Achilles tendinopathy responds to progressive calf loading, not to rest. The exercises are simple, but the dose and the tempo decide whether they work: slow repetitions, three times a week at minimum, held for at least 12 weeks. Where the pain sits, at the heel bone or higher up the tendon, changes which version you do.
The first steps out of bed are stiff. The tendon warms up, you forget about it, and then it punishes you a few hours after your run. If that pattern has lasted more than three months, more rest will not close it. The tendon has lost load capacity, and the only thing that gives capacity back is load.
This page is the programme itself: which exercises, how many, how slowly, and what to do when the pain does not settle. Read the first section before you start, because it decides which of the two protocols is yours.
First, find out where your Achilles tendon hurts
Sit down, cross the sore ankle over the opposite knee and pinch along the tendon with a thumb and finger, working up from the heel bone towards the calf. The tender point sits in one of two places, and the two need different exercises. If the sore point is not on the tendon at all but beside the ankle bone, you are looking at one of the other ankle tendons.
TWO FORMS, TWO SETS OF EXERCISES
MIDPORTION
- The sore spot is 2 to 6 cm above the heel bone, on the free part of the tendon.
- The tendon often feels thickened when you pinch it there.
- This is the form covered by 86 % of the patients in the randomised trials.
- Heel drops off a step are safe and are the core of the programme.
INSERTIONAL
- The sore spot is right where the tendon meets the heel bone, often with a hard lump.
- Pressure from the back of a shoe makes it worse.
- Dropping the heel below the step level compresses the tendon against the bone.
- Same exercises, but performed on the floor, with no heel drop below level.
If you are not sure, start on the floor. You lose nothing, and you avoid six weeks of compressing a tendon that cannot take it. Pain that runs along the inner arch or the outer border of the foot rather than up the back of the heel belongs to a different tendon altogether.
Why loading works when rest does not
The word tendinitis has largely been dropped, and for a reason. Cook and Purdam described tendon pathology as a continuum: a reactive tendon that swells after a sudden jump in training, a disrepair phase where the collagen loses its alignment, and a degenerative phase where patches of tissue stop carrying load altogether. Classic inflammation is not the main event in any of them.
That changes what the treatment has to do. Degenerated tissue does not come back, but the healthy fibres around it can be made stronger, and a stronger tendon carries the same run on less strain. Rest does the opposite: it takes away the only stimulus that builds capacity.
Alfredson’s group put the point bluntly in 1998. Fifteen recreational athletes with chronic Achilles pain, mean age 44, did heavy-load eccentric calf training for 12 weeks. All fifteen went back to full running. A comparison group of fifteen with the same diagnosis was treated the conventional way, with rest, anti-inflammatories, shoe changes and physiotherapy. Not one of them improved, and every single one ended up in theatre.
BACK TO FULL RUNNING AFTER 12 WEEKS
The exercises, step by step
Five movements. Two open the ankle up, three build the calf. Do them barefoot or in flat shoes, on a firm floor, and count the seconds out loud until the tempo becomes automatic.
1. Calf stretch at the wall, knee straight
Stand facing a wall, hands flat on it at shoulder height. Step the sore leg back, keep that knee straight and the heel pressed down onto the floor. Bend the front knee until you feel a pull in the upper calf. Hold for 30 seconds, repeat 3 times, both sides.
2. Calf stretch at the wall, knee bent
Same position at the wall, but this time bend the back knee slightly while the heel stays down. The pull moves lower, closer to the tendon itself. Hold for 30 seconds, repeat 3 times. These two stretches are preparation, not treatment: they will not rebuild anything on their own.
3. Double-leg heel raise
Stand with both feet hip-width apart, both knees straight, fingertips on a wall for balance. Rise slowly onto your toes so both heels lift clear of the floor, taking 3 seconds to reach the top. Hold that position for 2 seconds, then lower over 3 seconds until the heels touch down. Do 15 repetitions. This is your week one exercise, and your warm-up thereafter.
4. Slow heel lower off a step
Stand with the balls of both feet on the edge of a step, heels hanging off the back. Push up onto your toes using both feet, shift your weight entirely onto the sore leg, then lower that heel alone over 3 seconds until it drops below the level of the step. Use both feet again to come back up: the lowering phase is the working part. Three sets of 15 with the knee straight, then three sets of 15 with the knee slightly bent.
