Best Exercises for Achilles Tendon Pain (and Which Ones to Avoid): An Evidence-Based Guide

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If you have Achilles tendon pain, you've probably been told to "do heel drops." Maybe you found a video online, tried it for a week, and either felt no better — or felt worse.

Here's the problem: the right exercise for your Achilles depends entirely on where your pain is located, how irritable your tendon is, and what stage of recovery you're in. There is no single exercise that works for everyone. In fact, one of the most commonly recommended exercises — the eccentric heel drop off a step — can actually make certain types of Achilles pain worse.

This guide breaks down the exercises that have the strongest research behind them, explains exactly how to do each one, tells you which exercises to avoid (and why), and gives you a framework for progressing safely back to the activities you love.

One important note before we start: exercise is the single most effective treatment for Achilles tendinopathy. A living network meta-analysis of 29 randomized controlled trials in the British Journal of Sports Medicine found that every active treatment class was superior to a wait-and-see approach at three months — and loading exercise is the foundation of every successful program.

Key Takeaways

- Exercise-based loading is the cornerstone of Achilles tendinopathy treatment — it outperforms rest, medications, orthotics, and injections in head-to-head comparisons.

- Eccentric heel drops and heavy slow resistance training are equally effective for midportion Achilles tendinopathy, with no clinically relevant difference in outcomes at 12 or 52 weeks.

- For insertional Achilles tendinopathy (pain at the heel bone), standard heel drops off a step should be avoided. A 2025 randomized trial confirmed that limiting ankle dorsiflexion during exercise produces significantly better outcomes.

- The most important exercise parameter for midportion tendinopathy is contraction intensity (how heavy the load is). For insertional tendinopathy, it's range of ankle dorsiflexion (how far the ankle bends upward).

- Consistency matters more than perfection. Compliance was significantly higher with heavy slow resistance training (92%) than with eccentric training (78%) — and the best program is the one you'll actually do for 12 weeks.

- Pain during exercise is acceptable — but it should stay within a manageable range (2 to 5 out of 10) and should not be worse the next morning.

- Complete rest weakens the tendon. Modify your activity, but don't stop moving.

First: Know Your Type of Achilles Pain

Before starting any exercise program, you need to know where your pain is. This single detail changes everything about which exercises will help and which will hurt.

Midportion Achilles tendinopathy — pain and thickening in the body of the tendon, about 2 to 6 cm above the heel bone. This is the more common type, accounting for roughly two-thirds of cases. It occurs in a zone of poor blood supply where the tendon is vulnerable to degeneration.

Insertional Achilles tendinopathy — pain right where the tendon attaches to the heel bone. Often associated with a bony bump (Haglund's deformity), calcification, or bursitis. This type is more stubborn and responds differently to exercise.

If you're not sure which type you have, read Insertional vs. Midportion Achilles Tendinopathy: What's the Difference? or see a foot and ankle specialist for evaluation.

Why does this matter so much for exercise?

The insertional region of the Achilles tendon is compressed against the heel bone every time the ankle bends upward (dorsiflexes). Research measuring intratendinous pressure found that an ankle range of motion between −15° and 0° of flexion is a "safe zone" that applies high tensile forces without excessive compression — but going beyond that into dorsiflexion significantly increases compressive load at the insertion. Exercises that push the ankle past neutral — like heel drops off a step or deep wall stretches — increase this compression and can aggravate insertional disease.

For midportion tendinopathy, that same dorsiflexion is actually beneficial — it increases tendon loading in the watershed zone where the degeneration lives, stimulating the remodeling process.

The Best Exercises for Midportion Achilles Tendinopathy

Exercise 1: Eccentric Heel Drops (The Alfredson Protocol)

This is the most studied exercise for Achilles tendinopathy and the one most commonly recommended as first-line treatment.

