Achilles Tendon Exercises for Recovery

Your Achilles tendon is the strongest tendon in your body. When it hurts, everything from walking to climbing stairs becomes a chore. But here is what most people get wrong: resting a painful Achilles tendon actually makes it weaker.

The research is clear. Controlled loading through specific exercises is the gold standard treatment for Achilles tendinopathy. The Alfredson protocol alone shows an 89% satisfaction rate and return to activity (Alfredson et al., Am J Sports Med, 1998).

This guide breaks down the exercises phase by phase so you can start at the right level and progress safely.

What Is Achilles Tendinopathy?

The Achilles tendon connects your calf muscles (gastrocnemius and soleus) to your heel bone. Every time you walk, run, or jump, this tendon absorbs and transmits enormous force.

Doctors now prefer the term “tendinopathy” over “tendonitis” because the problem is not primarily inflammation. It is a failed healing response where the collagen fibers become disorganized and break down (Cook & Purdam, Br J Sports Med, 2009). Think of it like a fraying rope rather than a swollen joint.

There are two distinct types, and the difference matters for your exercise approach:

Midportion tendinopathy (55-65% of cases) affects the middle of the tendon, about 2-6 cm above the heel. It responds well to full-range eccentric exercises that stretch the tendon below neutral.

Insertional tendinopathy (20-25% of cases) occurs where the tendon attaches to the heel bone. This type needs a modified approach: exercises should stop at neutral (flat foot) and avoid dropping below the step edge, which compresses the insertion point.

Risk factors include sudden increases in training load, tight calves, age, fluoroquinolone antibiotics, and obesity. Runners are hit hardest, with up to 50% experiencing Achilles problems over a career (Kujala et al., 2005). But you do not need to be a runner to develop it.

The connection between the Achilles tendon and plantar fascia is direct. They share an attachment at the heel bone. Tightness or dysfunction in one often affects the other.

Symptoms Checklist

Do any of these sound familiar?

• Pain and stiffness in the back of your heel, especially in the morning
• Pain that warms up with activity but returns after rest
• Thickening or a bump on the tendon
• Tenderness when you squeeze the tendon
• Stiffness after sitting for extended periods
• Pain during or after running, walking, or climbing stairs
• Decreased calf strength (hard to do a single-leg calf raise)

If morning stiffness is your primary complaint, our guide on foot pain in the morning covers a complete before-you-stand-up routine.

Want to know what is going on with your Achilles? Take our free quiz for a personalized assessment.

Phased Exercise Program

Tendon rehab works in stages. Jumping ahead too fast risks setback. Moving too slowly delays recovery. Here is the evidence-based progression.

Phase 1: Pain Management (Week 0-2)

1. Bilateral Isometric Heel Raise Hold

Rise up on both toes and hold at the top for 45 seconds. Repeat 5 times, 2-3 times per day.

Isometric holds can provide immediate pain relief, making them useful for managing flare-ups or for athletes who need to keep training (Rio et al., Br J Sports Med, 2015). This is your go-to when the tendon is angry.

2. Seated Calf Raise (Bent Knee)

Sit in a chair with your feet flat. Press through the balls of your feet to raise your heels. This targets the soleus muscle with lighter load on the tendon. 3 sets of 15 in a pain-free range.

During this phase, reduce (but do not eliminate) activities that aggravate your pain. The goal is relative rest, not absolute rest.

Phase 2: Eccentric Loading (Week 2-12)

This is the core of Achilles tendon rehab.

3. Straight-Leg Eccentric Heel Drop (Alfredson Protocol)

Stand on a step with the balls of both feet on the edge. Rise up on both feet. Shift your weight to the affected leg and slowly lower your heel below the step over 3-5 seconds. Use your good leg to push back up to the top. Do not use the affected leg to rise.

3 sets of 15 reps, twice daily, 7 days a week for 12 weeks. Mild discomfort during the exercise (up to 5/10 pain) is acceptable. Sharp pain is not.

4. Bent-Knee Eccentric Heel Drop

Same exercise with your knee slightly bent. This shifts the load from the gastrocnemius to the soleus. Same dosage: 3 sets of 15, twice daily.

Insertional modification: If your pain is right at the heel attachment, do not drop below neutral (flat foot). Stop at the level of the step. Dropping below compresses the insertion and can make things worse.

Phase 3: Heavy Slow Resistance (Alternative or Progression)

Some people respond better to heavy slow resistance than pure eccentrics. A study comparing the two found similar outcomes but higher patient satisfaction with heavy slow resistance (Beyer et al., Am J Sports Med, 2015).

5. Bilateral Heel Raise with Weight

Stand on a step with added weight (weighted backpack or machine). Rise for 3 seconds, hold 2 seconds at top, lower for 3 seconds. Progress the load over 12 weeks:

• Weeks 1-2: 3 sets of 15
• Weeks 3-4: 4 sets of 12
• Weeks 5-8: 4 sets of 10
• Weeks 9-12: 4 sets of 6-8

Do these 3 times per week (not daily like the Alfredson protocol).

