Achilles tendonitis: the exercises that fix it

Achilles tendonitis is pain and stiffness in the cord above the back of your heel. It's usually worst for the first few steps in the morning or at the start of a run, then loosens up. It's common in runners, hikers and anyone who has ramped up mileage, hills or speed work too fast. Doctors now often call it tendinopathy, because it's more about a tendon that can't keep up with the load than about inflammation.

Why rest alone doesn't fix it

Tendons get stronger when you load them. Rest calms the pain, but the tendon stays weak, so the pain comes back when you return to running. The physical therapy guideline for this condition recommends a loading exercise program as the core treatment.

The routine below follows the Achilles rehab video (opens in a new tab) on my Home remedies page. It takes about 10 minutes. Watch it once to see the form, then follow along here.

Step 1: Warm up

• Ankle pumps: point your toes down, then pull them up toward your shin. Do 20.
• Ankle circles: 10 slow circles in each direction.

Step 2: Stretch both calf muscles

Your calf has two muscles that pull on the Achilles, and each needs its own stretch.

• Standing calf stretch (gastrocnemius): hands on a wall, sore leg back, knee straight and heel on the floor. Lean in until you feel a stretch in the upper calf. Hold 30 seconds, twice.
• Soleus stretch: same position, but bend the back knee and keep the heel down. You'll feel it lower, closer to the tendon. Hold 30 seconds, twice.

Step 3: Strengthen, in stages

Move to the next stage only when the current one is comfortable and your pain follows the rules below.

1. Isometric heel raises. Rise up onto the balls of your feet and hold for 10 seconds. Lower, rest a moment and repeat for one minute. Holds like this are often the least painful way to start loading a sore tendon.
2. Heel raises with body weight. Rise up and lower slowly. Work up to 3 sets of 10.
3. Heel raises on a slant board. Standing on an incline puts the calf on more stretch and makes the tendon work harder. Again, 3 sets of 10.
4. Eccentric heel drops, the gold standard. Stand on the edge of a step, rise up on both feet, shift your weight to the sore leg, and lower your heel slowly below the step over about 3 seconds. Use both feet to come back up. Work up to 3 sets of 10 to 15, with the knee straight and again with it slightly bent. When that gets easy, add weight with a backpack.

The classic heel-drop program in the research was done twice a day for 12 weeks. Let your pain guide how often you do it: most days is a good target, and fewer if the tendon is flaring.

If you'd rather go to the gym, there's a good alternative: heavy slow calf raises, about 3 seconds up and 3 seconds down, seated and standing, with enough weight that the last few reps are hard, 3 times a week. In a randomized trial of 58 people, this worked as well as heel drops at 12 weeks and at one year, and people completed more of their sessions.

If your pain is right where the tendon meets the heel bone, do your heel raises and drops on flat ground instead of off a step or slant board. Dropping below level can pinch that spot.

How much pain is OK

You don't have to stop running completely. In a trial of people with Achilles tendinopathy, those who kept running and jumping did as well as those who stopped, as long as they followed simple pain rules:

• Pain during the exercises or a run can go up to 5 on a scale of 0 to 10.
• Pain should settle right after you finish.
• Pain and stiffness the next morning shouldn't be worse than usual.

If you break those rules, cut back your running for a few days, not the exercises.

Other things that help

• Back off hills and speed work for a few weeks, and build mileage back up gradually.
• A small heel lift in your shoes can ease pain early on.
• Check your shoes. Big jumps in mileage on worn-out shoes are a common trigger.

When to see a doctor

• A sudden pop or snap, as if someone kicked you in the heel, trouble pushing off, or a gap you can feel above the heel. That can be a rupture and needs to be seen the same day.
• Pain after starting a fluoroquinolone antibiotic, such as ciprofloxacin or levofloxacin. These can damage tendons, so call the doctor who prescribed it.
• Swelling, redness or warmth that's getting worse, or pain that keeps you up at night.
• No improvement after 6 to 12 weeks of consistent exercises.

For more on care for runners, cyclists and hikers, see my guide to primary care for athletes.

Sources: Chimenti RL, Neville C, Houck J, et al. Achilles pain, stiffness, and muscle power deficits: midportion Achilles tendinopathy revision 2024. Journal of Orthopaedic & Sports Physical Therapy. 2024. doi:10.2519/jospt.2024.0302. Alfredson H, Pietilä T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. American Journal of Sports Medicine. 1998;26(3):360–366. Beyer R, Kongsgaard M, Hougs Kjær B, et al. Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. American Journal of Sports Medicine. 2015;43(7):1704–1711. pubmed.ncbi.nlm.nih.gov. Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy. American Journal of Sports Medicine. 2007;35(6):897–906.