Why Your Achilles Pain Won’t Go Away (And How to Fix It) | Dr. Kate, Physical Therapist

March 23, 2026

If you’ve been dealing with Achilles pain that just won’t go away, you’re not alone—and more importantly, there’s usually a clear reason why.

In this guide, Dr. Kate, a physical therapist who works closely with runners and endurance athletes, breaks down why Achilles tendon issues tend to linger and what actually needs to change to fix them.

One of the biggest problems she sees is this: Your Achilles tendon never fully rebuilds its capacity. Or if it does, it never exceeds it.

That means every time you return to normal training, you’re still operating right at your limit and the cycle of pain continues. The good news is that this is fixable.

But it requires a shift in how you think about rehab, strength, and what your tendon actually needs to handle the demands of running.

Running Isn’t Rehab (And Why That Matters)

One of the most common misconceptions runners have is thinking that running itself will fix Achilles pain.

But as Dr. Kate explains, running is not rehab. Running is the activity that loads the tendon. While it can create some adaptation, it’s not enough to rebuild the capacity your tendon needs to stay healthy long-term. That’s why structured rehab is essential.

The foundation of Achilles rehab is progressive loading exercises, ideally performed at the highest load you can tolerate. That’s what actually drives meaningful improvement.

The Real Goal of Achilles Rehab

The goal isn’t just to reduce pain. It’s to close the capacity gap that caused the injury in the first place.

Dr. Kate breaks this down into three key areas:

Tendon tolerance → the ability to handle load without flare-ups
Strength and endurance → especially through the calf complex
Power and elasticity → the “spring” needed for efficient running

Research shows that runners with Achilles tendinopathy can have strength deficits as high as 44%, which is significant.

And one of the most overlooked pieces of rehab is power that elastic component that directly translates to running performance.

The Non-Negotiables of Achilles Rehab

There are a few key principles that Dr. Kate emphasizes for every runner going through Achilles rehab.

Train Single Leg

Running is a single-leg activity.

If you’re only doing double-leg exercises, one side can compensate for the other—meaning you’re not fully addressing the issue.

Train Both Straight and Bent Knee

You need to include:

Straight leg calf raises
Bent knee calf raises

Both are essential for targeting different parts of the calf complex.

Progress Your Load

A common mistake is keeping rehab completely pain-free and never increasing difficulty. If you don’t progressively load the tendon, it won’t adapt and you’ll plateau.

Train Through the Range You Need

This includes progressing to deficit calf raises, not just stopping at ground level.

For insertional Achilles issues, this may need to be introduced gradually, but it’s still an important step.

Be Consistent

Rehab should be done at least 3 times per week, especially in the early stages.

Consistency is what builds capacity over time.

Why the Soleus Muscle Is So Important

One of the biggest gaps Dr. Kate sees in rehab programs is a lack of focus on the soleus muscle.

While the gastrocnemius is the more visible calf muscle, the soleus:

Has a large cross-sectional area
Produces significant force
Plays a major role in running

In fact, it can contribute more force than many major lower-body muscles. To properly target it, you need to include bent knee calf raises. Skipping this is a major limitation in many rehab programs.

The 4 Types of Exercises You Need

A complete Achilles rehab program should include four key types of loading.

1. Isometrics (Static Holds)

These are useful when the tendon is more sensitive.

They:

Allow you to load the tendon
Tend to be less aggravating

But they still need to be progressed over time.

2. Heavy Strength

This is one of the most important parts of rehab.

Key principles:

Low reps
Slow tempo
High load

Even early on, many runners can tolerate more heavy strength work than they expect especially when movements are controlled.

3. Muscular Endurance

This includes higher-rep work like:

3–4 sets
8–12+ reps

This helps build the endurance needed for longer runs and sustained effort.

4. Plyometrics (Later Stage)

These involve the stretch-shortening cycle.

Think:

Hopping
Jumping
Reactive movements

These directly replicate running and help restore that elastic “spring.”

They should be introduced later once the tendon can tolerate them.

Pain During Rehab: What’s Acceptable?

Pain doesn’t mean you’re doing damage but it still needs to be managed.

Dr. Kate recommends using a general guideline of:

Up to 5/10 pain during and after exercise

The key is making sure symptoms:

Don’t progressively worsen
Stay within your personal tolerance

These guidelines should always be adjusted based on how your body responds.

How to Combine Rehab With Running

If you’re still running while rehabbing your Achilles, how you structure things matters.

Dr. Kate recommends:

Run first
Do rehab after

This helps manage total load more effectively.

You also want to:

Allow proper recovery between sessions
Monitor how your symptoms respond
Adjust your program as needed

The goal is to load the tendon enough to improve but not so much that you overload it.

Where Tools Like LEVER Can Fit In

One of the biggest challenges during Achilles rehab is finding the balance between keeping your running consistent and not overloading the tendon.

This is where tools that reduce load—like body weight support systems—can play a helpful role.

As Dr. Kate explains, running itself is still a form of loading. So if your tendon isn’t yet able to tolerate full body weight at your normal training volume, reducing that load can help you stay active while your capacity builds.

Using body weight support allows you to:

Maintain your running frequency
Reduce stress on the Achilles tendon
Stay within your pain guidelines
Gradually reintroduce full loading over time

Instead of completely removing running, it gives you a way to modify the stress placed on the tendon, which can be especially useful during more sensitive phases of rehab.

Like any tool, it’s not a replacement for strength work or progressive loading but it can help bridge the gap between where you are now and where you want to be.

Other Factors That Can Influence Recovery

While rehab exercises are the foundation, there are other factors that can support your progress.

These include:

Strength work for hips, quads, and hamstrings
Small cadence adjustments (around 5%)
Sleep and stress management

There are also treatments like:

Massage
Acupuncture
Dry needling
Flexibility work

These can be helpful additions, but they are not the main solution. They’re what Dr. Kate refers to as adjuncts, meaning they support the process but don’t replace proper loading and strength work.

Achilles pain doesn’t linger because it’s random it lingers when the tendon never fully rebuilds the capacity needed to handle your training.

As Dr. Kate emphasizes, the goal isn’t just to manage symptoms, but to progressively load and strengthen the tendon so it can tolerate the demands of running again.

That means focusing on: