By Luther Chiew (Physiotherapist)
Premier Sports Medicine
Achilles pain in the morning can be a feature of Achilles tendinopathy, particularly when your first steps feel stiff and movement eases the discomfort. But this pattern alone cannot confirm the cause or tell you it is safe to run. Pay attention to symptoms during activity, afterward, and the next morning. Repeated or worsening pain deserves assessment. Do not keep pushing through worsening symptoms. This guide can help you recognise the pattern and decide when to seek assessment.
Need help with recurring running pain? See our Running Injury Clinic assessment and treatment.
The key points for runners
-
A tendon that warms up during a run may still struggle with your current training.
-
Pain at the heel attachment may require different treatment than pain higher up the tendon.
-
Keep a short record of your training and symptoms to guide decisions.
-
A sudden snap, with weakness or difficulty pushing off, requires urgent medical assessment.
Why does my Achilles hurt when I get out of bed?
Your Achilles tendon joins your calf muscles to your heel. It handles substantial forces when you walk, run, and push off the ground.
With Achilles tendinopathy, pain and stiffness can be more noticeable after a period of rest. That includes sleeping, sitting at a desk, or driving home. Symptoms may ease after you start moving, then return later. NHS guidance describes this variable pattern, including morning stiffness and discomfort that sometimes eases with exercise.
There is no reliable number of stiff minutes that confirms a diagnosis. Where it hurts, how it started, and what you can comfortably do also matter.
If it warms up when I run, is it getting better?
Feeling better during a run is useful information, but it is only part of the picture.
My advice here is simple: don’t judge your Achilles by its best ten minutes. I’d ask what happens once you finish and when you get out of bed the next day. If each morning feels worse or takes longer to settle, I’d review the training plan rather than rely on the fact that you can still finish a run.
That is a reason to reassess what you are doing, not proof that you have caused more damage. Symptoms need to be interpreted alongside strength, function, and your overall progress.
Where exactly is the pain?
Point to the sore area with one finger. Is it at the back of the heel, or a few centimetres above it?
-
At the heel attachment, this may fit insertional Achilles tendinopathy.
-
Higher up the tendon: this may fit midportion Achilles tendinopathy.
Location affects exercise selection. Dropping your heel below a step puts the ankle into a deeper bend and can aggravate an irritable tendon attachment. An exercise copied from another runner may therefore be a poor starting point for you.
The Dutch multidisciplinary guideline recommends initially considering a flat surface for strengthening with insertional symptoms. Your clinician can help you choose the range and resistance.
What would I look at beyond your weekly kilometres?
I’d ask about the weeks leading up to the pain, including:
-
Extra distance, faster sessions, hills, or a recent race.
-
A return after illness, injury, or time away.
-
Changes in strength training, footwear, or recovery time.
-
Previous tendon problems, health conditions, and medicines.
These are questions to investigate, rather than a checklist of proven causes in your case.
For example, your weekly distance might be unchanged, but you may have replaced two easy runs with hill repeats. I’d want to understand that change before recommending another exercise or blaming your shoes.
I’d also assess calf strength and how you tolerate relevant movements. The aim is to connect your symptoms with the demands you currently need to manage.
What can you do now?
1. Adjust the activity that aggravates it
Reduce or pause running that causes escalating pain, a limp, or worsening symptoms afterward. Depending on your response, that might mean shorter runs, less speed, fewer hills, or a temporary alternative such as comfortable cycling.
For diagnosed midportion Achilles tendinopathy, the 2024 clinical practice guideline supports tendon-loading exercise and continued activity within tolerance, rather than complete rest. That advice does not automatically apply to a new injury or a suspected tear.
2. Track the response, including the next morning
A few notes on your phone are enough. Record:
-
The activity: distance, pace, hills, and any calf exercises.
-
During and afterward: discomfort, any change in stride, and how quickly symptoms settle.
-
The following morning: first-step discomfort and roughly how long stiffness lasts.
I’d rather see that pattern than hear only that you managed your usual distance. It helps us decide what to keep, what to reduce, and when to reassess.
One better morning is encouraging, but don’t treat it as permission to jump straight back into your hardest session. There is no universal pain score that clears every runner to continue.
3. Build strength with an appropriate starting point
Progressive calf and tendon loading is a core part of rehabilitation. Exercise choice, resistance, and frequency should reflect your symptoms and capacity. A program may progress from supported or seated work to heavier standing exercises and, later, running-specific demands.
The goal is to build tolerance over time. Simply stretching harder or repeatedly testing a sore tendon with another run does not provide a structured progression.
When should you get help?
Arrange an assessment if morning pain keeps returning, stiffness is increasing, walking or stairs are affected, or you cannot progress your running without another flare.
Seek urgent medical assessment after a sudden snap or sharp injury with weakness, bruising, or difficulty pushing off. These can indicate an Achilles rupture. Do not test it with a run or calf raises. NHS guidance recommends urgent care for this presentation.
Questions runners ask
Should I stretch my Achilles before running?
Stretching is not a substitute for rehabilitation. A deep calf stretch may aggravate pain at the heel attachment. Ask which movements suit your presentation rather than forcing through discomfort.
Do I need an ultrasound or MRI?
Often, a history and clinical examination are enough. Imaging may help when the diagnosis is uncertain or symptoms take an unexpected course. A scan is not automatically the first step.
How long does recovery take?
Think in months rather than a few rest days. Guidelines commonly recommend at least 12 weeks of progressive strengthening, but that is a treatment period, not a promised recovery date. Your starting point, symptoms, and running goals affect the plan.
If symptoms have persisted despite rest or exercises, read our guide to why Achilles pain may not be improving.
Get a plan for your next run
If you are unsure what to change, bring your training history and symptom notes to an assessment. I’d want you to leave with an understanding of the likely problem, what activity is appropriate now, and how we will judge progress.
Book a Running Injury Assessment at Premier Sports Medicine.
About the author
Luther Chiew is a physiotherapist at Premier Sports Medicine with an interest in running, sports and overuse injuries. His background includes strength and conditioning, and he holds a Bachelor of Applied Science and a Master of Physiotherapy Practice from La Trobe University. Read Luther’s practitioner profile.
Sources
-
Chimenti RL and colleagues (2024). Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision. Clinical practice guideline supporting progressive loading and activity advice for midportion symptoms.
-
de Vos RJ and colleagues (2021). Dutch multidisciplinary guideline on Achilles tendinopathy. Guidance on pain location, assessment, imaging, and rehabilitation.
-
Mersey Care NHS Foundation Trust. Achilles tendinopathy. Patient information about symptom patterns and urgent warning signs.
General education for adult runners, not an individual diagnosis or exercise prescription. Clinical content reviewed and approved by Luther Chiew, Physiotherapist.
