How do you treat an Achilles tendinopathy?

Feb 22, 2019

Achilles Tendinopathy – Self Help Exercises

Here is a testimonial from one our patients:

“I came to Physio-logical in December with an injured Achilles one week after accepting a charity place for the Brighton marathon, and one week before I was due to start training, certainly bad timing! Your ongoing professional, articulate and tailored advice that allowed me to continue running, as part of an active recovery strategy, was absolutely key to not only getting me to the startline, but getting fit at the perfect time. This in turn allowed me to complete the marathon, but also smash my PB”. Mr C

What is Tendinopathy?

If the load we put on a tendon is too much and we continue to do this frequently then the amount of tissue breakdown starts to exceed the growth of new tissue. The structure of the tendon then starts to change and becomes less efficient at dealing with load. It is now believed this is the cause of pain rather than inflammation hence why now it is called tendinopathy not tendonitis.

There are two main stages:

Reactive Stage – the tendon will be painful and may swell in response to a sudden increase in load/change in footwear.

Degenerate (Chronic) Stage – the tendon may be thickened and you may feel nodules within the tendon. The tendon can progressively deteriorate until it can’t handle any load, this puts it at higher risk of rupturing.

The achilles tendon is the thick band of tissue that connects the calf muscle to the heel bone. The achilles tendon lifts the heel off the ground during walking and running. It is one of the strongest tendons in the body.



  • Pain is normally worse first thing in the morning and after sitting for long periods of time.
  • It usually effect’s those who take part in sporting activities such as running.
  • The tendon is normally painful if you squeeze it.

The best treatment for achilles tendinopathy is load management, activity modification, hands on physiotherapy including massage, frictions, ultrasound, kinesiology taping, acupuncture, stretches and eccentric calf raise exercises (see below).

Please be aware of your body and take advice from your GP before exercising if you have any aches or pains or send us an email ( for advice and guidance.

Treatment for a reactive achilles tendinopathy:

  • Load management

– only continue to run if it is pain free to run and pain free the next day (tendons make take 24 hours to respond to load). If it is painful to run      then it is best to rest for a few days until you can run pain free.

–  avoid tight shoes that cause direct tendon compression

–  wearing shoes with a heel may help to reduce load on the tendon

– using a heel raise within your shoe may also help reduce achilles load as a short term measure

  • NSAIDS / Anti-inflammatory medications such as ibuprofen – please speak to your doctor or pharmacist first prior to taking any medication – this can help to reduce swelling
  • Ice – to reduce pain – 15 minutes x 2-3 per day, protect your skin from ice burns by wrapping the ice in a towel
  • Kinesiology taping to offload the tendon
  • Massage the calf muscle to reduce tightness
  • Isometric calf exercises (heel raises) – tendon pain is likely to effect muscle function, using isometric exercises to reduce pain and maintain strength can be very beneficial
  • Ultrasound
  • Acupuncture

Calf Raises

  • Standing balance on both feet (you can use a chair for stability).
  • Rise up on your toes, drop down so your heel drops below the bottom of the step then come up 1cm, place 100% of your body weight on the injured side hold for 45 seconds and then repeat on the other leg.
  • Repeat 3 times, 2-3 times a day
  • It is ok to feel some discomfort (max 5/10)



Treatment for a degenerative achilles tendinopathy:

If you have had a niggling tendon for some time with periods of painful flare ups it is likely you have a more degenerate tendinopathy. Your achilles may be thickened.

You still may get flare ups similar to reactive stage above, during flare up please settle symptoms first (see above).

  • Load management – only continue to run if it is pain free to run and pain free the next day (tendons make take 24 hours to respond to load). If it is painful to run then it is best to rest for a few days until you can run pain free.
  • Eccentric calf exercises (mid tendinopathy only – effects the mid portion of the achilles typically 2-7cm above the calcaneus – heel bone, not insertional tendinopathy) will improve your tendon’s ability to handle load.


Once the pain has settled it is time to improve the load capacity of the muscle and tendon by improving calf strength.

Normally you should be able to manage 10-15 single leg calf raises with minimal increase in your pain before you progress to this level.

The calf complex is composed of 2 main muscles – gastrocnemius and soleus – both need to be strengthened.

The most simple way of achieving this is by doing calf raises on the edge of a step.

Eccentric Calf Raises

  • Standing balance yourself on both feet (you can use a chair for stability).
  • Rise up on your toes, slowly lower with both legs, when there is no pain, progress onto 1 leg.
  • Rise up on your toes, slowly lower on the injured leg with your leg straight, then repeat with your leg bent (100% bodyweight is on the injured leg).
  • Repeat 15 times do 3 sets of 15, 2 times a day, 7 days a week for 12 weeks.
  • Gradually add load with some weight in a backpack.

Heavy Slow Resistance

  • Standing balance yourself on your injured foot.
  • Rise up on your toes for a count of 3 and back down for a count of 3 with your leg straight then repeat with your leg bent.
  • Repeat 3 x 8 reps.
  • Repeat 3 times / week.
  • This is a heavy loaded exercise so load can be added to a back pack or you can use the smith machine at the gym.
  • Gradually increase load.
  • The target for strength is to be able to complete 8 reps taking 6 seconds per rep, pushing 0.4-0.5 times body weight. 

Single Leg Balance

  • Stand without any support and attempt to balance on your injured leg.
  • Begin with your eyes open and then try to perform the exercise with your eyes closed.
  • Hold the single leg position for 30 seconds.
  • Repeat 3 times, 2 times a day.


Energy storage exercises

  • Start these exercises when you have minimal or markedly reduced morning stiffness in the achilles tendon on waking.
  • Very mild tenderness on palpation of the achilles tendon.
  • Have been tolerating some running without a flare in tendon irritability and symptoms. 

Double Leg (DL)


  • Double leg (DL) quick jumps soft knees 3 x  60 jumps
  • Double leg quick jumps stiff knees 3 x 30 jumps
  • Double leg forwards/backwards 3 x 10 jumps
  • Double leg side/side 3 x 10 jumps
  • Repeat 3 x week
  • As a guide each week progress to include the next level
  • Eg. week 1 DL 3x 60 jumps, then week 2 add DL 3×30 stiff knee jumps etc


Single Leg (SL)

  • SL 3 x 60 hops
  • SL 3 x 30 stiff leg hops
  • SL 3 x 30 forward/backwards hops
  • SL 3 x 10 side hops
  • SL 3 x 5 zig zag hops
  • Add speed when familiar with above program
  • SL 3 x 10 hop on 20cm box + speed
  • SL 3 x 10 hopping for height (ie bounds for maximal power-increases rate of force development)
  • Repeat 3 x week
  • As a guide each week progress to include the next (ie add 1 set per session) based on tolerance

Have you been suffering from a niggling achilles tendon? Physio, sports therapy and sports massage therapy can all help. Please get in contact with us via, 07835 712306 or book online as we can help you to get rid of that ongoing niggling achilles tendon pain.

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