If your pain is insertional, do this exercise on the floor instead of a step and stop the movement when the heel reaches the ground. Going below level presses the tendon into the heel bone and will set you back.
5. Single-leg heel raise with added weight
Once 15 slow repetitions on one leg stop being hard, add load rather than repetitions. A rucksack with books in it is enough to start. Increase the weight when the last three repetitions of a set stop feeling heavy, and keep the same 3 seconds up, 2 seconds hold, 3 seconds down tempo throughout.
How much, how often, and for how long
The dose is where most home programmes fall apart. Here is the progression that the trials actually used.
TWELVE WEEKS OF PROGRESSIVE LOADING
WEEKS 1 TO 2
Double-leg heel raises, 3 sets of 15, every day. Stretches morning and evening. The aim is to build the habit and to let the tendon meet daily load again.
WEEKS 3 TO 5
Move to the slow heel lower on the sore leg, 3 sets of 15 with the knee straight, then 3 sets of 15 with the knee bent. Three sessions a week, never two days running.
WEEKS 6 TO 8
Add weight in a rucksack as soon as 15 repetitions become comfortable. Same tempo, same three sessions a week. Expect the morning stiffness to shorten before the pain during exercise falls.
WEEKS 9 TO 12
Heavier weight, fewer repetitions: 4 sets of 8, still slow. Reintroduce hopping and running only if the tendon is quiet the morning after each session.
AFTER WEEK 12
Keep two sessions a week indefinitely. The tendon loses the capacity you built within a few months of stopping.
Read that compliance figure again, because it is the practical finding. The two programmes are equally effective, so pick the one you will actually finish. Three slow sessions a week beat twice-daily eccentric sets that you abandon in week four. The same principle governs the patellar tendon at the knee, where slow heavy loading has been tested the same way.
Twelve weeks is a floor, not a target. Most people need four to six months before the tendon stops complaining after long runs, and progress is not linear.
Can you keep running? The pain rule
Yes, within a limit that has been tested. Silbernagel randomised 38 patients: one group carried on running and jumping using a pain-monitoring model, the other stopped all tendon-loading activity for the first six weeks. Both groups did the same rehabilitation programme.
the pain ceiling during activity that allowed patients to keep running throughout rehabilitation with no worse outcome at 12 months than those who stopped for six weeks.
Silbernagel K.G. et al., The American Journal of Sports Medicine, 2007. DOI: 10.1177/0363546506298279
Two conditions come with that number. The pain must settle back to its usual level by the next morning, and it must not climb week on week. Use the morning after as your instrument, not how it feels during the run itself.
Practically: keep running, drop the volume, cut out the hill sessions and the speed work first, and stay off soft uneven ground while the tendon is irritable.
What the evidence says about everything else
Van der Vlist and colleagues built a living network meta-analysis of 29 randomised trials covering 42 different treatments. Two conclusions came out of it, and both are useful.
First, doing nothing is the worst option: every active treatment beat wait-and-see at three months. Second, no active treatment was clearly better than any other at 3 or 12 months. Since a calf exercise programme is cheap, easy to prescribe and carries almost no risk, that is where the authors say to start.
| Option | What the evidence shows | When it makes sense |
|---|---|---|
| Calf loading programme | Equal to every other active treatment, lowest harm and cost | First line, from day one |
| Shockwave therapy | Adds a benefit on top of loading in midportion cases | After 3 months of a programme you actually completed |
| Heel raises in the shoe | Reduce symptoms while you build strength | Insertional pain, short term only |
| Corticosteroid injection | Short-lived relief, and NICE advises against injecting the tendon | Not into the tendon |
| Complete rest | Beaten by every active treatment at 3 months | Only in the first days of a flare |
When to see your GP or a physiotherapist
In most parts of England you can self-refer to an NHS musculoskeletal physiotherapy service without seeing your GP first. Check your local service online before you book an appointment you may not need.
See a physiotherapist if the pain has lasted more than six weeks, if you cannot work out which of the two forms you have, or if you have completed 12 honest weeks with no change. A supervised programme is not more effective than a home one, but it is far more likely to be finished correctly.
Go to an urgent treatment centre or A&E the same day if you felt a sudden snap at the back of the ankle, heard a pop, and cannot push off or stand on tiptoe on that leg. That is a suspected Achilles rupture, and it is a different problem entirely.
