Achilles Tendon Rehab Exercises
This article will cover simple rehab exercises for the most common Achilles tendon problems. It’s worth noting up front that Achilles problems can be slow to heal, and that exercise protocols typically need to be followed for 3 months to get results. Whilst that’s a long time, without intervention, symptoms can last 6 months to over 2 years, with many people experiencing chronic pain and reduced activity levels. Just ‘waiting and seeing’, usually doesn’t work well with Achilles tendon problems.
Apart from a full rupture of the Achilles tendon, the three main Achilles problems are;
Mid Portion Achilles Tendinopathy
Insertional Achilles Tendinopathy
Achilles Paratenonitis
The first two Achilles problems are both tendinopathies, which are non-inflammatory conditions caused by overuse, where tendon pain and weakness result from disorganized collagen, abnormal nerve and blood vessel growth, and disrupted tissue repair—rather than classic inflammation. Midportion tendinopathy accounts for 60% to 75% of Achilles tendon diagnoses and is more common in an active population, such as long-distance runners. Insertional tendinopathy represents only 25% of Achilles tendon diagnoses and generally affects older or less active people.
The third type of problem, Achilles paratendonitis, is inflammation of the paratenon (the sheath surrounding the tendon), not the tendon itself. Achilles paratenonitis often affects runners and active middle-aged individuals who rapidly increase training or run on hills. It’s caused by irritation of the tendon sheath due to friction, poor biomechanics, or sudden changes in load.
How do you know which type of problem you have?
Pain 2–6 cm above the heel → You most likely have mid-portion Achilles tendinopathy
Pain right at the back of the heel bone → You likely have insertional Achilles tendinopathy
Burning, creaking, or pain around the sides of the tendon → Most likely Achilles paratenonitis (paratendinitis)
These distinctions matter because each condition responds best to a different type of loading and exercise. Misidentifying your tendon problem could delay your recovery or worsen symptoms. If you’re unsure which type of problem you have, seek some advice from a healthcare professional.
Mid-Portion Achilles Tendinopathy Exercise
The most well researched exercise for this problem is the Alfredson eccentric heel drop. You may get some mild pain doing the exercise, but this should not worsen over time.
How To Do It:
Stand on a step with the balls of both feet.
Rise up on both legs, then slowly lower just the affected leg.
Perform with knee straight (gastrocnemius focus) and bent (soleus focus).
Frequency: 3 sets of 15 reps, 2-4 times a day
Duration: 12 weeks minimum.
Mid-Portion Achilles Tendinopathy Exercise
Insertional Achilles Tendinopathy Exercise
The exercise recommended is a modified version of the Alfredson protocol, which places slightly less stress on the tendon than the original exercise. The exercise is part of the well-studied Silbernagel protocol.
How To Do It:
Same as the Alfredson protocol, but stand on a flat surface so your heels don’t drop down at the end of the exercise.
Frequency: 3 sets of 15 reps, once or twice daily.
Duration: 12 weeks.
Adjuncts: Heel lifts in shoes, gentle calf stretches (only if tolerated), avoiding backless or rigid shoes.
Insertional Achilles Tendinopathy Exercise
Achilles Paratenonitis Exercises
This problem involves inflammation or irritation of the sheath around the Achilles tendon. It can be very painful with creaking or burning sensations, and is often caused by overuse or poor footwear. It requires a more gentle approach than the first two problems and uses isometric calf contractions - the standing calf raise hold.
How To Do It:
Start position: Stand flat on the ground with feet shoulder-width apart.
Movement: Rise slowly onto the balls of both feet and hold at the top (heels off the ground, but level—not dipped).
Hold Time: 30–45 seconds
Reps: 4–5 holds
Rest: 1–2 minutes between reps
Frequency: 1–2 times per day
Progression: Begin with both legs → progress to single-leg when pain decreases. Avoid heel drop below neutral (to prevent paratenon compression)
Achilles Paratenonitis Exercise
How osteopathy can help
Achilles problems are often symptoms of deeper mechanical issues in your body—not just in the ankle, but up through the foot, hips, and even spine. Here's how correcting those imbalances can reduce pain, improve function, and prevent reinjury:
Tight calves and limited ankle dorsiflexion increase strain on your Achilles. Try stretching both your calf muscles (with bent and straight knees), doing ankle mobility drills like knee-to-wall, and using a foam roller. Osteopaths can help by freeing up stuck ankle joints and releasing tension in the calf-Achilles chain.
Flat feet or excessive pronation twist your leg inward, putting stress on the tendon. Exercises like short-foot drills, toe splaying, and balance training can build a stable base. Osteopathic techniques help by realigning midfoot joints, supporting your arch, and fine-tuning your walking pattern.
Weak hips cause your legs to collapse inward when you move, increasing Achilles load. Strengthen with glute bridges, band walks, and step-downs. Osteopaths may adjust your pelvis, activate key hip muscles, and release tight areas like the IT band or piriformis to restore healthy motion.
A stiff or unstable spine throws off your walking and running rhythm, sending excess force to your Achilles. Improve mobility with trunk twists and cat–cow stretches, and build core strength with exercises like dead bugs and side planks. Osteopathic care targets the spine, diaphragm, and deep muscles like the psoas to reconnect your whole movement chain.
Achilles tendon pain is often the result of a “whole-body” issue—not just a local injury. By combining the right exercises with osteopathic manual therapy, you can fix the root causes, improve how your body moves, and come back stronger, faster, and more resilient.
Come and see me at Osteo Studio for help with your Achilles tendon problem
Cliff Russell, Registered Osteopath
