Achilles tendinopathy exercises

Achilles tendinopathy is an overload problem of the thick tendon that joins the calf muscles to the heel bone. That tendon takes several times body weight with every running stride, so it is strong but sensitive to sudden changes in what it is asked to do. The tissue becomes irritated and less tolerant of load, rather than damaged or close to giving way.

It typically follows a change: more running, more hill or speed work, a new sport, a return to exercise after a break, a switch to flatter shoes, or a job that suddenly involves far more time on your feet. Age plays a part from the forties onwards, and stiff or weak calves make the tendon work harder for every step.

The hallmark is pain and stiffness in the tendon for the first steps in the morning and at the start of exercise, often easing as you warm up and then returning later that evening or the next day. There may be a tender, slightly thickened area a few centimetres above the heel, or pain right where the tendon meets the heel bone.

It responds well to progressive loading, and rest alone tends to make it worse rather than better, because a rested tendon loses capacity. Most people improve substantially over about 12 weeks of consistent calf work, with full running tolerance taking three to six months. This programme calms the tendon, builds calf and tendon strength through a staged plan, then rebuilds running or walking load.

Who this programme is for

Adults with gradual-onset Achilles or heel pain linked to activity that is stiff for the first steps in the morning. It suits both a recent flare and a tendon that has been grumbling for months. Sudden severe calf pain with a feeling of being kicked, and difficulty pushing off, may be a rupture and needs urgent assessment.