Achilles Tendinopathy:

What Your Squat Has to Do With Your Running Pain

I've worked with hundreds of runners dealing with Achilles pain, and almost every one of them says the same thing: "I tried stretching it, I tried rest, I tried the heel drops everyone recommends online. It helps for a while, and then it comes right back."

If that's your story, what I'm about to tell you might change how you think about Achilles tendinopathy entirely.

Your Achilles tendon is not the problem. It's the victim.

The tendon is being overloaded. Loaded in ways it wasn't designed to handle, or asked to absorb forces that should be distributed across a larger system. And until you address what's creating that overload, the tendon will keep breaking down no matter how diligently you stretch and roll it.

What Is Achilles Tendinopathy? (And Why "Tendinitis" Is the Wrong Word)

The terminology matters here. Tendinitis implies acute inflammation, the kind of injury that responds well to rest and anti-inflammatories. Most chronic Achilles pain is actually tendinopathy, a degenerative process involving structural changes in the tendon tissue from repetitive overloading, not acute inflammation.

This distinction is clinically important because tendinopathy doesn't respond to the same treatments as tendinitis. NSAIDs don't reverse tendon degeneration. Rest doesn't rebuild tendon structure. And stretching a degenerated tendon can actually worsen it in some cases.

What tendinopathy does respond to is progressive mechanical loading specifically, eccentric and heavy slow resistance exercises that stimulate tendon remodeling. But even that's not the full picture, because if you're loading a tendon that's still being overloaded by poor mechanics, you're fighting yourself.

The Movement Factors Behind Achilles Tendinopathy

The Squat Connection

Here's something that surprises most runners: how you squat and how your ankle moves is one of the most reliable predictors of Achilles tendon stress.

The Achilles tendon's job is to transmit the force generated by the calf muscles to the heel bone, driving propulsion during running. It also acts as a spring, storing energy during the loading phase of each stride and releasing it during push-off.

For the tendon to function efficiently as a spring, the ankle needs to move through adequate dorsiflexion (bending toward the shin) during loading. When ankle dorsiflexion is restricted, whether from calf tightness, joint stiffness, or poor movement patterning, the tendon is compressed and strained at an angle it isn't designed to handle.

You can test this right now. Do a bodyweight squat. Does your heel lift off the floor before your knees reach 90 degrees? Do your knees drift outward? These compensations are your body's way of working around limited ankle dorsiflexion and they're creating excess stress on your Achilles tendon every time you run.

Calf Overload and Underuse of the Posterior Chain

The calf complex (gastrocnemius and soleus) generates a tremendous amount of force during running. But it shouldn't be generating all of it alone.

When the glutes and hamstrings aren't contributing adequately to propulsion (which happens when hip extension mechanics are poor), the calf compensates by working harder than it should. More force through the calf means more load through the Achilles tendon. Over time, that excess load exceeds the tendon's capacity to recover between runs, and breakdown begins.

This is why Achilles tendinopathy is far more common in runners with poor hip extension mechanics than in those with efficient posterior chain activation. The tendon is failing — but the cause starts at the hip.

Overpronation and Tibial Rotation

Excessive pronation at the foot causes the tibia to internally rotate with each step. That rotation creates a wringing or twisting stress on the Achilles tendon, particularly on the medial side, that compounds over thousands of strides.

Runners with significant overpronation often develop insertional Achilles tendinopathy, where the pain is located right at the attachment point on the heel bone, rather than in the mid-tendon. This distinction matters because the treatment approach differs slightly.

Training Load Spikes

Like all tendinopathies, Achilles issues are strongly correlated with rapid increases in training volume or intensity. The tendon adapts more slowly than muscle and cardiovascular fitness so it's entirely possible to feel aerobically ready for a mileage jump while your tendons are nowhere near ready.

This is especially common in runners who return from a break feeling good and immediately resume their previous mileage. The tendon capacity has declined; the ambition hasn't.

Why "Heel Drops" Alone Don't Solve It

Eccentric heel drops, lowering slowly from a raised heel off the edge of a step, are the most evidence-based exercise for Achilles tendinopathy, and they absolutely have a role in treatment.

But here's what gets missed: heel drops load the tendon in isolation. They don't address the ankle dorsiflexion restriction that's causing the tendon to be strained. They don't address the hip extension weakness that's overloading the calf. They don't change the gait mechanics that created the problem in the first place.

Heel drops will help your tendon get stronger. But if the mechanics don't change, you're building tendon strength in a system that's still going to overload it every time you run.

The Corrective Approach to Achilles Tendinopathy

Step 1: Restore ankle dorsiflexion. This is often the highest-leverage intervention. Ankle mobilization, calf flexibility work, and dorsiflexion-focused strengthening can quickly reduce tendon compression and restore the mechanical advantage the tendon needs to function correctly.

Step 2: Load the tendon progressively. Eccentric and heavy slow resistance calf work (heel drops done correctly, with appropriate load) is essential for stimulating tendon remodeling. The key is dosage. Too much too soon stresses a healing tendon; too little provides no stimulus for adaptation.

Step 3: Correct hip extension and glute activation. Strengthening the posterior chain so the calf isn't compensating for inadequate propulsion from above takes chronic overload off the Achilles tendon between each session of targeted loading.

Step 4: Address foot mechanics. If overpronation is contributing, foot intrinsic strengthening and gait modification reduce the rotational stress on the tendon.

Step 5: Gait retraining. Cadence, step length, and foot strike all influence Achilles tendon load. Small, targeted adjustments can meaningfully reduce the stress placed on the tendon with every stride.

Watch: Your Squat Is Causing Your Achilles Pain

In this video I walk through exactly how ankle mechanics and hip patterns create the Achilles overload most runners never connect and what to start doing about it.

What You Can Do Right Now

Ankle dorsiflexion test. In a half-kneeling position, drive your knee forward over your foot as far as possible without your heel lifting. If you can't get your knee past your toes, ankle mobility restriction is almost certainly contributing to your Achilles pain.

Single-leg calf raise. Stand on one leg and perform a slow, full-range calf raise. Does your heel track straight up and down, or does it roll outward? Rolling outward indicates overpronation and medial Achilles stress.

Hip extension check. During a lunge, can you drive your back hip into full extension and feel your glute engage? If your hip flexors are tight and your glute doesn't fire, posterior chain weakness is loading your Achilles.

Check your training log. Did your pain start within 2–4 weeks of a significant mileage increase, a new shoe, or a surface change? Load factors are almost always part of the picture.

The Bottom Line

Achilles tendinopathy is a loaded tendon problem but the loading is almost always coming from somewhere other than the tendon itself. Restricted ankle mobility, poor hip extension mechanics, overpronation, and training load spikes all contribute, and they all need to be addressed for a lasting resolution.

Runners who understand this don't just get out of pain. They often find that correcting Achilles mechanics improves their overall running efficiency, reduces their injury risk across the board, and helps them run faster with less effort.

Dealing with chronic Achilles pain? Book a free movement consultation — I'll assess your ankle mechanics, hip patterns, and gait to identify exactly what's driving your tendon overload and build a corrective plan around it.

You'll also find useful context in my post on IT band syndrome in runners — hip extension weakness and poor posterior chain activation show up in both conditions more often than most runners realize.

Dr. Heather Gansel is a movement specialist and performance coach with 25+ years helping runners resolve chronic pain by identifying and correcting the root-cause movement imbalances behind their injuries. She works virtually with runners worldwide. Learn more.