The Achilles tendon is a strong, fibrous cord that connects your calf muscles—specifically the gastrocnemius and soleus—to your heel bone. Like all tendons, its role is to transfer force from the muscles to the bone, allowing movement. In the case of the Achilles, it facilitates plantarflexion, which is the motion of rising onto your toes.
Many people are familiar with the term tendinitis, which refers to inflammation of a tendon. However, when pain becomes persistent and leads to a loss of function, the more accurate term is tendinopathy. Achilles tendinopathy typically does not involve significant inflammation, which is why anti-inflammatories and rest are often ineffective for long-term relief. Unlike acute tendinitis, which resolves relatively quickly, tendinopathy usually requires more specific interventions. Achilles tendinopathy is best described as pain at the Achilles tendon that can go down towards the heel that is aggravated by mechanical loading.
Tendon issues generally arise when there’s a mismatch between the load placed on the tendon and the tendon’s capacity to handle that load. This can occur in two ways:
1. A sudden increase in load
2. A decrease in tendon capacity
Achilles tendinopathy often starts when there’s a significant increase in activity. For instance, someone might increase their daily steps from 5,000 to 15,000 while on vacation, putting added strain on the Achilles before it has time to adapt.
On the other hand, a runner might maintain the same weekly mileage but stop performing strength training exercises like weighted heel raises. This reduction in strength decreases the tendon’s capacity, causing it to struggle under the same load it previously handled with ease. Both situations can lead to persistent Achilles pain when the tendon is loaded.
Once Achilles tendinopathy develops, how can it best be treated? Since tendinopathy results from a mismatch between tendon load and capacity, adjusting both factors can help relieve symptoms.
If a runner dramatically increases their mileage, the first step might be to reduce that mileage to a level the tendon can tolerate. This process may involve some trial and error. In more severe cases, a temporary halt to running and a switch to walking or cross-training activities like cycling may be necessary.
At the same time, you can work on increasing the tendon’s load capacity through targeted exercises designed to strengthen the muscles and tendon. We’ll outline an effective Achilles tendon exercise progression in the next section. Fortunately, decreasing the load while simultaneously increasing load capacity can speed up your recovery.
Your starting point in an exercise progression depends on the severity of your Achilles pain. It's crucial to start with easier exercises and gradually progress as your strength improves and symptoms subside.
The easiest starting point is isometric exercises, which involve holding a position without movement. A simple isometric exercise for the Achilles is standing on your toes and holding the position for 15 to 60 seconds. Aim for 3 to 10 repetitions, depending on the hold time.
Once isometric calf raises can be done without a significant increase in pain, you can progress to calf raises with movement. Begin with double-leg calf raises, then gradually add weight (e.g., holding a dumbbell). Afterward, progress to unweighted single-leg raises, and then weighted single-leg raises. To further challenge the tendon, you can add deficit heel raises, where you perform the movement off a step or elevated surface for a greater range of motion. Aim for 8 to 15 repetitions per exercise, repeated for 2 to 3 sets.
For those returning to activities like running or sports, adding plyometric exercises can be an important part of rehabilitation. Start with double-leg pogo hops (jumping in place), then progress to side-to-side and forward-and-backward hops. After mastering these, move on to single-leg variations. Perform these exercises for 15 to 30 seconds, repeating 3 to 5 times per leg.
Once you can complete these exercises without significant pain, you should be ready to return to your desired activity or sport. However, remember to gradually increase the load on your tendon to avoid re-injury.
While no one likes experiencing pain, it’s important to understand that pain doesn’t always indicate damage, especially during the rehabilitation process. When doing exercises or returning to activity, it’s normal to encounter some discomfort. As long as you keep pain around a 3/10 level and ensure it doesn’t linger beyond the day of exercise, you're unlikely to cause harm to the tendon. Don’t be afraid to push into mild pain—but do so intelligently.
If you're struggling with Achilles tendinopathy and aren’t sure how to handle it, our experts at Maven are here to help. Book an appointment today, and we’ll guide you through a personalized rehabilitation program so you can return to doing what you love with confidence.
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