Runner's Pain Point #2: Calf Strains & Achilles' Tendinitis

Week 2 of our Runner’s Pain Point Series focuses on Calf Strains & Achilles' Tendinitis. It’s been projected that these issues account for >10% of injuries in runners…so definitely a prevalent issue.

I don’t want to waste too much text discussing what calf strains and Achilles' tendinitis are…If you’re reading this you likely have a basic idea of what the basic physiological factors at play (inflammation, muscle injury).

This article is going to focus on WHY they occur and how you can address that why.

Traditional Thinking

Most rehab approaches to these injuries focus very locally (on the site of the injury). If you’ve searched online, you’ve likely found a lot of recommendations for stretching, foam rolling, ice/heat, massage, rest, and eccentric loading exercises.

All of that is great supplementally…and necessary for symptom management.

However, if you really want to get back to running quickly and make sure that you stay healthy, it’s important to look at this issue a little deeper.

Don’t Let Anyone Tell You It’s Overuse!

Overuse might be the biggest cop out explanation for why you have pain. If your body has the capacity to appropriately absorb or transition stress when you run, overuse is usually not a problem.

Just about all of the runners I see with calf/Achilles’ problems have an underlying movement issue that is causing stress to be disproportionately placed there.

Don’t Let Your Calves Become Glutes

Because running is such an upright sport, overextension (think arch in the lower back with chest puffed up) is a prevalent movement issue…and it’s probably the most common dysfunction we see driving calf strains and Achilles’ tendinitis.

Want to see how it works?

Take your shoes off and stand up.

Stay tall, keep your knees straight, and lean forward until you feel like your heels are going to come off the floor.

Hold that position.

You’re overextended.

Feel your calves on? Feel your toes gripping the floor? That’s your nervous system attempting to create stability.

Picture walking around like that. You have to use your calves (instead of your glutes) to create propulsion.

Picture walking around like that every day. How long until your calves or Achilles’ start to hurt?

…And no amount of stretching or foam rolling is going to cure that.

Breaking the overextension pattern is a must if you want to cure calf pain and keep it away. Here are just a few ways we like to do it…

  1. Bench 90/90 Alternating Crossover Reach:

  2. All Four Left AF IR Breathing:

  3. Wall Supported Resisted Reach:

Right vs. Left Calf Issues

Achilles' Tendon issues (as with most injuries) tend to happen on the right for different reasons than the left.

As you will continue to see as a big theme in this blog series…if you are human…whether right or left handed…your body is DESIGNED to favor your right side.

It’s not a bad thing…until that pattern becomes too strong.

When that happens, we have a hard time getting our center of mass over our left foot when we run. This gives the left foot a tendency to overpronate, which can increase stress on the Achilles' Tendon.

It also causes the right glute to lose position, which in turn causes the right calf to overwork for propulsion and control of your body’s side-to-side movement. That’s why you see a lot of runners have a tendency to whip their right heel. That’s also why we see more runners with calf strains on the right.

Here are video links for some of our favorite exercises for right calf issues:

Here are links for some of our favorite exercises for left calf issues:

[there are many factors that go into our prescription of these exercises, so please do not view these as a protocol…the intention is to open your mind to a different way of thinking about your pain]

Flat Feet & Orthotics

What about flat feet? If overuse is the #1 cop-out explanation for why you have pain, “flat feet” is not far behind.

When runners are told their pain is due to overuse and flat feet...

When runners are told their pain is due to overuse and flat feet...

Very few people have structurally flat feet. One of my best friends has something called navicular drop. His feet are so flat they look like pancakes! And they are that flat whether he is standing/bearing weight or not. He needs an orthotic.

Most people don’t have feet like that. And at the end of the day, less people need orthotics than you would think.

In a grossly oversimplified statement…

Flat feet = weak hips.

Foot dysfunction is driven from the top down

…but, on the flip side…it’s reinforced from the foot up.

So if you’ve fallen too far into a dysfunctional hip stability pattern, it’s tough to fully fix the global dysfunction of the system without support from the feet.

In those cases, orthotics would be recommended.

The goal of orthotics should never be to solely alleviate pain. If you slap orthotics on a “flat” foot and call it treatment, you’re going to lose in the long run (and jack yourself up even more).

The ultimate goal of orthotics is to help you feel the ground better so that you can authentically learn how to create stability in your system.

It’s All In The Hips

The last step in addressing the root cause of calf injuries is to develop adequate strength & movement capacity in the hips.

I won’t dive too deep into this, but the idea is, you need to get out of bad patterns (overextension, right dominant…as discussed above) and get strong in good ones.

Here are some of our favorite exercises for developing that capacity in runners with calf issues:

Bottom Line…

So here’s your formula for treating calf strains and Achille’s tendonitis:

  1. Treat Localized Symptoms

  2. Get Out of Overextension

  3. Address Right/Left Asymmetry

  4. Build Capacity in the Hips

Hope this helps! Please feel free to reach out with any questions. You can comment below, or send me an email at

Stay tuned for next week! We’ll be discussing Hip Bursitis!

Dr. Mike

If you would like to learn more top specialist strategies that we offer to our injured athletes at Next Level PT, please click here to request our free eBook "8 Steps Injured Athletes Must Take..."