Achilles Tendonitis Exercises

Most cases of Achilles tendonitis can be effectively treated with physical therapy exercises. A physical therapist (PT) can teach you Achilles tendonitis exercises you can do at home to help you recover.

Achilles tendonitis is an acute inflammation of the Achilles tendon that causes pain along the back of the ankle or heel. The Achilles tendon is a thick, fibrous structure that connects your calf muscles (the gastrocnemius and the soleus) to your heel bone (the calcaneus).

There are two types of Achilles tendonitis:

• Insertional tendonitis is when the pain is located where the Achilles meets the heel
• Mid-portion tendonitis causes pain about 2 inches above where the Achilles meets the heel 

In either case, Achilles tendonitis can lead to pain when standing, walking, or running and can significantly limit your daily function.

This article will cover research-based techniques that are used to treat Achilles tendonitis. You’ll also learn which activities to avoid if you have Achilles tendonitis.

Flexibility Stretches

Tight calf muscles put extra strain on the Achilles tendon during daily movements and intense physical activity. This is why physical therapists recommend exercises that build or restore flexibility in the calf muscles if you have Achilles tendonitis.

Studies have shown that stretching the calf muscles and the tendons around the ankle can help reduce pain from insertional Achilles tendonitis. It might also help mid-portion tendonitis, but more research is needed.

Gastrocnemius Stretch

The gastrocnemius is the biggest calf muscle and makes up a portion of the Achilles tendon. To stretch this area:

1. Stand facing a wall with your feet hip-width apart and staggered, with your hurting foot in the back.
2. Bend your front knee while keeping the heel of your back foot on the ground and your knee straight.
3. Lean into the wall until you can feel a low to moderate-intensity stretch in the calf of your back leg.
4. Hold the pose for 30 seconds. Repeat three to five times. You can do the stretch several times each day.

Soleus Stretch

The soleus is a smaller and deeper calf muscle that also makes up a significant portion of your Achilles. To improve flexibility in this structure:

1. Face a wall and stagger your feet, keeping your hurting leg in the back.
2. With the heel of your back foot on the ground, slightly bend the knee of your painful leg.
3. Shift your body weight toward the wall without lifting your hurting heel off the ground. Stop when you feel a stretch in the lower portion of your calf.
4. Stay in the position for 30 seconds before relaxing. Try three to five repetitions at a time and repeat this stretch twice a day.

Eccentric Strength Techniques

Eccentric exercises are moves that build strength in a muscle by putting tension on the structure as it is lengthened. This technique relieves the pain of mid-portion Achilles tendonitis. It might provide some benefit for the insertional variety, but more research is needed.

Researchers are not sure why eccentric strengthening helps Achilles tendonitis. One theory is that this technique puts a load on the Achilles and helps the tendon adapt to the daily strains that it goes through.

Another idea is that eccentrics exercises change the stiffness or flexibility of the tendon, which in turn helps to relieve pain. 

It could also be that the exercises help you build power in your calf muscles, which reduces the strain on the Achilles tendon.

Gastrocnemius Heel Raise

To target the gastrocnemius muscle eccentrically, try this heel raise variation:

1. Stand with your feet shoulder-width apart and your hands resting on a counter.
2. Keeping your knees straight, lift both heels in the air as you rise up through your first and second toes.
3. Lift your unaffected foot off the ground and slowly lower your other heel back down over the course of 2 to 3 seconds.
4. Complete three sets of 10 to 15 repetitions, twice daily.

Soleus Heel Raise

The soleus is another part of the Achilles tendon and an important structure to target by doing eccentric strengthening. 

Try this small tweak to the previous exercise to focus on this muscle:

1. With your feet shoulder-width apart and your knees slightly bent, lightly touch a countertop.
2. Keeping a small bend in your legs, rise up onto both heels.
3. Lift the non-painful leg in the air and gradually lower your other heel back to the ground.
4. Try three sets of 10 to 15 eccentrics and do this two times per day.

Heavy Resistance Exercises

Exercises that put the Achilles tendon under higher amounts of weight are another option when treating mid-portion tendonitis. These techniques have been found to be equally effective as eccentric strengthening exercises at relieving Achilles tendonitis pain.

However, it is important to approach these exercises with caution, as you don't want to injure the Achilles tendon further by over-straining it with heavy weights. 

While these techniques use equipment found in a gym or health club, you should not do them alone. The exercises should be done under the supervision of a PT.

Leg Press Heel Raise

You can do this exercise with a leg press machine to strengthen the gastrocnemius and soleus muscles and reduce your Achilles tendon pain.

Here’s how to do the exercise:

1. Sit in the leg press with your feet positioned shoulder-width apart on the footplate. Your knees should be straight.
2. Choose a heavier amount of weight. Ideally, you should be able to do a maximum of 15 reps in a row before you have to stop. 
3. Using this resistance, slowly rise onto both your toes and then lower your heels back down to the plate. Take about 3 seconds to complete each phase of the exercise. Repeat three times.
4. Complete three to four sets. Do this three times weekly. Try to gradually increase the amount of weight you use every one to two weeks.
   

Seated Calf Raise

This version of the calf raise uses another piece of fitness equipment to target the deeper soleus muscle.

Here’s how to do this exercise:

1. Position yourself in a seated calf raise machine with both feet resting on the plate and the resistance pad over each of your knees.
2. Select a resistance that lets you complete a maximum of 15 repetitions in a row. 
3. Rise onto your toes with both feet over the course of about 3 seconds.
4. Slowly lower your heels back to the footplate over 3 more seconds.
5. Perform three or four sets of three repetitions. This technique can also be done three times weekly, with higher amounts of weight being used each week.

Summary

Achilles tendonitis is a condition that is common but painful. Achilles tendonitis can usually be treated with physical therapy exercises. 

If you are having pain in your Achilles, ask your provider about a referral to a physical therapist. They can talk to you about your symptoms and recommend the treatments that will offer you the best chance at a full recovery and can help you avoid future injuries.