctuates during runs.
05:10 – Why These Cases Are Challenging
The warm-up effect, post-run soreness, and training “push-through” patterns.
08:20 – Medical Evaluation Priorities
Training changes, hormonal factors, surgery history, and load management.
12:30 – Tendons Require More Than Rest
Why conservative care emphasizes strength, mechanics, and progressive loading.
16:10 – Foot Posture and the Kinetic Chain
Rigid vs flexible feet, arches, glute engagement, and core contribution.
20:05 – Achilles Mechanics: The “Wringing Out” Effect
How pronation and poor control increase tendon stress.
24:40 – Running With Tendinopathy: Pain Monitoring Guidelines
When continued running can be appropriate and how to track symptom response.
28:10 – PT Interventions: Eccentrics, BFR, and Load Progression
Strength-based tendon rehab and improving blood flow.
32:45 – Nutrition for Tendon Healing
Energy availability, collagen synthesis decline with age, and micronutrient support.
37:20 – Collagen Supplement Timing and Practical Use
Why collagen works best 30–60 minutes before tendon loading.
41:10 – During-Run Fueling and Injury Risk
Carbohydrate needs, glycogen depletion, fatigue-related mechanics breakdown.
45:30 – Chronic Tendon Changes Take Time
Why tendinopathy develops over years and requires patience in rehab.
48:10 – Proximal Drivers: Low Back, Hip Extension, and Glute Function
How upstream issues overload the Achilles.
52:20 – Footwear Considerations and Heel-to-Toe Drop Shifts
Carbon-plated shoes, shoe rotation, cushion effects, and transition errors.
57:30 – Final Takeaways

• Sara: Tendon recovery takes time but allows continued activity
• Kelsey: Fueling protects long-term tissue health
• Kate: Rest alone fails tendons need load and strength adaptation

1:01:30 – Closing and Case Submission Info

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