6. Single-Leg Heel Raise

Progress from bilateral when you can complete the bilateral version pain-free. 3 sets of 8-12 reps. This is a major milestone in your recovery.

Phase 4: Return to Sport (Week 12-24)

7. Double-Leg Hop in Place

3 sets of 10. Your pain should stay at or below 3 out of 10. If it spikes above that, you are not ready for this phase yet.

8. Single-Leg Hop

3 sets of 10. Progress to forward and lateral hops as tolerated.

9. Graduated Running Program

Start with walk/jog intervals (e.g., 1 minute jog, 2 minutes walk). Gradually increase the running ratio over 4-6 weeks. Monitor symptoms the morning after each run. If morning pain increases, back off the volume.

If you are an athlete working through this process, sports physical therapy can help structure your return-to-play timeline.

Get a Plan That Fits Your Phase

Not sure where you fall in this progression? Our quiz takes 2 minutes and gives you specific guidance.

Take the free pain assessment quiz

Treatment Options

Exercise (First Line)

Everything in the phased program above. Consistency over 12 weeks is the minimum commitment for meaningful tendon remodeling.

Physical Therapy

A PT can determine which type of tendinopathy you have (midportion vs insertional), monitor your loading progression, and address contributing factors like calf weakness or running form. If your symptoms have not improved after 6 weeks of home exercises, a PT evaluation is a smart next step. Read about how long physical therapy typically takes.

Shockwave Therapy

Extracorporeal shockwave therapy (ESWT) has moderate evidence for chronic cases that do not respond to exercise. It is not a first-line treatment.

Surgery

Rarely needed. Reserved for cases that fail 6-12 months of quality conservative treatment.

Recovery Timeline

Phase	Timeframe	Focus
Reactive/Acute	Week 0-2	Isometrics, pain management, relative rest
Loading	Week 2-6	Eccentric exercises or heavy slow resistance
Strengthening	Week 6-12	Progress to single-leg, increase load
Return to Sport	Week 12-24	Plyometrics, graduated running
Full Recovery	3-6 months typical	Some chronic cases take 6-12 months

Warning Signs: When to See a Doctor

• Sudden pop or snap in the calf or heel area (possible Achilles rupture, which is a medical emergency)
• Inability to perform a single-leg calf raise at all (possible partial tear)
• A visible gap or dent in the tendon
• Pain that worsens progressively despite consistent load modification for 4+ weeks
• Pain at rest or during the night (may indicate a more serious problem)
• New Achilles pain while taking fluoroquinolone antibiotics (stop the medication and contact your doctor immediately)

Frequently Asked Questions

Should I rest completely with Achilles tendonitis?

No. Complete rest weakens the tendon. Controlled loading (starting with isometrics, progressing to eccentric exercises) is the gold standard treatment. The tendon needs mechanical stimulus to remodel and heal.

What is the Alfredson protocol?

A 12-week eccentric exercise program: 3 sets of 15 slow heel drops with a straight knee plus 3 sets of 15 with a bent knee, twice daily. You should feel mild discomfort but not sharp pain. It has the longest track record of any Achilles rehab protocol.

How long does Achilles tendonitis take to heal?

Typically 3-6 months with consistent exercise. Chronic cases may take 6-12 months. The tendon remodels slowly, so patience and consistency are both essential.

Is it okay to run with Achilles tendonitis?

Only if pain stays mild (3/10 or less) and does not worsen the next morning. Reduce your mileage and intensity. If symptoms escalate, switch back to walking and eccentric exercises.

What is the difference between midportion and insertional Achilles tendinopathy?

Midportion (2-6 cm above the heel) responds well to full-range eccentric exercises. Insertional (right at the heel) requires modified exercises where you stop at neutral and do not drop below the step. The distinction affects which exercises are safe for you.

Related Conditions

• Plantar Fasciitis Exercises: Heal Your Heels - The Achilles and plantar fascia share an attachment
• Ankle Strengthening Exercises - Strong ankles support your Achilles
• Runner’s Knee: IT Band, Patellofemoral Pain and Fixes - Runners often deal with both conditions
• IT Band Stretches: The Complete Guide - Part of a complete lower body rehab program

Ready to Start Healing Your Achilles?

The sooner you start the right loading program, the sooner your tendon begins to remodel. Do not wait for the pain to go away on its own. Give it what it needs: controlled, progressive exercise.

Take our free pain assessment quiz for a personalized plan, or browse our full guide to foot and ankle pain.

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Written by Dr. Sarah Chen, DPT, OCS. Dr. Chen is a board-certified orthopedic clinical specialist with over 10 years of experience treating foot and ankle conditions. She believes in empowering patients with evidence-based exercises they can do at home.