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Writer's pictureAlison Gould

Adapting Pilates for Achilles tendonitis

Updated: 2 days ago

Is Pilates good or bad for Achilles tendonitis? It depends on how you do it. Sports physio Alison Gould demonstrates how you can adapt your Pilates exercises to avoid aggravating the pain and stiffness in your heel and calf that typically accompany Achilles tendonitis. Remember, if you need help with an Achilles injury, you're welcome to consult one of our team via video call.


Learn how to adapt Pilates for Achilles tendonitis pain.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in most of our articles.


In this article:


We've also made a video about this:



Is Pilates good for Achilles tendonitis?


So, can Pilates make an Achilles injury worse? Well, yes and no.


With an Achilles tendonitis or tendinopathy, some of the collagen fibres that make up the Achilles tendon are injured and less robust, and this is what causes the typical symptoms of stiffness and pain in the tendon. (Here’s an article that explains the causes and symptoms of Achilles tendonitis and tendinopathy and what is going on inside your tendon in detail.)


You can rest assured that Pilates will not cause more damage to the injured collagen fibres in your Achilles tendon.


Pilates won't cause more damage but can exacerbate the symptoms associated with Achilles tendonitis or tendinopathy.
Pilates won't cause more damage but can exacerbate the symptoms associated with Achilles tendonitis or tendinopathy.

However, some Pilates exercises might exacerbate those symptoms of pain and stiffness, particularly if your Achilles tendon is pretty irritated.


How could this happen? There are two main things that can make the symptoms of an Achilles injury worse.

  • One is activities that work the injured tendon too hard – for example going up on your toes, which makes your calf muscles pull on the tendon.

  • The other is when you stretch the tendon – this happens when your foot goes into dorsiflexion (moving your toes towards your shin).



Activities that work the Achilles tendon

When we have an Achilles tendinopathy, our Achilles tendon loses its robustness; it loses its ability to cope with activities such as going up on our toes. And if you subject it to too much activity (either in intensity or number of repetitions), you might irritate it and worsen your symptoms.


Any activity where you go up on your toes works the Achilles tendon.
Any activity where you go up on your toes works the Achilles tendon.

The tricky thing about tendons is that they often don’t complain during the aggravating activity. It may take them up to 24 hours to pipe up and say “Hey! That really irritated me, and now I’m more stiff and sore than before!” Or sometimes a tendon might grumble a bit at the start of a Pilates session but then go quiet once it has warmed up – only to complain later in the day after you’ve sat down for a while or the next day.


So, if you want to figure out whether your Pilates exercises are making your Achilles pain worse, check whether your symptoms have increased in the 24 hours after a Pilates session. But also keep in mind other activities during that period that may have caused it or contributed to it.

Stretching the Achilles tendon

The bottom of the Achilles tendon is attached to the heel bone. When we move our foot into a dorsiflexed position, it stretches the tendon and compresses it against the heel bone.


When your foot moves into dorsiflexion it stretches the Achilles tendon and compresses it against the heel bone — this is normal and not a problem for an uninjured Achilles.
When your foot moves into dorsiflexion, it stretches the Achilles tendon and compresses it against the heel bone - this is normal and not a problem for an uninjured Achilles.

As I explained above, one of the symptoms of Achilles tendonitis is a stiff sensation in the calf and tendon, and many people have a natural urge to “stretch the stiffness away”. (Read more about what causes this stiff feeling.)


However, when your tendon is irritated and sore, this stretching and compression can have the same effect on it as when you poke a bruise with your finger – not very pleasant! And obviously the effect can be worsened with repeated or sustained stretches. (Read more about stretching and Achilles tendinopathy.)


This doesn’t mean you have to avoid putting your foot into dorsiflexion completely. It’s about limiting the number of times you do it and how far you take your foot into that position.


How to adapt your Pilates exercises for Achilles tendonitis


👉 Not everyone with Achilles tendonitis will have to adapt all of these exercises. You only have to adapt the ones that irritate your injured tendon. And once it has recovered, you can go back to the original way of doing them.


