Achilles Tendinitis Exercises

Achilles tendinitis, also known as Achilles tendonitis, is a common injury or disorder that often occurs following excessive or sudden increases in physical activity. Key symptoms typically include tightness, discomfort, or pain in the tendon area, and limited ankle mobility.

It is important to differentiate this from related, more severe conditions:

• Achilles tendinosis: Characterised by microtears and degeneration within the tendon structure, often from unmanaged, chronic tendinitis.
• Achilles tendon rupture: A partial or complete tear of the tendon, which requires immediate medical attention.

Neglecting the early pain and symptoms of tendinitis can severely affect your mobility and function [1]. To help promote healing and restore mobility, the following Achilles tendonitis exercises and stretches are often recommended by orthopaedic surgeons and physical therapists [1].

Important Safety Note: We strongly recommend that these exercises and stretches be performed under the supervision of a physical therapist to ensure proper form and to prevent further injury.

Exercises to Improve Strength and Mobility

These exercises primarily focus on controlled movement to load and strengthen the tendon and surrounding muscles.

1. Tiptoes (Heel Raises)

Perform the following steps for this exercise:

• Stand on both feet with your legs straight. You may use a counter or chair for balance.
• Slowly rise up on both tiptoes.
• Hold at the top momentarily.
• Slowly lower your heels back down.
• Aim for three sets of 15 repetitions if the symptoms and pain are mild. If pain increases, reduce the number of sets or stop immediately [1].

2. Bilateral Heel Drop (Eccentric Exercise)

Eccentric exercises, which focus on the muscle lengthening under tension, are crucial for tendon recovery [2].

Perform the following steps:

• Stand on the edge of a raised platform (like the bottom step of a staircase) with only the balls of your feet on the step. Your heels should be comfortably suspended over the edge.
• Rise up on your tiptoes using both legs.
• Maintaining control, slowly lower your heels below the level of the step until you feel a gentle stretch in the calf.
• Repeat the movement. A minimum of 15 repetitions is often suggested [1].

3. Single Heel Drop (Advanced)

A single heel drop is similar to a bilateral heel drop, but the entire body weight is placed on the affected leg during the lowering phase. A person should only attempt this exercise when comfortable and pain-free performing the bilateral heel drop [1].

Achilles Stretching Exercises

Stretches for the Achilles tendon and calf muscles help improve flexibility and reduce stress on the tendon. You should only perform them under the supervision of a physical therapist if you find them difficult or uncomfortable.

1. Runner’s Stretch (Gastrocnemius Stretch)

This stretch targets the larger calf muscle (gastrocnemius).

• Stand facing a wall, placing your hands at eye level.
• Take the leg you want to stretch back, ensuring your heel stays flat on the ground, and keep your toes pointing forward.
• Slowly bend your front knee toward the wall while keeping your back leg straight.
• Lean your body into the wall until you feel a stretch in the calf of the back leg.
• Hold for 30 seconds and repeat.

2. Toe-to-Wall Stretch (Soleus Stretch)

This stretch is excellent for people who feel an uncomfortable pull during the runner’s stretch, as it specifically targets the lower calf muscle (soleus) and can help improve ankle mobility.

Perform the following steps:

• Position yourself facing the wall with the toes of the affected foot resting against the wall while the heel remains on the floor.
• Gently lean your body forward, ensuring that the heel remains in contact with the floor.
• Maintain this position for the duration of your stretch.

Calf Strengthening Exercises

The calf muscle connects directly to the Achilles tendon; therefore, strengthening the calf is vital to reducing chronic strain on the tendon [3].

1. Seated Heel Raises

This exercise works the calf muscles to lift the heel, improving localised strength.

• Position yourself in a chair, with your feet shoulder-width apart and your back straight.
• Place your hands on your thighs for gentle, consistent resistance (optional).
• Elevate your heels as high as you can, hold for a moment, and then slowly lower.
• Perform 5-6 sets of 20-25 repetitions daily, provided there is no pain.

2. Standing Heel Raises

This exercise engages the full range of the calf muscle group.

• This exercise is performed while standing, similar to the Tiptoes exercise described above.
• Focus on a controlled, slow descent to maximise the strengthening benefit.

3. Resistance Band Calf Exercise

This exercise helps strengthen the muscles around the ankle and calf against resistance.

• Position yourself on the floor, extending your legs directly in front of you.
• Secure a light resistance band around the ball of the foot you wish to exercise, keeping the knee slightly bent.
• Gently pull the band to flex the foot towards you.
• Slowly point your foot away from you, working against the tension of the band.
• Pause for a moment at the end of the range, then return to the start.
• You can repeat the exercise as many times as you are comfortable, aiming for 2-3 sets of 15-20 repetitions. Gradually increase the band’s resistance (thickness) as your strength improves.

Returning to Day-to-Day Activities

Until the symptoms of Achilles tendinitis significantly subside, you should generally avoid high-impact activities such as running, jumping, and heavy lifting. When you feel you are ready to resume daily exercise, start gradually, increasing the intensity by no more than 10-20% each week [1]. If symptoms are mild, stretching may be possible in the early stages of Achilles tendinitis.

It is always recommended that you consult your physiotherapist or physician before performing any exercises or stretching for Achilles tendinitis. Based on your symptoms and pain level, they can suggest an individualised recovery plan best suited for you.

Regularly performing strengthening and eccentric exercises has been shown to build resilience in the calf and heel muscles, which are crucial for reducing the strain placed upon the Achilles tendon [2].

Frequently Asked Questions (FAQs)

What exercises may aggravate Achilles tendinitis?

Exercises that involve repetitive, high-impact strain, such as consistently walking up and down stairs, running on uneven ground, or sudden hill climbing, may contribute to or aggravate Achilles tendon injury [1].

Is massaging Achilles tendinitis helpful?

Therapeutic massage, particularly deep pressure or cross-friction massage, may help reduce pain and improve mobility in Achilles tendinitis when performed by a professional, but it should be used as a complement to a structured exercise program [3].

What are the common self-care methods for Achilles tendinitis?

Self-care methods like R.I.C.E. (Rest, Ice application, Compression, and Elevation) of the injured foot are commonly recommended to help manage initial pain and swelling of acute Achilles tendinitis [1].

How should I approach intense exercise after recovering from Achilles tendinitis?

It is strongly recommended to gradually increase your exercise duration and intensity once you recover from Achilles tendinitis to avoid overloading the tendon and causing a relapse. Avoid sharp, sudden increases in activity.

Are Achilles tendinitis stretching exercises beneficial?

Yes, stretching techniques help improve the flexibility of the calf muscles, which reduces the passive tension and strain on the Achilles tendon, thereby helping relieve pain and promote healing [1].

Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Please consult a qualified healthcare provider or physical therapist before beginning any new wellness practice, especially if you have an existing medical condition, severe pain, or are on medication.

References

[1] American Academy of Orthopaedic Surgeons (AAOS). (2020, October). Achilles Tendinitis. OrthoInfo. https://orthoinfo.aaos.org/en/diseases-conditions/achilles-tendinitis/

[2] Silbernagel, K. G., Hanlon, S., & Sprague, A. (2020). Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. Journal of Athletic Training, 55(5), 438–447. https://doi.org/10.4085/1062-6050-356-19

[3] Radovanović, G., Bohm, S., Peper, K. K., Arampatzis, A., & Legerlotz, K. (2022). Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial. Sports Medicine – Open, 8(1). https://doi.org/10.1186/s40798-022-00545-5