Some of our patients have been asking whether it’s a good idea to cycle with Achilles tendonitis. Can it help to maintain fitness, or could it actually make things worse? In this article, we break down how cycling affects the Achilles tendon, when it’s beneficial, and when you might need to be cautious.
Whether you're an avid cyclist or just looking for a way to keep moving, here’s what you should know before hopping on your bike.
Remember, if you need 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 most of our articles.
In this article:
We've also made a video about this:
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Your Achilles tendon and cycling
Your calf muscles are attached to your heel bone via the Achilles tendon. The calf muscles pull your heel bone upwards and make your toes point downwards (also called plantar flexion). So, whenever the calf muscles work, the Achilles tendon works.
We use our calf muscles and Achilles tendon mostly when we walk, run, or jump. Cycling also involves them, but in slightly different ways.
You use the gastrocnemius – more than the soleus – as you push down on the pedal stroke, but this creates a much lower force on the Achilles than walking, running, or jumping.
And there is a second force that can come into play nearer the bottom of the pedal stroke if your heel were to drop down, which brings your toes closer to your shin (dorsiflexion) and causes the Achilles tendon to stretch and compress over the heel bone.
Cycling to maintain fitness during Achilles tendonitis
As explained above, we use the calf muscles and Achilles tendon mostly for weight-bearing activities such as walking, running, and jumping. So, it’s these activities that have to be stopped or reduced while the patient is recovering from an Achilles injury.
Therefore, cycling can be really useful for maintaining fitness, especially cardio fitness, during the Achilles rehab process if you follow the advice below. (Here’s our article with general advice on cross-training when you have an Achilles tendonitis.)
If you're unsure about your diagnosis, please have a look at our article on what causes Achilles tendonitis and how it is diagnosed.
Where you feel your Achilles pain matters
Where you feel your pain with an Achilles tendonitis might make a difference as to whether cycling aggravates it or not.
You can feel Achilles pain in different areas. If it tends to be higher up the calf – that's more a mid-portion Achilles tendonitis. If it is lower down, near where the tendon attaches into the back of the heel, it might be more likely to be an insertional tendonitis.
If your heel drops down at the bottom of a pedal stroke, especially if you have an insertional Achilles tendonitis, it causes the injured part of the tendon to strongly stretch and compress over the heel bone. This is not a problem for a healthy tendon but can make your symptoms worse if your tendon is injured.
It’s like pressing repeatedly on a bruise. It won’t damage the tendon, but it isn’t going to be helpful for the healing process and will very likely make the pain and stiffness feel worse.
Further down I have some specific advice on how to deal with the situation if you want to cycle with insertional Achilles tendonitis, and it is painful.
And here’s our video with more detail on why it’s important to distinguish between mid-portion and insertional Achilles tendonitis.
Use pain to guide your cycling
The research on Achilles tendonitis recovery shows that it’s OK to experience low levels of discomfort during and after activities. The tricky thing with tendons is that they often have a delayed pain response – they often only start hurting quite some time after we’ve done something.
👍 If, while you cycle and in the 24 hours afterwards:
your pain level doesn’t exceed 3 out of 10 (or what we would call “just a niggle”),
and any increased discomfort due to the cycling settles back down to your normal levels within that 24-hour period,
you should be OK to continue at that level.
👎 However, if your tendon pain is significantly worse after cycling, you need to look at adapting your cycling load, which we’ll discuss in the next section.
(Here’s my article with more detail on how pain levels can help us to manage an Achilles tendonitis.)
Cycling load (intensity and mileage)
An Achilles tendonitis doesn't like a big change or a peak in a load, where you suddenly ramp up your activity (cycling, in this case). This can either aggravate an existing Achilles tendonitis or cause it in the first place.
Examples of increasing your cycling load:
Going from easy cycling on a static bicycle to doing spinning classes.
Standing out of the saddle for longer than usual.
Moving from a static bicycle to a road bike or mountain bike.
Upping the mileage drastically.
Changing to cycling on more challenging terrain.
Cycling more often with fewer recovery days inbetween.
If your tendon pain exceeds the “3 out of 10” guideline, you need to look at what you’ve done recently and reduce the load until your tendon can handle it.
Cycling gear tips to protect your injured Achilles tendon
Most of these tips have to do with making things easier for your tendon if you have an insertional Achilles tendonitis.
The correct bike set-up to reduce or prevent your heel dropping down at the bottom of the pedal stroke.
Footwear: Make sure that the back of your shoe doesn’t press or rub onto your injured tendon. This can especially be a problem with clip-in shoes, which are quite hard and rigid.
The above problem can be solved by temporarily ditching the cleats, and/or using heel-raising shoe inserts (in both shoes) to raise the painful part of your heel above the problem part of the shoe. (These inserts can also be useful in your regular shoes to take the strain off your injured tendon as you go about your daily business.)
You could also experiment with wearing either thicker socks (to cushion the tendon against the shoe) or thinner socks (to reduce pressure if your feet swell while you cycle).
Here are some examples of heel-raising shoe inserts:
👉 If none of the above cycling gear adjustments helps, and your tendon remains painful despite a decrease in your cycling load, you will have to accept that the cycling will have to wait until your tendon is stronger thanks to a rehab programme.
Which brings us to the next question.
What about cycling as rehab for Achilles tendonitis?
Research has shown that a combination of load management (reducing or stopping aggravating activities) and a progressive strength training programme for the calf muscles and Achilles tendon is the best non-surgical treatment for Achilles tendonitis.
Is cycling such a strengthening rehab activity for an Achilles tendonitis? No. This is not something we would prescribe for our patients. Cycling doesn’t load the tendon in a way that is useful for walking, running or jumping.
What is needed is targeted strength work, which comes in the form of calf raises or using machines in a gym. These exercises must start at the right level for the patient’s current tolerance and get more challenging as their Achilles tendon’s capacity improves.
And that's something that a practitioner has to prescribe for you on an individualised basis, considering factors such as the severity of your injury, the current strength of your tendon, and what types of activity you aim to do once you have completed your rehab.
How we can help
Need 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 or at least 10 years' experience in the field. All of us have a wealth of experience working with athletes across a broad variety of sports and 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.