Achilles tendonitis is a condition that causes pain along the back of the ankle or heel due to acute inflammation of the Achilles tendon. This 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 and mid-portion. Insertional tendonitis occurs when the pain is located where the Achilles meets the heel, while mid-portion tendonitis causes pain about 2 centimeters to 6 centimeters above this area.
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In either case, Achilles tendonitis can lead to pain when standing, walking, or running and can significantly limit your daily function.
Fortunately, most cases of Achilles tendonitis can be effectively treated with physical therapy exercises. In this article, we'll review some of the research-based techniques that are used to treat this condition.
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.
Studies show that stretching the calf muscles and the tendons around the ankle can help reduce the pain associated with insertional Achilles tendonitis. It may also be helpful for mid-portion tendonitis, though the research is still not conclusive on this.
Gastrocnemius Stretch
The gastrocnemius is the largest calf muscle and makes up a portion of the Achilles tendon. To stretch this area:
- Stand facing a wall with your feet hip-width apart and staggered, with the affected foot in the back.
- Keeping the heel of the hindfoot on the ground and the knee straight, bend the front knee.
- Lean into the wall until a low to moderate intensity stretch is felt in the calf of the back leg.
- Hold the pose for 30 seconds. Repeat three to five times. This can be done 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:
- Face a wall and stagger your feet, keeping the painful leg in back.
- With the heel of the back foot on the ground, slightly bend the knee on the painful leg.
- Shift your bodyweight towards the wall without lifting your affected heel off the ground. Stop when you feel a stretch in the lower portion of your calf.
- Maintain the hold for 30 seconds before relaxing. Try three to five repetitions at a time and repeat this twice daily.
Eccentric Strength Techniques
Eccentric exercises refer to moves that build strength in a muscle by applying tension to the structure as it is lengthened. This type of technique has been found to be especially helpful in relieving the pain associated with mid-portion Achilles tendonitis. It may also provide some benefit for the insertional variety, though this is more questionable.
It is not completely understood why eccentric strengthening is effective in treating this condition. One theory is that this type of technique places load on the Achilles and helps the tendon adapt to the everyday strains that travel through it.
Another hypothesis is that eccentrics exercises alter 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 the calf muscles, which reduces strain on the tendon.
Gastrocnemius Heel Raise
To target the gastrocnemius muscle eccentrically, try this heel raise variation:
- Stand with your feet shoulder-width apart and your hands resting on a counter.
- Keeping your knees straight, lift both heels in the air as you rise up through your first and second toes.
- Lift your unaffected foot off the ground and slowly lower your other heel back down over the course of 2 to 3 seconds.
- Complete three sets of 10 to 15 repetitions, twice daily.
Soleus Heel Raise
Because it also forms a significant portion of the Achilles tendon, the soleus is another important structure to target with eccentric strengthening. Try this small tweak to the previous exercise to focus on this muscle.
- With your feet shoulder-width apart and your knees slightly bent, lightly touch a countertop.
- Keeping a small bend in your legs, rise up onto both heels.
- Lift the non-painful leg in the air and gradually lower your other heel back to the ground.
- Try three sets of 10 to 15 eccentrics and do this two times per day.
Heavy Resistance Exercises
Exercises that subject the Achilles tendon to higher amounts of weight are another option when treating mid-portion tendonitis. These techniques, which utilize common pieces of equipment found in a gym or health club, 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 injury the Achilles tendon further by over-straining it with heavy weights. Ideally, these exercises should be done under the supervision of a physical therapist.
Leg Press Heel Raise
Using a leg press machine, this exercise helps to strengthen the gastrocnemius and soleus muscles and reduce your Achilles tendon pain.
- Sit in the leg press with your feet positioned shoulder-width apart on the footplate. Your knees should be straight.
- Select a heavier amount of weight. Ideally, the weight should allow you to do a maximum of 15 reps in a row before you are unable to complete another.
- Using this resistance, slowly rise onto both toes and then lower the heels back down to the plate. Take about 3 seconds to complete each phase of the exercise. Repeat three times.
Complete three to four sets. Do this three times weekly and try to gradually increase the amount of weight you use every one to two weeks.
Seated Calf Raise
This version of the calf raise utilizes another piece of fitness equipment to target the deeper soleus muscle.
- Position yourself in a seated calf raise machine with both feet resting on the plate and the resistance pad over each of your knees.
- Select a resistance that allows you to complete a maximum of 15 repetitions in a row.
- Rise onto your toes with both feet over the course of about 3 seconds.
- Slowly lower your heels back to the footplate over 3 more seconds.
- 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.
A Word from Verywell
Achilles tendonitis is a condition that is both relatively common and extremely uncomfortable. Fortunately, in the majority of cases, this diagnosis is effectively treated using physical therapy exercises, such as the ones detailed above.
If you are experiencing pain in any region of your Achilles, be sure to speak to your physician about a referral to a physical therapist. Your physical therapist will be able to evaluate your symptoms and recommend the treatment techniques that offer you the best chance at a full recovery and can help you avoid future injuries.
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
von Rickenbach KJ, Borgstrom H, Tenforde A, Borg-Stein J, McInnis KC. Achilles tendinopathy: evaluation, rehabilitation, and prevention.Curr Sports Med Rep. 2021;20(6):327-334. doi:10.1249/JSR.0000000000000855
Kedia M, Williams M, Jain L, et al. The effects of conventional physical therapy and eccentric strengthening for insertional Achilles tendinopathy. Int J Sports Phys Ther. 2014;9(4):488-497.
Beyer R, Kongsgaard M, Hougs Kjær B,Øhlenschlæger T, Kjær M, Magnusson SP. Heavy slow resistance versuseccentric training as treatment for achilles tendinopathy: a randomizedcontrolled trial. Am J Sports Med. 2015;43(7):1704-1711. doi: 10.1177/0363546515584760
O’Neill S, Watson PJ, Barry S. Why are eccentric exercises effective for Achilles tendinopathy? Int J Sports Phys Ther. 2015;10(4):552-562.
:max_bytes(150000):strip_icc()/IMG_36371-36db884b1cb041febec9cf44c1c6a1db.jpg "Physical Therapy Exercises for Achilles Tendonitis (2)")
By Tim Petrie, DPT, OCS
Tim Petrie, DPT, OCS, is a board-certified orthopedic specialist who has practiced as a physical therapist for more than a decade.
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