06/05/2026
Recurring calf pain in runners is not always a calf strain.
Especially if it follows this pattern:
• it settles when you rest
• it feels okay for a bit
• you start running again
• the same pain comes back
• the cycle repeats
That pattern can sometimes point towards the tendon being involved, commonly the Achilles.
This is where Cook and Purdam’s tendon continuum is useful.
Tendons are not simply “inflamed” or “healed.”
They exist on a spectrum.
In the early reactive stage, a tendon can become more sensitive and thickened in response to a spike in load.
If the overload continues, the tendon can move into a more disorganised state, where its ability to tolerate load may be reduced.
In longer standing cases, there can be more degenerative structural changes within parts of the tendon.
But here is the important bit:
Pain, structure and function do not always match perfectly.
A scan might show tendon changes, but that does not automatically tell you what you can or cannot do.
Your symptoms, training history, load tolerance and goals all matter.
That is why rest often feels like it works at first.
Rest reduces demand.
So symptoms settle.
But if the tendon has not rebuilt the capacity it needs for running, hills, speed work or longer sessions, the same issue can come back again.
That is why current Achilles tendinopathy guidance still puts tendon loading, education and load management at the centre of rehab.
Not complete rest.
Not random exercises.
Not ignoring pain and pushing through everything.
The aim is to find the right level of load, build tolerance gradually, and progress from there.
That is why exercises like weighted calf raises can be so useful.
They help expose the tendon to load in a controlled way, so it can become more tolerant over time.
So if your “calf pain” keeps settling with rest, then coming back when you run, it might be time to look beyond the muscle.
DM me MOVE if your Achilles is stopping you.
