Can I run a marathon with Achilles tendonitis?
- Alison Gould
- Mar 17, 2023
- 7 min read
Updated: Jul 9
We often get patients asking us whether or not they can run a marathon with Achilles tendonitis. In this article, we’ll look at case studies of two actual Achilles tendonitis patients who attempted to run a marathon while injured to give you an idea whether the answer to this question might be a “yes” or a “no” for you.
Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.
The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.
In this article:
We've also made a video about this:
Let’s start with a brief overview of what the Achilles has to do during a marathon and how marathon training might cause Achilles tendonitis.
What your Achilles has to do during a marathon
The job of the Achilles tendon is to attach your calf muscles to the back of your heel bone. When your calf muscles contract, the Achilles is like a cable that transfers that force to move the joint and propel you forward.
Depending on your stride length, you will take between 25,000 and 50,000 steps when you run a marathon!
With every step, these are the mechanical demands on your Achilles tendon:
When you land, it absorbs forces equal to 6 to 12 times your bodyweight in ground reaction force (depending on which research you consult).
And then it has to cope with the push-off with your whole bodyweight against gravity.
That’s an awful lot of cumulative load – imagine doing 1 set of 25,000 heel raises! 😯
Why marathon training sometimes cause Achilles pain
A healthy body is regenerating tissue all the time – breaking down old tissue and laying down new stuff.
When we train, all our tissues (muscles, tendons, bones, etc.) sustain micro-injuries. This signals to the brain that those areas of the body should be stronger. Your body then uses the recovery time after your training session to repair those areas and lay down the new tissue stronger than it was before, and as a result we get stronger and fitter.
💡 However, if there’s not enough recovery time after high-demand training sessions, that repair process can get disrupted, causing those small injuries to stack up, and overuse injuries such as Achilles tendonitis to develop.
So … Can I run a marathon with Achilles tendonitis?
The answer to this question will depend on whether there's enough time for your tendon to recover to a point where it is able to cope with the workload the marathon demands.
Your Achilles doesn't necessarily have to be 100% pain-free to safely cope with a marathon, and everyone’s case is different, so I would always suggest that you get a health professional, preferably one who is experienced in treating runners, to assess your situation and give you the right advice.
However, I can give you two examples of patients we saw in our online clinic who developed Achilles pain during training. One completed their marathon and even got a personal best; the other had to pull out mid-race.
Example 1 👍
The situation at three weeks until race day:
Very mild Achilles pain towards the end of longer training runs: 2 to 3 out of 10 pain with some mild stiffness afterwards.
Better by the following morning – no pain.
No pain caused by heel raises.
No pain caused by hopping.
We helped this patient to adjust their training plan during those last few weeks to allow their Achilles time to recover and they completed the marathon without any problems on the day.
This is likely because the tendon was just about coping with the training, and the pain was just letting the runner know that the Achilles tendon was fatigued towards the end of the longer runs.
The reduced training / tapering in the last few weeks before the marathon allowed enough recovery time for the tendon to catch up on repairs and rebuild stronger than it was before, and therefore the race was OK in the end.
Example 2 😔
The situation at three weeks until race day:
Achilles tendon sore every morning for at least half an hour – hobbling and unable to walk “normally” until it had “warmed up”.
Mild pain when walking around the house.
Painful to do a single-leg heel raise.
Painful to hop.
Very painful tendon at the start of a training run, then it would ease off for a while, then pain would return further into the run and steadily worsen.
The time until the onset of pain was getting shorter and shorter with each run as the injury was getting worse week-on-week.
For this patient, there wasn't enough time to sufficiently offload the tendon to allow for enough recovery and rehab before race day. Their tendon was in a state of dysrepair and was going to take months to fully recover.
This patient had raised a lot of money for charity to run the marathon and wanted to attempt the race anyway, fully knowing the risk. However, they had to pull out during the race as the pain was too severe.
How treatment during marathon training can vary
How far you are from race day has a big impact on what treatment plan is most likely to help you complete the marathon safely.
If you're far out from race day, you have enough time to let the tendon recover and build more strength and endurance, so your treatment plan will likely include a mix of:
reducing your running load to allow your tendon to recover
cross-training to maintain and improve fitness without straining the Achilles
general strength training for the rest of the body to ensure all your muscles are sharing the work during running
specific calf and Achilles strength training exercises – these have to be balanced with your running workouts to ensure your Achilles is able to recover fully between sessions.
However, if you're only a few weeks away from your race, then it should be all about recovery – reducing your running load and all other activities that work your tendon. If you try and build strength at this point, you'll likely just cause even more overload and make the injury worse.
Other factors, such as how for long you've had your symptoms, your general health, and your Achilles tendon's current strength will also influence what mix of treatments will work best for you.
What is the risk of rupturing my injured Achilles tendon during the marathon?
The biggest concern for most people considering running a marathon with an injured Achilles tendon is the thought of fully rupturing it during the race.
The good news for runners is that a rupture is far more likely to happen in “explosive” and multi-sprint sports such as basketball, soccer/football, and racquet sports. In one study looking at the sports-related incidence of Achilles rupture in the USA, running, hiking, and stretching were grouped together and made up 6% of the total incidence, whereas basketball alone made up 43%.
However, there are some factors that can increase the risk of Achilles tendon rupture while running a marathon:
Fluroquinolone antibiotics. This is a very specific type of antibiotic with a side effect that weakens tendons. Other antibiotics do not have this side effect, so it does depend on what has been prescribed for you.
Steroid injections into the Achilles tendon. These are good at calming down pain but bad for tendons in the long run.
Anabolic steroids.
Many Achilles tendon ruptures happen without pre-disposing symptoms, so it’s very difficult to avoid all risk. However, a tendon that has been symptomatic for quite some time does run the risk of being structurally weaker and therefore easier to injure – which is why these injuries should be managed appropriately rather than ignored.
💡 What’s more relevant to know for most people is that the longer you avoid dealing with an injury like Achilles tendonitis, the longer it takes to get better when you do start with rehab.
So, if you’re struggling, don’t wait for months before consulting someone, get it on the right track as quickly as possible!
How we can help
Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the author
Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn, Facebook, Instagram, and Twitter.
