Achilles Tendon Pain: Exercises That Actually Work

Achilles tendon pain almost always improves faster with the right exercise than with rest. Despite how it feels first thing in the morning, the tendon is usually not simply inflamed and waiting to settle down — it has lost some of its capacity to handle load, and it rebuilds that capacity through gradual, progressive strengthening. Below I explain what is genuinely happening at the back of your ankle and share the loading routine I use with my own patients every week.

What Achilles tendinopathy really is

The Achilles is the thick, powerful tendon that connects your calf muscles to your heel bone, and it transmits enormous force every time you walk, climb stairs or push off to run. When it becomes painful, thickened or stiff — classically worst in the morning, or during the first few minutes of activity before it warms up — we call it a tendinopathy. For many years this was labelled tendinitis, implying an active inflammation that rest would cure. We now understand it quite differently. Tendinopathy is largely a load-related problem: the tendon has been asked to do more than it was conditioned for, or its loading changed too quickly, and its structure has adapted poorly in response. It is not an angry inflammation you can simply rest away — and prolonged, complete rest usually makes matters worse, because it lets the tendon weaken further.

The two common types

It helps to know which type you have, because they behave differently.

• Mid-portion tendinopathy causes pain a few centimetres above the heel, in the main body of the tendon. This is the more common form and generally tolerates a full loading programme well.
• Insertional tendinopathy causes pain right where the tendon meets the heel bone. This type dislikes deep stretch and compression, so dropping the heel far below a step early on tends to aggravate it. Early exercises should keep the ankle from bending too far upwards.

Why loading, not rest, is the treatment

Tendons are living tissue that respond directly to the demands you place on them. When you load a tendon in a controlled, progressive way, it gradually becomes stronger, thicker and more tolerant of activity. When you rest it completely, the opposite happens — it weakens and de-conditions, so the moment you return to normal walking or sport the pain comes straight back, often worse than before. This is precisely why progressive loading is the evidence-based cornerstone of treatment, recognised across modern physiotherapy. The goal is not to avoid every twinge of discomfort, but to reintroduce load in measured, manageable steps so the tendon has a reason and an opportunity to adapt. In practice, this means starting where your tendon is comfortable today and adding a little more, patiently, week by week.

A graded loading routine

Here is the structure I typically follow. Please treat it as a general framework rather than a personal prescription — the right starting point depends on how irritable your tendon is.

Stage one — isometric calf holds

Why

Isometric holds, where you contract the muscle without moving the joint, can ease tendon pain and let you keep loading when the tendon is too sensitive for heavier work.

How

Stand and push up onto the balls of both feet, then simply hold that raised position. For insertional pain, hold on flat ground rather than off a step, and do not let the ankle bend far.

Dose

Hold for around 30 to 45 seconds, rest, and repeat four to five times. You can do this once or twice on most days.

Stage two — heavy slow calf raises

Why

Slow, heavy strengthening is what genuinely rebuilds tendon capacity, and the slowness matters as much as the load.

How

Perform calf raises rising up over about three seconds and lowering over about three seconds. Work both muscles of the calf: straight-knee raises target the gastrocnemius, and bent-knee raises, with the knee softly bent, target the soleus. Progress over time by holding weight or moving to one leg. For mid-portion pain you can eventually lower the heel gently below a step for extra range; for insertional pain, keep to flat ground and avoid dropping the heel below the step in the early weeks.

Dose

Aim for around three sets of eight to twelve slow repetitions, on alternate days, so the tendon has time to respond between sessions.

What to expect, and the pain rule

Tendons are slow to change, far slower than muscle. Meaningful improvement usually takes weeks to months rather than days, and progress is rarely a straight line — good weeks and flatter weeks are both part of recovery. This is normal and not a sign that you are harming yourself. Some discomfort during loading is entirely acceptable, provided it stays within sensible limits. The simple rule I give patients is this: keep pain at or below about three or four out of ten both during and after exercise, and make sure it has settled back to your baseline by the following morning. If your tendon is noticeably more painful or stiffer the next day, you did a little too much — ease back slightly, then build again from there.

Staying active while it recovers

You rarely need to stop moving altogether. Staying active within comfortable limits helps the tendon far more than resting on the sofa. If you run, you can often continue in a reduced way, as long as your pain stays within the rule above and does not worsen from day to day — shorten your distance, slow your pace, and cut out hills and sprints for a while. If running clearly flares your symptoms, it is sensible to switch temporarily to lower-impact activity such as cycling or swimming while you build your calf strength, then reintroduce running gradually.

Footwear and a simple heel raise

A small heel raise placed inside both shoes lifts the heel slightly and reduces the load and stretch through the tendon. This can give useful short-term relief, and it is particularly helpful for insertional tendinopathy. Supportive, cushioned shoes with a modest heel-to-toe drop are usually kinder to a painful Achilles than completely flat shoes in the early stages. Think of these as temporary aids that make loading comfortable, not as permanent fixes.

Common mistakes to avoid

• Resting completely. Total rest feels sensible but de-conditions the tendon and delays recovery.
• Stretching aggressively. Forceful stretching, especially into deep upward bend, often irritates the tendon — most of all in insertional cases.
• Doing too much too soon. Jumping straight to heavy or fast work overloads a sensitive tendon and flares the pain.
• Expecting a quick fix. Tendons reward patience and consistency; chasing an overnight cure leads to stop-start setbacks.

Red flags — when to seek urgent help

Most Achilles pain builds gradually and is not dangerous. But some symptoms need prompt medical attention rather than a home exercise plan. Please seek urgent assessment if you experience any of the following.

• A sudden, sharp pain, or a feeling of being kicked or struck, or a pop at the back of the ankle, followed by weakness pushing off or difficulty walking or standing on tiptoe. This can indicate an Achilles rupture and needs urgent medical evaluation.
• A tendon or ankle that becomes hot, red and swollen, particularly with fever or feeling generally unwell, which may point to infection.
• Numbness, pins and needles, or spreading loss of sensation in the foot.

If any of these apply, do not push through with exercises — see a doctor the same day.

Getting it right for you

The hardest part of tendon rehabilitation is judging the right load and progressing at the right pace. If you would value a programme built around your tendon type, its irritability and your goals, I offer online consultations where I can assess your history, design your loading plan and monitor it over video as you improve.

In one line

Achilles tendon pain is a load problem, not a rest problem — settle it with isometric holds, rebuild it with slow, heavy calf raises over weeks to months, and seek urgent care for any sudden pop, weakness or inability to stand on tiptoe.