NHS Aligned Achilles Tendinopathy Exercises: 4–12 Week Staged Plan
Start a progressive tendon-loading programme now: calf raises building towards single-leg work and step heel-drops, done at least three times weekly and stretched around your pain limits. Combine strengthening with calf stretches, and use a simple 0 to 10 pain scale to keep discomfort manageable, rather than avoiding load altogether. What counts as “manageable” and how you progress differs depending on whether your pain sits in the mid-tendon or at the heel bone, which the sections below explain.
TL;DR:
Progressive tendon loading at least three times weekly is essential, combining strengthening exercises with stretching and careful pain management based on a 0 to 10 scale.
Begin with supported, double-leg heel raises before progressing to single-leg work in both knee positions, then advance gradually to step heel-drops and resistance exercises.
Insertional tendinopathy requires modifying heel drops to avoid excessive range, especially dropping below the step, to prevent aggravating the tendon attachment at the heel.
Consistent tracking of exercise dose and next-morning pain levels improves progression decisions, with pain up to 4 out of 10 acceptable if it settles quickly.
A tailored, staged approach over 3 to 6 months generally yields the best recovery, emphasizing patience, targeted exercises, and avoiding excessive range or load too early.
Table of Contents
Achilles tendinopathy exercises: the staged programme
Progressive tendon-loading exercise is now the recommended first-line treatment for midportion Achilles tendinopathy according to the 2024 AOPT clinical practice guideline. That guidance covers eccentric loading, heavy slow resistance, isometric holds, and plyometric work, all performed at least three times weekly at the highest load you can tolerate without a lasting flare-up.
That’s a meaningful shift from older advice that focused almost entirely on eccentric heel drops. The current thinking is broader: what matters most is consistent, progressive loading of the tendon, not which specific exercise variant you choose. NHS-style programmes typically move through three stages, and understanding the logic behind each stage matters more than memorising a fixed exercise list.
Stage 1: supported and double-leg loading
Begin here if your Achilles is irritable, painful most days, or you’ve had a recent flare. The goal is to reintroduce load without provoking the tendon further.
Seated heel raises. Sit with feet flat, lift both heels off the floor using your calf muscles, hold for two to three seconds, then lower slowly. This reduces bodyweight through the tendon while still teaching the calf to fire.
Assisted double-leg heel raises. Standing, hold a rail or worktop for balance, rise onto both toes, pause briefly at the top, then lower under control over three to four seconds. The slow lowering phase is where most of the tendon-loading benefit happens.
Standing double-leg raises without support. Once seated and assisted versions feel comfortable, remove the hand support and repeat the same movement.
Most leaflets suggest a starting pattern of three sets of around fifteen repetitions, adjusted to how your tendon responds, according to NHS exercise guidance. If fifteen feels too much on day one, do fewer and build up. There’s no prize for rushing this stage.
Stage 2: single-leg progressions
Move here once double-leg work is pain-free or only mildly uncomfortable, and you can manage daily walking without a significant next-day reaction.
Single-leg heel raises with knee straight load the gastrocnemius, the larger calf muscle that crosses the knee.
Single-leg heel raises with knee slightly bent shift emphasis onto the soleus, the deeper muscle that works regardless of knee position.
A genuinely complete programme includes both knee positions, since each targets a different part of the calf complex feeding into the Achilles tendon. Skipping one because it feels harder is a common shortcut that leaves part of the tendon under-trained.
Hold the rail lightly for balance if needed, but the aim is to progress towards doing the raise unsupported. Several sets of ten to fifteen reps on the affected side is a reasonable starting dose, mirroring the double-leg pattern but now asking one leg to do the full job.
Stage 3: step heel-drops and loaded work
This stage introduces eccentric loading through greater range and, eventually, external resistance or speed.
Stand with the balls of both feet on the edge of a step, heels hanging off.
Rise onto your toes using both legs (or push up with the unaffected leg if you need extra support).
Shift weight onto the affected leg and lower the heel slowly below the level of the step, over three to four seconds.
Step back up with both feet and repeat.
This is where midportion and insertional Achilles problems diverge sharply, and it’s worth reading the modifications section below before attempting a heel-drop from a step, because lowering below the step edge can aggravate insertional symptoms if the range is too deep.
Once step heel-drops feel controlled and pain stays within acceptable limits over several sessions, some people progress towards heavy slow resistance work (using a weighted backpack or resistance machine) or, eventually, light plyometric drills such as hopping, depending on their goals and a clinician’s input.
Pro Tip: Change only one variable at a time. If you’ve just added single-leg work, don’t also increase range or add weight in the same session. Practical clinic guidance recommends isolating one progression at a time so you always know exactly what caused a flare if one occurs.
A few safety habits apply across every stage:
Wear supportive, cushioned shoes for loading sessions, not bare feet on a hard floor.
Use a stair rail or worktop for balance during single-leg and step work, especially early on.
Perform exercises on a firm, non-slip surface.
Stop and reassess if pain spikes sharply during a set, rather than pushing through.
