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Achilles tendinopathy exercises
Achilles tendinopathy is an overload problem of the thick tendon that joins the calf muscles to the heel bone. That tendon takes several times body weight with every running stride, so it is strong but sensitive to sudden changes in what it is asked to do. The tissue becomes irritated and less tolerant of load, rather than damaged or close to giving way.
It typically follows a change: more running, more hill or speed work, a new sport, a return to exercise after a break, a switch to flatter shoes, or a job that suddenly involves far more time on your feet. Age plays a part from the forties onwards, and stiff or weak calves make the tendon work harder for every step.
The hallmark is pain and stiffness in the tendon for the first steps in the morning and at the start of exercise, often easing as you warm up and then returning later that evening or the next day. There may be a tender, slightly thickened area a few centimetres above the heel, or pain right where the tendon meets the heel bone.
It responds well to progressive loading, and rest alone tends to make it worse rather than better, because a rested tendon loses capacity. Most people improve substantially over about 12 weeks of consistent calf work, with full running tolerance taking three to six months. This programme calms the tendon, builds calf and tendon strength through a staged plan, then rebuilds running or walking load.
Who this programme is for
Adults with gradual-onset Achilles or heel pain linked to activity that is stiff for the first steps in the morning. It suits both a recent flare and a tendon that has been grumbling for months. Sudden severe calf pain with a feeling of being kicked, and difficulty pushing off, may be a rupture and needs urgent assessment.
Get checked by a clinician first if
- Sudden severe pain at the back of the ankle with a snap or a feeling of being kicked, and difficulty walking or pushing off - possible Achilles rupture, seek same-day assessment
- Pain, swelling and warmth in the calf with no clear cause, or breathlessness - seek urgent advice to rule out a clot
- The heel or ankle is hot, red and swollen with a fever
- Pain that is worse at rest and at night rather than with activity
- The pain followed a significant accident, fall or direct blow and you have not been checked over
- You feel unwell with the pain - a fever, night sweats, or losing weight without trying
- The area is hot, very swollen and red, especially if you also feel feverish
- Pain that is severe, steadily getting worse, or keeps you awake every night and does not ease with a change of position
Not sure it's this? Try a self-check
Quick movement tests you can try at home to see what your symptoms might point towards. A guide, not a diagnosis.
- Single-Leg Calf Raise CheckThe strength and endurance of the calf and the Achilles tendon
The staged programme
Stage 1
Settle the pain
Start here while the tendon is very painful and stiff. Reduce aggravating load, use gentle ankle movement and calf stretching, and begin with isometric calf holds and easy two-legged heel raises.
Stage 2
Build strength
The core of the programme. Progressively load the calf and tendon, including slow heel drops that lower the heel below the step, three times a week, building the weight and range over several weeks.
Stage 3
Return to activity
The final stage restores springy, faster loading. Add single-leg and quicker calf work, then rebuild running with a walk-run progression, keeping hills and speed for last.
How long recovery takes
Most cases improve over 3 to 6 months with a consistent loading programme, though the tendon can stay mildly sensitive for longer. Pain in the mid-portion of the tendon usually responds better and faster than pain right at the heel attachment.
Knowing when to progress
Some pain during and after loading is acceptable - up to about 3 to 5 out of 10 - provided it settles within 24 hours and the tendon is no stiffer than usual the next morning. Use morning stiffness as your main gauge: if it is increasing week on week, you are progressing too quickly.
Common questions
Should I rest until the pain goes?
No. Rest reduces pain briefly but the tendon becomes weaker and the pain returns with activity. Graded loading is what builds the tendon's capacity. Reduce, do not stop.
Can I keep running?
Often yes, at a reduced volume, if pain during and after a run stays low and settles by the next day. Cut back hills and speed first. Stop running only if easy running is clearly painful or the tendon is worsening.
Do heel raises in my shoes help?
A temporary heel lift can reduce the load on the tendon and ease symptoms in the early weeks, particularly for insertional pain at the heel bone. It is a short-term aid alongside the strengthening.
Is stretching good or bad for it?
Gentle calf stretching is fine for mid-portion tendinopathy. For pain right at the heel bone, deep stretching that compresses the tendon against the bone can aggravate it, so keep those stretches gentle and within comfort.
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