You may think that I’m crazy to suggest you should do exercises when your Achilles tendon is still very painful. It’s only natural to think “Wait a second, should my pain not first calm down and then I can start rehab?”
Let me explain why keeping your Achilles tendon too still can actually make things feel worse and why these gentle movements – one can hardly call them “exercises” – can help to alleviate your Achilles pain and speed up your recovery. Remember, if you need help with an Achilles injury, you're welcome to consult one of our team via video call.
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.
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In this article:
We’ve also made a video about this:
You can start these exercises even when your Achilles tendon is still very painful. As long as you pick the correct ones, they will help to reduce your pain and help your tendon to recover quicker.
How do these exercises help your Achilles pain?
So, why am I recommending that you do exercises for Achilles pain when your tendon is still very painful?
Improved circulation
Improved circulation helps with:
increasing the amount of nutrients and other stuff necessary for the healing process in your tendon
flushing away extra fluid produced by the injury and which makes your tendon feel stiff and uncomfortable
and flushing away chemicals produced by the injury which, if they’re allowed to accumulate, sensitise your nerve endings and makes your pain worse.
Overcoming fear of movement
There's strong evidence that the level of pain we experience with Achilles tendonitis is often disproportionate to how bad the injury is. Either we feel more pain than the amount of actual tissue damage suggests, or vice versa.
Fear of moving your tendon because it’s going to hurt has two detrimental effects for your recovery:
If you’re really worried about movement, it can actually make your pain worse in the long run on a psychological level.
Fear of movement might prevent you from doing the actual rehab exercises needed to eventually get your Achilles tendon better.
The good thing about the movements in this article is that you can do them in a way with which you feel comfortable and safe and that might make you just slightly worried, not terrified. You do not have to push into pain, and you do not have to do more repetitions than you feel comfortable with.
Seated calf raises
The first exercise that can be useful for painful Achilles tendons is calf raises while you’re sitting. It is the most gentle of the three exercises.
Instructions:
Sit in a chair with both feet on the floor.
Keep the balls of your feet on the floor and lift your heels up slowly and gently.
Pause for a moment.
Lower your heels back down slowly and gently.
Dosage:
As many as you feel comfortable with, once a day.
Aim to eventually get to three sets of 20 each with a minute’s rest between sets.
You can also spread it out so that you do 1 set of 20 in the morning, afternoon, and evening.
💡Top tips:
Don’t put your feet under the chair – this will stretch your tendon unnecessarily and may increase your pain. Rather have your knees at a 90-degree angle or have your feet even a bit further in front of you – wherever it is comfortable.
Concentrate on going very slow as you lower your heels – this will improve the connection between your brain and your calf muscles and tendon.
If it’s uncomfortable to go all the way up on your toes, don’t. Just go to where it feels comfortable.
Likewise, if it’s uncomfortable to lower your heels all the way down (as is often the case for insertional Achilles tendonitis), place a folded towel under your heels or do it in shoes with a bit of heel (like most types of running shoe).
Double-leg calf raises
The second exercise I find good for a painful Achilles tendon is double-leg heel raises while holding on to something for support.
📽️Play video demo (I am not wearing shoes here so that you can see the movement better. Please wear shoes if you’re doing this on a hard surface, otherwise it might injure the balls of your feet.)
Instructions:
Stand with your feet about hip distance apart and hold on to something sturdy.
Go up on your toes.
Pause for a second.
Come back down slowly.
Don’t turn your feet to the outside or inside – your weight should be evenly distributed along the ball of each foot, from your big toe to your little toe.
Dosage:
As many as you feel comfortable with, once a day.
Aim to eventually get to three sets of 20 each with a minute’s rest between sets.
You can also spread it out so that you do 1 set of 20 in the morning, afternoon, and evening.
💡Top tips:
Don’t go all the way up if that feels uncomfortable.
Don’t go all the way down if that feels uncomfortable. Again, use a folded towel under your heels or shoes with somewhat of a heel. Or you could get some shoe inserts to raise your heels a bit.
Here are some examples of shoe inserts on Amazon:
Isometric calf raises
Isometrics is when you hold a position for a certain amount of time.
Instructions:
Stand with your feet hip-width apart.
Go up onto your toes, but only about halfway up.
Then hold the position. Start with short holds (about 10 seconds) and slowly increase the time (up to 1 minute).
Come back down slowly.
Rest for at least 1 minute before doing another repetition.
Dosage:
Do between 3 and 5 repetitions, once a day.
Rest at least 1 minute between repetitions.
💡Top tips:
If/when double-leg isometric holds become too easy, you can switch to doing them on the injured side only.
You can also make these harder by adding weight (double leg or single leg), but please consult your physio first – it’s usually top athletes and people used to weight training who do this.
AVOID these exercises
The exercises you want to avoid when you have a really painful Achilles tendon is a calf stretch or an Achilles stretch – any stretch that takes the ankle into dorsiflexion.
This is a quite common type of exercise that people start doing when their Achilles tendon feels stiff, because naturally they think, “Ah, my tendon feels stiff and sore, I need to stretch it out.”
However, like I explained above, that feeling of stiffness is due to fluid accumulation, and no amount of stretching will get rid of it.
When your Achilles tendon is irritated, stretching it compresses it against your heel bone. Often it feels very good while you're doing it, but then it has a delayed pain response and several hours later it feels worse.
This will not be the case for everybody. Some people do find it useful, but especially if you've got insertional Achilles tendinopathy, stretching is not something we would advise you to do during the early stages of your recovery.
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.
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.
About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.