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Rehabilitation2026-03-09•7 min read

Achilles Tendonitis Exercises: Tendinopathy Treatment Guide

What Is Achilles Tendonitis?

Achilles tendinopathy is pain and dysfunction of the Achilles tendon — the large tendon connecting your calf muscles to your heel.

Types:

Midportion: Pain in middle of tendon (2-6 cm above heel)

Insertional: Pain where tendon attaches to heel bone

Symptoms:

  • Pain in Achilles area
  • Stiffness, especially in morning
  • Thickening of tendon
  • Pain with activity (running, stairs, jumping)
  • May improve briefly with warm-up

    • Why It Happens

    The Core Problem

    Tendon loading exceeds recovery capacity. Repeated microtrauma without adequate healing leads to degenerative changes.

    Risk Factors

  • Sudden training increase
  • Tight calf muscles
  • Weak calf muscles
  • Older age
  • Overpronation
  • Running hills
  • Poor footwear

    • The Evidence: Eccentric Loading Works

    The Alfredson protocol (eccentric heel drops) has strong evidence for Achilles tendinopathy.

    Exercises for Midportion Tendinopathy

    Phase 1: Isometrics (Week 1-2)

    Isometric Calf Raise

  • Rise onto toes (both feet)
  • Hold for 45 seconds
  • 5 sets, 2-3x daily
  • Reduces pain

    • Phase 2: Eccentric Loading (Week 2-12)

    Eccentric Heel Drops (Straight Knee)

  • Stand on step, heels over edge
  • Rise on both feet
  • Lower slowly on affected leg (3-5 seconds)
  • Drop heel below step level
  • Rise again on both feet
  • 3 x 15, twice daily

    • Eccentric Heel Drops (Bent Knee)

  • Same as above but knee slightly bent
  • Targets soleus muscle
  • 3 x 15, twice daily

    • Key points:

  • Do even if there's mild pain (0-5/10)
  • Progress by adding weight (backpack)
  • Continue for 12 weeks minimum

    • Phase 3: Heavy Slow Resistance (Alternative)

    Calf Raise (Slow Tempo)

  • 3 seconds up, 3 seconds down
  • Progress weight
  • 3 x 15, 3x weekly

    • Research shows HSR is equally effective to eccentrics.

    Exercises for Insertional Tendinopathy

    Important: Traditional eccentrics can worsen insertional problems due to compression.

    Modified Approach

    Isometrics on Flat Ground

  • Rise onto toes
  • Hold 45 seconds
  • Don't drop heel below flat
  • 5 x 45 seconds

    • Heel Raises (No Overhang)

  • Rise on toes on flat ground
  • Don't let heel drop below floor level
  • 3 x 15, slow tempo

    • Progress to:

  • Single leg when ready
  • Add weight
  • Avoid positions that compress insertion

    • Additional Strengthening

    Seated Calf Raises

  • Weight on knees
  • Targets soleus
  • 3 x 15

    • Leg Press Calf Raises

  • Full range
  • Heavy load possible
  • 3 x 15

    • Stretching: Be Careful

    For Midportion

    Gentle calf stretching may help:

  • Hold 30 seconds
  • Don't overstretch
  • After exercise, not before

    • For Insertional

    Avoid aggressive stretching. It compresses the insertion. Skip traditional calf stretches.

    Sample Program

    Midportion Tendinopathy

    Daily (12 weeks):

    1. Eccentric heel drops (straight): 3 x 15

    2. Eccentric heel drops (bent): 3 x 15

    3. Gentle calf stretch: 30 sec each (after)

    3x Weekly (Optional addition):

  • Heavy slow calf raises: 3 x 15

    • Insertional Tendinopathy

    Daily:

    1. Isometric holds (flat): 5 x 45 seconds

    2. Heel raises (no drop): 3 x 15

    3. Avoid stretching

    3x Weekly:

  • Leg press calf raises: 3 x 15

    • Activity Modification

    During Rehab

  • Reduce running volume 30-50%
  • Avoid hills initially
  • No speed work
  • Cross-train (cycling, swimming)

    • Return to Running

  • Pain-free for daily activities first
  • Start with walk-run intervals
  • Gradual progression (10% per week)
  • Continue strengthening indefinitely

    • Heel Raises in Shoes

    A temporary heel lift (1/4 to 1/2 inch) can:

  • Reduce tendon strain
  • Allow more comfortable walking
  • Bridge during early rehab

    • Remove gradually as symptoms improve.

    Common Mistakes

    1. Complete Rest

    Problem: Tendons weaken without load

    Fix: Active loading, not rest

    2. Stretching Insertional Tendinopathy

    Problem: Compresses the insertion

    Fix: Avoid for insertional type

    3. Stopping When Pain-Free

    Problem: Tendon not fully remodeled

    Fix: Complete 12-week protocol

    4. Too Much Too Soon

    Problem: Flare-ups

    Fix: Gradual progression, follow pain rules

    Pain Rules

    0-3/10 during exercise: OK

    4-5/10: Reduce intensity

    6+/10: Stop, modify

    24-hour rule: Pain should not be worse the next morning.

    Recovery Timeline

  • **4 weeks:** Pain reduction
  • **8 weeks:** Noticeable improvement
  • **12 weeks:** Significant progress
  • **3-6 months:** Full recovery for severe cases

    • Tendons heal slowly. Be patient.

    When to See a Doctor

  • Sudden onset of severe pain (possible rupture)
  • No improvement after 6-8 weeks
  • Complete inability to rise on toes
  • Significant swelling
  • Night pain

    • The Bottom Line

    Achilles tendinopathy requires:

    1. Loading, not rest — Eccentrics or HSR

    2. Right exercise for type — Midportion vs insertional

    3. Consistency — 12 weeks minimum

    4. Patience — Tendons are slow

    5. Maintenance — Ongoing calf strength

    The evidence is strong: load your tendon appropriately and it heals.

    Foundational Rehab provides Achilles tendinopathy rehabilitation programs.

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