Hamstring stretches

A typical Pilates stretch that might affect an injured Achilles tendon is the one where you lie on your back, put an exercise band around your foot, and pull your straightened leg upwards to stretch the hamstring. This obviously pulls your foot into a dorsiflexed position, which stretches the Achilles tendon.


Don't pull your foot back when doing the hamstring stretch with a band because that also stretches the Achilles..

💡 The solution:

Lose the exercise band and just raise your leg by itself while keeping your foot nice and relaxed and not in a dorsiflexed position.


📽️ Video demo


Keep your foot pointed when doing the hamstring stretch.

Side leg lifts

Another example of exercises in Pilates where there's a lot of a pullback in that position is in the side-lying series of exercises, where you're working the top glute muscles by lifting the top leg and maybe doing some movements like figure-eights. Quite commonly in Pilates, they ask you to pull your foot back towards you, as this activates the leg muscles and makes the leg-lifts easier.


Don't bend your foot up when doing the side leg lift exercise.

💡 The solution:

Regardless of the movement you’re doing with your leg, keep your foot in a relaxed position where it’s not in dorsiflexion. So, you're still working those glutes, but you're not putting that extra stress or strain on your Achilles tendon.


📽️ Video demo


Relax or point your foot when doing the side leg lift exercise.

Calf stretches, squats, and lunges

The typical “runner’s calf stretch”, where you keep your foot flat on the floor and tilt your lower leg forward, squats, as well as lunges (especially if you hold the lunge position for a while) will also stretch the Achilles tendon.


💡 The solution:

Roll up a towel or exercise mat and put it under your heel (both heels for squats) to reduce the dorsiflexion of your foot.


Place a rolled up towel (or roll your mat) under your heel to reduce the stretch on the Achilles tendon.

📽️ Video demo


Front planks

With a front plank, your upper body weight is supported on your hands or forearms, and your lower body on your toes in a dorsiflexed position, which again might aggravate the symptoms of an injured Achilles tendon.


Doing the front plan on your toes can bend your ankle into dorsiflexion and stretch your Achilles.

💡 The solution:

Support your lower body weight on your knees and on your feet in a pointed (think ballet dancer) position, so that the tops of your feet rest on the floor. If this is uncomfortable, you could put a cushion or a rolled-up mat or towel under your feet.


📽️ Video demo


Rather do planks on your knees and relax your feet into a pointed position.

Bridges

With bridges, the closer your feet are to your bum, the more they are in a dorsiflexed position. And sometimes a Pilates instructor might tell you to go onto your tiptoes while you’re in the bridge position. It should be clear by now that both of these movements could irritate an injured Achilles tendon.


Placing your heels too close to your bum can cause your Achilles to stretch and hurt.
Sometimes a Pilates instructor will ask you to go up on your toes while in the bridge position. This can also irritate Achilles tendonitis.

💡 The solution:

Move your feet further away from your bum, and don’t go into the tip-toe position while you are bridging – keep your feet flat on the floor.


📽️ Video demo


Have your feet a bit further away from your bum in the bridge if your Achilles is hurting.


Going up on your toes

Finally, just avoid any Pilates move that requires you to go onto your tiptoes unless a medical professional involved in your Achilles injury rehab has cleared you to do so.


Examples are:

  • Calf raises

  • Tip-toe walking

  • Coming out of a squat and then going onto tiptoes (double trouble!)

  • Any of the Pilates plie-type movements.


📽️ Video demo


Check with your physio if your Achilles is ready for exercises that require you to lift up onto your balls of your feet.
Check with your physio if your Achilles is ready for exercises that require you to lift up onto the balls of your feet.

How we can help


Need help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

Meet the TMA physios

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. All of us have a wealth of experience working with athletes across a broad variety of sports and ranging from recreationally active people to professional athletes. You can meet the team here.

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Alison Gould

About the Author

Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn, Facebook, Instagram or Twitter.





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