Tell your GP if you have recently taken a fluoroquinolone antibiotic such as ciprofloxacin, if you have a diagnosis of inflammatory arthritis, or if both tendons hurt at once. Those change the assessment.
The background that speeds recovery up or slows it down
Tendon tissue turns over slowly and responds to the state of the body around it. Sleep, body weight, blood glucose control and smoking all change how fast a loaded tendon adapts, and they work through the same background inflammatory load that a sensitive CRP puts a number on. None of them is a small effect over a 12-week programme.
Nutritional support can sit alongside the exercises. Curcumin and boswellia have a reasonable literature behind them, provided they are absorbed rather than passed straight through, which is the criterion behind our highly absorbable anti-inflammatory formula and its version for tendon tissue.
No supplement replaces the loading programme. It works on the terrain while the calf does the real work.
Frequently asked questions
What exercises are best for Achilles tendinopathy?
Slow calf strengthening. Double-leg heel raises to begin, then a single-leg heel lower off a step, 3 seconds up, 2 seconds hold, 3 seconds down, three sets of 15, three times a week. Stretches at the wall help symptoms but do not rebuild the tendon on their own.
How long does Achilles tendinopathy take to heal?
Twelve weeks is the minimum studied, and it is where the trials measure their results. Most people need four to six months before long runs stop provoking the tendon. Morning stiffness usually shortens before pain during exercise falls.
Can I run with Achilles tendinopathy?
Yes, up to 5 out of 10 pain during the run, provided the tendon is back to its usual state the next morning and the pain is not climbing week on week. In a randomised trial of 38 patients, those who kept running did as well at 12 months as those who stopped for six weeks.
Is walking good for Achilles tendinopathy?
Walking on flat ground is fine and helps, as long as it stays under the same pain ceiling. Steep hills and long walks in flat unsupportive shoes are the two things that commonly flare it, especially with insertional pain.
Which exercises should I avoid with Achilles tendonitis?
With insertional pain, avoid anything that drops the heel below the level of the foot: heel drops off a step, deep calf stretches on a kerb, and downhill running. With midportion pain, avoid sudden jumps in training volume and plyometric work until you are past week nine.
How often should I do Achilles tendinopathy exercises?
Three sessions a week, never on consecutive days, for the strengthening work. Stretches can be done daily. Compliance matters more than the exact protocol: a trial comparing two schedules found identical results, with 92 % of sessions completed on the three-a-week programme against 78 % on the twice-daily one.
What to remember
Find the sore point before you choose the exercise: insertional pain does not tolerate a heel drop below level. Load the calf slowly, three times a week, and add weight rather than repetitions. Hold the programme for 12 weeks before you judge it. You may keep running under 5 out of 10 pain if the tendon is quiet the next morning. Every active treatment beats rest, and none clearly beats the exercises.
Sources
Alfredson H., Pietilä T., Jonsson P., Lorentzon R. “Heavy-Load Eccentric Calf Muscle Training For the Treatment of Chronic Achilles Tendinosis.” The American Journal of Sports Medicine, 26, 1998. DOI: 10.1177/03635465980260030301
Cook J.L., Purdam C.R. “Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy.” British Journal of Sports Medicine, 43, 2009. DOI: 10.1136/bjsm.2008.051193
Silbernagel K.G., Thomeé R., Eriksson B.I., Karlsson J. “Continued Sports Activity, Using a Pain-Monitoring Model, during Rehabilitation in Patients with Achilles Tendinopathy: A Randomized Controlled Study.” The American Journal of Sports Medicine, 35, 2007. DOI: 10.1177/0363546506298279
Beyer R., Kongsgaard M., Hougs Kjær B., Øhlenschlæger T., Kjær M., Magnusson S.P. “Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial.” The American Journal of Sports Medicine, 43, 2015. DOI: 10.1177/0363546515584760
van der Vlist A.C., Winters M., Weir A., Ardern C.L., Welton N.J., Caldwell D.M., Verhaar J.A.N., de Vos R.J. “Which treatment is most effective for patients with Achilles tendinopathy? A living systematic review with network meta-analysis of 29 randomised controlled trials.” British Journal of Sports Medicine, 55, 2021. DOI: 10.1136/bjsports-2019-101872