Achilles tendon stretches for tightness and mobility
Stretching plays a supporting role alongside strengthening rather than replacing it. The two calf muscles need slightly different stretch positions because of where they attach.
Gastrocnemius stretch (straight-knee): stand facing a wall, affected leg back with the knee straight and heel flat on the floor, front knee bent. Lean forward gently until you feel a stretch through the upper calf. Hold for about half a minute, repeat several times.
Soleus stretch (bent-knee): same position, but bend the back knee slightly while keeping the heel down. This shifts the stretch lower, targeting the soleus rather than the gastrocnemius.
Towel stretch: sit with your leg out straight, loop a towel around the ball of your foot, and gently pull the foot towards you, holding for 30 seconds.
Seated ankle range-of-motion drills: slow ankle circles and controlled up-and-down pumps, useful in Stage 1 when standing exercises still feel too much.
Avoid forceful or bouncing (ballistic) stretches. A slow, sustained hold is far kinder to an irritable tendon than a series of quick pulls, which can provoke rather than settle symptoms.
If your pain sits at the heel bone rather than the mid-tendon, be cautious with aggressive calf stretching. Deep, forced dorsiflexion can compress the insertional area against the heel in a way that mid-tendon stretching does not, so keep stretches gentle and stop short of any pinching sensation at the back of the heel.
How much pain is too much during exercise?
Some discomfort during rehab is normal and doesn’t mean you’re causing damage. The practical rule most NHS leaflets use is straightforward: pain up to around 4 out of 10 during exercise is generally acceptable, provided it settles down within a few hours or by the next morning, according to NHS Achilles tendinopathy advice.
The next-day response matters more than how it feels mid-session. Worse first steps out of bed the morning after training is a sensitive signal that the previous session pushed too hard, even if it felt fine at the time.
A simple traffic-light approach helps you decide what to do next:
Green (0 to 3/10, settles quickly): continue as planned, and consider progressing next session.
Amber (4/10, settles within a day): keep the same load, don’t progress yet, monitor closely.
Red (above 4/10, or still sore the next morning): drop back to the previous stage or reduce reps and sets until symptoms calm down.
Keeping a short diary, noting the exercise dose and your morning symptom grade, makes these decisions far easier than trying to remember how yesterday felt.
Pro Tip: Write down sets, reps, and next-morning pain score after every session for the first fortnight. Patterns that are invisible day-to-day (like a flare every time you add a set too soon) become obvious once it’s on paper.
A sample 4 to 12 week progression plan
Recovery timelines vary, but many people need three to six months of consistent loading before symptoms settle meaningfully, and longstanding cases can take up to a year, according to physiotherapy guidance on midportion Achilles tendinopathy. A week-by-week structure keeps progress steady without rushing any single variable.
Weeks 1 to 2: Stage 1 exercises, three sets of ten to fifteen reps, three to four times weekly. Focus on consistent technique and settling baseline soreness.
Weeks 3 to 4: progress reps towards fifteen if tolerated, then begin introducing single-leg support (Stage 2) on the stronger movements, keeping double-leg work as a warm-up.
Weeks 5 to 6: full single-leg raises, both knee positions, three sets of ten to fifteen reps. Reduce hand support gradually.
Weeks 7 to 9: introduce step heel-drops (Stage 3) at a shallow range, three sets, monitoring next-day response carefully before increasing depth.
Weeks 10 to 12: increase range towards full heel-drops (midportion only), then consider adding light external resistance or beginning gentle plyometric drills once strength and symptom stability allow.
Clinics generally favour low-tech progressions first, such as removing hand support or adding a rep, before reaching for external weight or greater range, according to Cambridge University Hospitals guidance. Speed and impact work come last, only once strength gains are established and symptoms stay consistently low.
Before progressing towards running or hopping, look for these functional milestones:
Pain-free single-leg heel raises for 15 repetitions, both knee positions.
No meaningful next-day soreness after two consecutive Stage 3 sessions.
Comfortable walking, including inclines and stairs, without a flare.
Adding load isn’t automatically progress. The safest step up is often the smallest one, single-leg support before extra range, extra range before extra weight, rather than jumping straight to a harder variant because you’re impatient with the timeline.
Insertional vs midportion Achilles tendinopathy: exercise changes
Where your pain sits changes which exercises are safe. Midportion tendinopathy causes pain and thickening two to six centimetres above the heel bone, in the tendon’s main body. Insertional tendinopathy causes pain right at the point where the tendon attaches to the heel, often with a tender or enlarged bump.
The difference matters most in Stage 3. Deep heel-drops, where the heel lowers below the level of a step, can aggravate insertional symptoms because the tendon compresses against the heel bone at end range, according to patient guidance on Achilles tendon conditions.
Insertional: keep the heel level with or above the step edge; avoid dropping below it unless a clinician specifically advises deeper range.
Midportion: progressing the heel below step level is usually well tolerated and forms a normal part of Stage 3, once earlier stages are comfortable.
