Achilles tendinopathy exercises at home

What's going on in a sore Achilles

The Achilles is the thick tendon that joins your calf muscles to your heel. It handles big forces every time you walk, run or jump. Achilles tendinopathy is what happens when the tendon has been asked to do more than it was ready for, often after a jump in running, a new sport, hill work, or a change of shoes. It tends to feel stiff first thing in the morning and at the start of activity, then may ease as you warm up, then ache afterwards.

Tendons respond to load. Too much irritates them, but too little leaves them weak, so complete rest usually means the pain comes straight back when you return to activity. The approach most physios use is to find a level of exercise the tendon tolerates, then step it up slowly.

How to judge pain during tendon exercises

Tendon rehab is one of the few areas where some discomfort during exercise is normal. A common guide is that pain during exercise up to about 3 to 5 out of 10 is acceptable, as long as it settles within a day and the tendon isn't stiffer or sorer the next morning than it was before.

Use the next morning as your test. If the Achilles is no worse than usual when you first get up, the load was about right. If it's clearly worse, drop back for a few days.

Stage 1: isometric holds (calming things down)

Isometrics mean holding a position without moving. They're often used first because many people find them settle tendon pain.

1. Heel raise hold. Stand holding a counter. Rise onto your toes with both feet, about halfway up, and hold for 30 to 45 seconds. Lower slowly. Rest a minute. 5 holds. As it gets easier, shift more weight onto the sore side.
2. Bent-knee calf stretch. Stand facing a wall, step the sore leg back a little and bend both knees, keeping the heel down. Hold 30 seconds, twice. Keep it gentle; aggressive stretching can irritate the tendon.
3. Ankle alphabet. Seated, trace the alphabet with your big toe to keep the ankle moving. Once through.

Stage 2: heel raises and slow lowering

When the holds are comfortable and morning stiffness is steady or improving, start moving through the range.

1. Double heel raises. Holding a counter, rise up on both feet over 2 seconds and lower over 3. 3 sets of 15.
2. Slow heel drops. Stand on a step with your heels hanging off. Rise up on both feet, shift onto the sore leg, and lower slowly over 3 to 4 seconds. Step back up with both feet. 3 sets of 10. If the tendon pain is right at the heel bone, do these on flat ground instead of a step, since dropping below level can aggravate that type.
3. Straight-knee calf stretch. Back leg straight, heel down, lean into the wall. 30 seconds, twice.

Stage 3: single-leg strength

A healthy Achilles needs to handle your full body weight on one leg many times over. This stage builds that.

1. Single-leg heel raises. Up on one foot, fingertip on the counter for balance. Build up to 3 sets of 10 to 15 with a full, slow range. A useful target is matching your good side.
2. Bent-knee single-leg raises. Same movement with the knee slightly bent, which works the deeper soleus muscle. 3 sets of 10.
3. Add weight. When 3 sets of 15 single-leg raises are easy, wear a backpack with a few books in it, or hold a dumbbell.

Stage 4: getting back to running and jumping

Only once single-leg strength is close to the other side. Start with small two-footed hops on the spot, then skipping, then a walk-run plan on flat ground. Keep up two strength sessions a week even once you're back, because the Achilles is often the first thing to complain when training jumps.

Common mistakes

• Resting completely until it stops hurting, then going straight back to the same training.
• Stretching hard several times a day instead of strengthening.
• Progressing because the calendar says so rather than because the next-morning test is good.
• Doing only double-leg raises forever. The tendon needs single-leg load eventually.
• Stopping the strength work as soon as you're pain free.

Stop and get checked if

• You felt a sudden snap or a kick to the back of the leg, or can't rise onto your toes on that foot
• There's a gap or dent you can feel in the tendon
• The area is hot, red and very swollen
• Pain is getting steadily worse despite reducing load, or is there at night at rest
• You started a new medicine (some antibiotics are linked with tendon problems) and the pain began soon after

Mid-portion or insertional: why it matters

Achilles pain tends to sit in one of two places. Mid-portion pain is 2 to 6 centimetres above the heel, in the cord of the tendon itself. Insertional pain is right where the tendon meets the heel bone. The exercises are similar, but insertional pain is often irritated by stretching and by letting the heel drop below the level of a step, because that squeezes the tendon against the bone.

If your pain is at the heel bone, keep heel raises and heel drops on flat ground, go easy on calf stretches, and consider a small heel lift in your shoe for a few weeks. If you're not sure which type you have, a physio can tell quickly by pressing along the tendon.

A sample week

• Strength days (3 to 4 a week, not back to back at first): your current stage's exercises, 3 sets each.
• Other days: 20 to 30 minutes of walking, cycling or swimming at an easy effort.
• Every morning: note your stiffness on a 0 to 10 scale for the first few steps. That number tells you whether to progress, hold or drop back.
• Once a week: retest how many single-leg heel raises you can do on each side.

Things that make a tendon worse

• Sudden jumps in running distance, hills or speed work.
• Switching to much flatter or minimal shoes overnight.
• Long periods of doing nothing followed by a big session at the weekend.
• Very aggressive calf stretching, especially with insertional pain.

Keeping it going with Apex One

Apex One has a guided Achilles program that follows these stages, for between physio sessions. In Apex One+, the program talks you through each exercise out loud, times your holds, and asks you to rate pain before and after each session, so you have something concrete to show your physio. The voice counts reps at a steady pace; the camera isn't used for rehab exercises.

Count every rep with your phone

Questions

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