Achilles tendonitis is treated primarily through targeted exercise, load management, and patience. Acute cases caught early can improve in two to six weeks, while chronic cases that have lingered for months often take six to twelve months to fully resolve. The cornerstone of treatment is a structured strengthening program, not rest alone.
Where the Pain Is Matters
The location of your pain determines which approach works best. Midportion tendonitis, felt in the middle of the tendon a few inches above the heel, responds well to standard eccentric exercises or heavy slow resistance training. Insertional tendonitis, where the tendon attaches directly to the heel bone, needs a modified version of those same exercises because the full range of motion used in standard protocols can compress the tendon against the bone and make things worse.
If your pain is right at the back of your heel, especially if it’s tender to the touch where the tendon meets bone, you likely have insertional tendonitis. You’ll want to avoid letting your heel drop below the level of a step during exercises, keeping the range of motion limited to flat ground or above. If the pain sits higher up in the tendon body, you have midportion tendonitis and can use the full exercise protocols described below.
Exercise Is the Primary Treatment
Two exercise approaches have strong evidence behind them: eccentric heel drops and heavy slow resistance training. A randomized trial of 58 patients with chronic midportion Achilles tendonitis found that both methods produced significant improvements in pain and function over 12 weeks, and those improvements held up at one year. Neither approach outperformed the other in clinical outcomes.
The eccentric heel drop protocol (often called the Alfredson protocol) involves standing on the edge of a step, rising up on both feet, then slowly lowering on the affected leg only. You perform three sets of 15 repetitions, twice daily, with both a straight knee and a bent knee version to load different parts of the calf. The bent-knee version targets the deeper calf muscle. Start with body weight and add resistance gradually, typically by holding a weighted backpack or dumbbell, once you can complete the sets without significant pain.
Heavy slow resistance training uses gym equipment like a seated calf raise machine or a leg press, performed with heavier loads and slower movement speeds. In the trial comparing the two approaches, patients doing heavy slow resistance had a 92% compliance rate versus 78% for eccentric exercises, and satisfaction trended higher (100% vs. 80% at 12 weeks). The likely reason: heavy slow resistance requires fewer daily sessions and feels more like a normal gym workout.
Either approach works. Pick the one you’ll actually stick with for three months.
Managing Pain in the Short Term
Anti-inflammatory medications like ibuprofen can take the edge off pain, but don’t expect them to speed healing. A double-blinded study gave patients with chronic Achilles tendonitis either ibuprofen or a placebo for one week and found no difference in tendon pain, function, or the biological markers of tissue repair. The tendon cells simply didn’t respond to the drug. Use NSAIDs sparingly for comfort if needed, but they aren’t doing anything to fix the underlying problem.
Ice after activity, temporary activity modification, and a small heel lift in your shoe (roughly 6 to 12 millimeters) can all reduce strain on the tendon during the early weeks. The heel lift shortens the distance the tendon has to stretch with each step. It’s a useful short-term tool, not a permanent solution.
What About Injections and Shockwave Therapy?
Platelet-rich plasma (PRP) injections have become popular, but the evidence doesn’t support their use. A systematic review with meta-analysis of high-quality randomized trials found no difference in outcomes between PRP and placebo injections at 3, 6, or 12 months. The authors concluded PRP should not be used as a first-line treatment for chronic midportion Achilles tendonitis.
Corticosteroid injections carry a risk of weakening the tendon and are generally avoided in load-bearing tendons like the Achilles.
Extracorporeal shockwave therapy, which delivers acoustic pulses to the affected area, is sometimes used as an add-on treatment, typically in weekly sessions over five weeks. It may help some patients, particularly those with insertional tendonitis, though evidence on how consistently it works remains mixed.
How Long Recovery Takes
Timeline depends heavily on how long you’ve had symptoms before starting treatment. If you caught it within the first few weeks of pain, consistent load management and exercise can bring significant relief in two to six weeks. If you’ve been dealing with it for months, you’re looking at a longer road. Chronic cases commonly take six to twelve months of consistent rehabilitation to resolve fully.
The 12-week mark is an important checkpoint. Most structured exercise programs run for at least this long, and the clinical trials showing strong results used 12-week protocols. If you’re not seeing meaningful improvement by then, it’s worth reassessing your approach with a physical therapist or sports medicine provider. You may need to adjust your exercise selection, address biomechanical factors like overpronation, or explore adjunct treatments like shockwave therapy.
Returning to Activity
The biggest mistake people make is stopping exercise once the pain improves and then jumping back into full activity. Tendon tissue remodels slowly, and pain reduction doesn’t mean the tendon has regained its full load capacity. A gradual return to running or sport, increasing volume by no more than about 10% per week, gives the tendon time to adapt.
During rehabilitation, you don’t need to stop all activity. The general guideline is that pain during or after exercise is acceptable if it stays below roughly a 3 or 4 out of 10 and settles back to baseline by the next morning. If your pain spikes higher than that or is still elevated the following day, you’ve done too much.
Continue your calf strengthening exercises even after you’ve returned to full activity. Tendons respond to consistent loading over time, and maintaining a baseline strength program helps prevent recurrence. A small percentage of patients who don’t respond to any conservative approach may eventually need surgical intervention, but the vast majority recover without it.