Unclear or mixed pain location: get a physiotherapy assessment before pushing into deeper ranges, since the wrong exercise choice can slow recovery rather than speed it up.
If you’re not sure which type you have, that uncertainty itself is a reason to seek an assessment rather than guess and risk the wrong loading pattern.
Do footwear and simple aids help symptom control?
Shoes matter more than most people expect during Achilles rehab. A well-cushioned, supportive shoe reduces impact through the tendon during daily walking, which matters just as much as the exercises themselves in the early stages.
Gel heel pads cushion impact and can be moved between pairs of shoes cheaply.
Heel lifts temporarily reduce ankle dorsiflexion, which can ease load on a midportion tendon while it settles, though they’re a short-term aid rather than a long-term fix.
Ice massage, applied for up to five minutes at a time, can help calm acute soreness after a session.
Orthotics are worth discussing with a clinician if foot posture or biomechanics seem to be contributing, rather than trying generic insoles first.
None of these replace loading exercise. They simply make the loading programme more comfortable while the tendon adapts.
When should you see a physiotherapist about Achilles pain?
Most Achilles tendinopathy responds to consistent, progressive loading over weeks and months. Certain signs, though, need faster attention.
Seek urgent medical review if you experience:
A sudden popping or snapping sensation in the back of the ankle.
Inability to push off the ground or rise onto your toes at all.
Significant swelling, bruising, or a visible gap in the tendon.
These can indicate a tendon rupture and need same-day assessment rather than a wait-and-see approach.
Book a routine physiotherapy assessment if:
You’ve followed a consistent, progressive loading programme for several months with no meaningful improvement.
Function keeps declining despite exercise (walking distance shrinking, more limping, not less).
You’re unsure whether your pain is midportion or insertional, or which exercise modifications apply to you.
A step-by-step Achilles injury assessment can help clarify whether what you’re feeling fits a typical tendinopathy pattern or needs further investigation, such as imaging.
How Parks Therapy Centre applies this evidence in clinic
Guidelines describe the loading principles. Applying them to an individual person’s tendon, work demands, and daily pain pattern is where clinical judgement comes in. A multidisciplinary physiotherapy and sports injury care service has been provided since 1986; Achilles tendinopathy is a common tendon problem that clinicians typically assess and treat.
In practice, that means individualising dose rather than handing every patient the same fixed sheet. Someone with a desk job and mild morning stiffness needs a different starting point from a runner with daily pain on hills. Clinicians typically use the same diary and traffic-light monitoring described above, adjusted session by session based on how the tendon actually responds, not just how the textbook progression reads.
Progressive loading is the foundation, but the pace of progression has to match the person in front of you, their pain pattern, their activity demands, and how their tendon responds week to week, not a generic timeline.
Where symptoms are slow to settle, adjuncts such as shockwave therapy or acupuncture sometimes support the exercise programme rather than replace it. Anyone wanting a structured plan, or a second opinion on whether their pain is midportion or insertional, can book a physiotherapy assessment directly with a clinic.
Why staged loading beats quick fixes for Achilles pain
The evidence has moved on from treating eccentric heel drops as the only answer. The 2024 tendon-loading guidance makes a broader point: isometric holds, heavy slow resistance, and plyometric work all have a place, and the deciding factor is consistency and appropriate progression, not brand loyalty to one exercise style.
Where conventional advice often falls short is the middle ground between “rest completely” and “push through the pain.” Neither works well. Complete rest lets the tendon deteriorate further under-loaded; ignoring a 7 out of 10 flare and training anyway typically sets recovery back weeks. The 4 out of 10 guideline, checked against next-day response, is a far more useful compass than either extreme.
If there’s one thing worth prioritising above everything else in this article, it’s the diary. Not the exact exercise variant, not the exact rep count. People who track dose against next-morning symptoms consistently make better progression decisions than people relying on memory and mood.
— Ivan
This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.
Sources
FAQ
What not to do with Achilles tendonitis?
Avoid complete rest, since under-loading slows tendon recovery rather than protecting it. Also avoid pushing through pain above roughly 4 out of 10, and avoid deep heel-drops if your pain is insertional rather than midportion, as the extra range can aggravate the heel attachment point.
How to heal Achilles tendinopathy fast?
There’s no genuine shortcut. Consistent progressive loading, at least three times weekly, alongside sensible activity modification, gives the best realistic pace, and most people need three to six months of steady work, sometimes longer for stubborn cases.
What exercises are recommended by the NHS for Achilles heel tendinopathy?
NHS leaflets typically recommend a staged programme moving from seated and double-leg heel raises to single-leg progressions and step heel-drops, usually starting around three sets of fifteen reps and adjusted to symptoms. Calf stretches for both the gastrocnemius and soleus support the strengthening work.
Is walking good for Achilles tendinopathy?
Walking at a tolerable pace and distance is generally helpful and shouldn’t be avoided completely. It’s worth reducing long or painful walks, stairs, running, and jumping until your tendon tolerates more load, according to physiotherapy advice for midportion Achilles tendinopathy.
Recommended