RecoverMe

Calf / lower leg · Achilles Tendinopathy

Achilles Tendinopathy

Your Achilles tendon — the thick cord at the back of your ankle — is irritated and overloaded. Despite the old name ending in '-itis', this isn't active inflammation and nothing is torn through; it's a wear-and-load problem. It comes in two kinds: one a little way up the cord, and one right where it meets the heel bone — which matters for how you train it back.

The tendon got loaded faster than it was conditioned for — a jump in running/walking/hills, new shoes, or returning to sport too quickly. That's why the fix is progressive loading (not rest): a calmer isometric start, then heavy slow strengthening and eccentric heel drops over about 12 weeks.

How it typically shows up

Gradual-onset pain and stiffness in the Achilles tendon — in the cord 2-6cm above the heel (mid-portion) or right at the heel-bone attachment (insertional) — worst for the first steps in the morning and with loading, NOT in the muscle belly and NOT from a sudden 'pop' (which would be a rupture, routed out). A tendon load problem that responds to progressive loading; the insertional type needs the heel-drop range kept to floor level.

How long recovery takes

Tendons get stronger with the right exercise, but slowly — expect roughly a 12-week program, with that morning stiffness easing as you go. Slow, strong calf work is what helps most, building back toward running and impact as the tendon tolerates load.

Some discomfort while you train is fine, as long as it settles by the next morning — if pain lingers into the next day or climbs week to week, ease the load. If your sore spot is right at the heel bone, keep the heel level with the floor (don't let it drop below) so you don't pinch the tendon.

The phased recovery approach

  1. Phase 1 · 1–3 weeks

    Calm

    Calm an irritable tendon with isometric calf holds and load management, staying within the pain rule (up to ~5/10 that settles by morning).

    What you get back: calmer, looser mornings.

    • Ankle Circles — 1–2 sets × 8–12 reps · Sitting or lying with the leg supported, draw slow full circles with the foot, both directions
    • Ankle Pumps — 1–2 sets × 8–12 reps · Point the foot down then pull it up, slow and full-range
    • Isometric Calf Hold (mid-range) — 3–5 sets × 20–45s hold · Rise to a comfortable mid-range on both feet (or the sore one), hold still
    • Isometric Calf Push (seated) — 3–5 sets × 20–45s hold · Sitting, press the ball of the foot gently into the floor or a wall, calf working

  2. Phase 2 · 6–12 weeks

    Rebuild

    Build the tendon with eccentric heel drops and heavy slow calf raises over ~12 weeks. Mid-portion: drop the heel below the step. Insertional (pain at the heel bone): floor level only.

    What you get back: a strong, loaded calf raise.

    • Ankle Circles — 1–2 sets × 8–10 reps · Sitting or lying with the leg supported, draw slow full circles with the foot, both directions
    • Ankle Pumps — 1–2 sets × 8–10 reps · Point the foot down then pull it up, slow and full-range
    • Eccentric Heel Drop — 3–4 sets × 12–15 reps · Rise onto both toes, shift weight to the injured leg, slowly lower that heel below or to the step
    • Loaded Calf Raise — 3–4 sets × 12–15 reps · Calf raise holding weight, or on a machine, from floor/neutral into plantarflexion only

  3. Phase 3 · 4–12 weeks

    Back to running

    Restore explosive calf capacity and return to running/jumping, continuing to load the tendon.

    What you get back: running and jumping.

    • Ankle Circles — 1–2 sets × 8–10 reps · Sitting or lying with the leg supported, draw slow full circles with the foot, both directions
    • Ankle Pumps — 1–2 sets × 8–10 reps · Point the foot down then pull it up, slow and full-range
    • Eccentric Heel Drop — 3–4 sets × 12–15 reps · Rise onto both toes, shift weight to the injured leg, slowly lower that heel below or to the step
    • Loaded Calf Raise — 3–4 sets × 12–15 reps · Calf raise holding weight, or on a machine, from floor/neutral into plantarflexion only

  4. Phase 4 · 1–3 weeks

    Back to daily life

    Keep loading the tendon and hold calf strength, mobility and balance so standing, stairs and walking stay painless.

    What you get back: standing, stairs and walking.

    • Graded Walking — 1 sets × 600–1800s hold · Walk on flat, predictable ground and stop before a limp or push-off compensation appears
    • Ankle Circles — 1–2 sets × 8–10 reps · Sitting or lying with the leg supported, draw slow full circles with the foot, both directions
    • Ankle Pumps — 1–2 sets × 8–10 reps · Point the foot down then pull it up, slow and full-range
    • Eccentric Heel Drop — 2–3 sets × 12–15 reps · Rise onto both toes, shift weight to the injured leg, slowly lower that heel below or to the step

  5. Phase 5 · 2–6 weeks

    Back to the gym

    Rebuild heavy loaded calf-raise and machine / leg-press calf capacity for the gym — full symmetric single-leg heel-raise strength, no impact, before unrestricted loaded training.

    What you get back: loaded calf training again.

    • Machine / Leg-Press Calf Raise (heavy) — 3–4 sets × 8–12 reps · Calf raise on a leg-press sled or standing calf machine — full range, heel dropped below the platform then all the way up
    • Loaded Calf Raise — 3–4 sets × 8–12 reps · Calf raise holding weight, or on a machine, from floor/neutral into plantarflexion only
    • Single-Leg Heel Raise — 3–4 sets × 8–12 reps · Rise onto the ball of the injured foot, fingertip on a wall for balance
    • Ankle Circles — 1–2 sets × 8–10 reps · Sitting or lying with the leg supported, draw slow full circles with the foot, both directions

Exact exercises, sets and progression depend on your severity, equipment and goal — this is the shape of the program, not a one-size prescription.

What matters while you recover

  • How much pain is okay (the tendon rule)

    Tendons need load to heal, so some pain during the exercises is fine — up to about 5/10 — as long as it settles back to your normal by the next morning and isn't getting worse week to week. If it lingers or climbs, drop the load a little. This is the opposite of resting until pain-free.

  • Mid-portion vs insertional — mind the range

    Your heel drops default to FLOOR LEVEL — lowering only to level, not below. That's the safe range for everyone, and it's essential if your tenderest spot is right at the heel bone (insertional): dropping the heel below the step pinches the tendon at its attachment and flares it, so DON'T. If instead your pain is in the cord a few centimetres above the heel (mid-portion), once you're loading comfortably you can progress to dropping the heel below the step for a bigger stretch. Same loading idea, just a shorter range for insertional.

  • Slow but reliable

    Achilles tendinopathy responds well to a progressive loading program, but tendons are slow — give it around 12 weeks of consistent work. Morning stiffness easing is a good early sign. Nothing is torn, and staying active within the pain rule is safe and helps.

Common questions

Should I rest it until it stops hurting?
No — tendons need load to recover. Resting tends to make them weaker and more sensitive. The plan loads it progressively within a pain rule, rather than waiting for the pain to vanish first.
How much pain is okay during the exercises?
Up to about 5/10 during loading is fine, as long as it settles back to your normal by the next morning and isn't getting worse week to week. If it lingers or climbs, ease the load.
Is mine mid-portion or insertional, and why does it matter?
If your tenderest spot is in the cord a few centimetres above the heel, it's mid-portion — you can drop your heel below a step. If it's right at the heel bone, it's insertional — keep your heel drops to floor level only, because dropping below pinches the tendon and flares it.

Go deeper

Related calf / lower leg conditions

Sources