Achilles tendinopathy exercise program

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Achilles tendinopathy is common in runners; up to 10%. It does, however, happen to non-runners too.  It is most common between the ages of 30 and 50 and it is likely due to overuse of the tendon and poor healing. Pain is usually related to activities like running.  Stiffness is common after long periods of no use, such as first thing in the morning. There is often a localized swelling where the pain is.  Most commonly this is in the middle of the Achilles’ tendon.  It can also happen at the very bottom of the Achilles’ tendon near the heel, which unfortunately makes this condition harder to treat. 1


There is no evidence that stretching helps this condition.1 You will get all the stretch needed from the heel drop exercises.

Strengthening: 2

The following exercise should be done twice a day. The exercise will cause soreness for the first 1-2 weeks, but you should work through that.  Only stop if the pain is debilitating.  Your goal should be 3 sets of 15, but you will likely not get there initially, so do not get discouraged.  Just do as many as you can.

Heel drops: place your bad foot on a step with your heel hanging off the edge.  Push up with both feet so you are on your toes.  Remove your good leg and let your heel drop down quickly, stopping the movement at the end with your own muscles.  Do this with both your knee in the straight and slightly bent positions.  Do 3 sets of 15 of each exercise (6 sets in total).  Once this is comfortable, increase the weight in 5 pound intervals by using a backpack with weight in it.


Please see your doctor again 6 weeks after starting this program.  At that appointment they can check your progress.  If you have had no improvement, your family doctor may decide you have more widespread dysfunction and may want to refer you to physiotherapy. They may also want to consider referring you to a sports medicine specialist if the diagnosis is unclear. 

You may have heard of treating this condition with orthotics or steroid injections.  Unfortunately, research has shown neither of these to be effective. 3,4

1. Carcia CR, Martin RL, Houck J, Wukick DK. Achilles pain, stiffness, and muscle power deficits: Achilles tendinitis. J Orthop Sports Phys Ther. 2010;40:A1-26.

2. Alfredson H, Cook J. A treatment algorithm  for managing Achilles tendinopathy: new treatment options. Br J Sport Med. 41:211-6.

3. Wyndow N, Cowan SM, Wrigley TV, Crossley KM. Neuromotor control of the lower limb in Achilles tendinopathy: implications in foot orthotic therapy. Sports Med. 2010;40:715-27.

4. Scott A, Huisman E, Khan K. Conservative treatment of chronic Achilles tendinopathy. CMAJ. 2011;183:1159-65.

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