Achilles Tendonitis (AT) is a painful condition affecting the large tendon connecting the calf muscles to the heel bone. This common issue arises when the Achilles tendon experiences excessive strain, leading to irritation and microscopic changes within its structure. The pain and stiffness are typically the result of repetitive stress or a sudden increase in activity that overwhelms the tendon’s capacity to adapt. Effective recovery requires a structured, multi-phase approach focused on reducing initial pain and gradually rebuilding the tendon’s strength and tolerance for load.
Immediate Relief and Activity Modification
The first step in managing Achilles Tendonitis involves reducing immediate irritation and protecting the tendon from further injury. This initial phase focuses on passive pain management and strategically modifying daily activities to lower the load on the tendon. Complete rest is generally discouraged because tendons need mechanical stimulus to heal, but activities causing sharp pain, such as running and jumping, must be stopped immediately.
Instead of full immobilization, relative rest means temporarily switching to low-impact exercises like swimming or cycling to maintain fitness without aggravating the tendon. Applying ice to the affected area for 15 to 20 minutes several times a day helps manage local pain and swelling. Simple shoe modifications can also provide immediate relief by reducing the stretch on the tendon. Placing a small heel lift or wedge inside both shoes slightly shortens the calf-Achilles complex, taking tension off the painful area during walking.
This phase of acute symptom management is temporary and does not address the underlying issue of a weakened tendon. While gentle stretching may feel good, the long-term solution lies in carefully controlled strengthening. The goal during these first few days or weeks is simply to calm the tendon down enough to begin the active rehabilitation process.
Structured Strengthening Through Eccentric Exercise
Once the initial sharp pain has subsided, rehabilitation shifts focus to actively strengthening the tendon through eccentric exercise, considered the most effective way to remodel the tissue. Eccentric movement refers to the muscle lengthening under tension, which for the Achilles tendon involves slowly lowering the heel. This controlled loading stimulates the production of collagen fibers, increasing the tendon’s tensile strength and ability to withstand force.
The standard rehabilitation protocol involves a heel drop exercise performed on a step, allowing the heel to descend below the level of the forefoot. To perform this, stand on the edge of a step with your heels hanging off, holding onto a railing or wall for balance. Use both legs to rise up onto your toes, then shift all body weight onto the injured leg for the lowering phase. The key is to lower your heel slowly and with control, taking three to five seconds to reach the bottom position.
This process should be repeated in three sets of 15 repetitions, performed twice daily, totaling 90 repetitions per day for the affected leg. The protocol requires performing the exercise with the knee straight (targeting the gastrocnemius muscle) and repeating the entire set with the knee slightly bent (isolating the deeper soleus muscle). Mild to moderate discomfort is common and acceptable, indicating the tendon is being appropriately loaded, but sharp, stabbing pain should be avoided. As tolerance improves, typically after a few weeks, progress the exercise by holding a backpack or vest to add external weight. This progressive increase in load is fundamental to restoring the tendon’s capacity to handle the forces required for daily life and sport.
Addressing Underlying Causes and Preventing Recurrence
Achilles Tendonitis often develops not just from a localized tendon issue, but from systemic factors that place undue stress on the lower leg. To prevent recurrence, the long-term plan must address these underlying causes and manage the transition back to full activity. Footwear plays a significant role; shoes that lack proper support or have become overly worn can alter foot mechanics and increase strain on the tendon.
Select supportive shoes appropriate for your activity and avoid overly flat or minimalist footwear during recovery. Analyzing your training schedule is another step, particularly for runners, as a sudden increase in the intensity or duration of activity is a primary cause of this injury. Gradual load management is achieved by adhering to a cautious progression, such as the guideline of increasing weekly running distance or intensity by no more than 10 percent.
Improving the strength and stability of the entire kinetic chain can reduce future risk. Weakness in the hip muscles or poor ankle flexibility can lead to abnormal forces being transmitted down to the Achilles tendon. Incorporating exercises that improve single-leg balance and hip stability, in addition to the eccentric calf exercises, helps ensure the body is prepared to handle the required forces during dynamic activities. A full recovery is not simply the absence of pain, but rather the restoration of the tendon’s full functional capacity through these comprehensive long-term strategies.