How to do it:

1. Stand on a step or stair with the balls of both feet on the edge, heels hanging off.

2. Rise up onto your toes using both legs.

3. Shift all your weight to the affected leg.

4. Slowly lower your heel below the step over 3 to 5 seconds — this is the eccentric (lowering) phase.

5. Use your uninjured leg to push back up to the starting position. Do not use the injured leg to rise.

6. Repeat.

The protocol:

- 3 sets of 15 repetitions with the knee straight (targets the gastrocnemius)

- 3 sets of 15 repetitions with the knee slightly bent (targets the soleus)

- Perform twice daily, 7 days per week

- Continue for 12 weeks

What the research says:

In a clinical trial, the eccentric group improved from a mean VISA-A score of 60.7 at baseline to 89.4 at one year — a clinically meaningful improvement well beyond the minimal clinically important difference of 7.37 points. A systematic review of 22 studies (1,137 participants) found moderate-level evidence favoring eccentric exercise over control for improving pain and function in midportion tendinopathy.

Important notes:

- Pain during the exercise is expected and acceptable. The original protocol was designed to be performed "with pain." However, pain should stay manageable — aim for 2 to 5 out of 10.

- It will likely feel worse before it feels better during the first 2 to 3 weeks. This is normal.

- Do not skip the bent-knee version. The soleus muscle contributes significantly to Achilles tendon loading and must be trained separately.

- Add weight progressively (a backpack with books, a weighted vest, or dumbbells) once bodyweight becomes easy.

Exercise 2: Heavy Slow Resistance Training (HSR)

This is the main alternative to eccentric heel drops — and many patients prefer it because it's done fewer times per week and has higher compliance rates.

How to do it:

The HSR protocol involves three exercises, each performed through a full range of motion at a speed of 6 seconds per repetition (3 seconds up, 3 seconds down):

1. Seated calf raise (knee bent) — on a seated calf-raise machine or with a barbell across the thighs

2. Standing calf raise (knee straight) — with a barbell on the shoulders or in a Smith machine

3. Leg press calf raise (knee straight) — on a leg-press machine, pushing through the balls of the feet

The protocol (12 weeks):

- Week 1: 3 sets of 15 repetitions

- Weeks 2–3: 3 sets of 12 repetitions

- Weeks 4–5: 4 sets of 10 repetitions

- Weeks 6–8: 4 sets of 8 repetitions

- Weeks 9–12: 4 sets of 6 repetitions

- Perform 3 sessions per week (every other day)

- Increase weight progressively as repetitions decrease

What the research says:

A level-1 randomized controlled trial of 58 patients in the American Journal of Sports Medicine found both HSR and eccentric training produced significant improvements in VISA-A and pain scores from 0 to 12 weeks, maintained at 52 weeks, with no difference between groups. However, compliance was significantly higher with HSR (92% vs 78%, p < 0.005), and patient satisfaction trended higher at 12 weeks (100% vs 80%).

A 2025 Delphi consensus study of 17 international experts identified contraction intensity as the most important exercise parameter for midportion Achilles tendinopathy rehabilitation — supporting the principle that the tendon needs to be loaded heavily enough to stimulate adaptation.

Why some patients prefer HSR:

- Only 3 sessions per week instead of twice daily

- Requires gym access but feels more like a "real workout"

- Progressive overload is built into the program

- Higher satisfaction and compliance in the research

Exercise 3: Isometric Holds (For Acute Pain Management)

Isometric exercises — holding a position without movement — may be useful as a starting point when the tendon is too irritable for eccentric or heavy loading.

How to do it:

1. Stand on a step with the ball of your foot on the edge.

2. Rise to a mid-range position (not fully up on toes, not heel dropped below).

3. Hold for 30 to 45 seconds.

4. Rest 1 minute. Repeat 4 to 5 times.

5. Perform 2 to 3 times daily.

What the research says:

A 2026 systematic review of 13 randomized controlled trials found that current evidence provides limited support for the superiority of isometric exercise over other modalities. Pain reduction and functional improvement were statistically significant in only 3 of the 13 studies. A randomized trial specifically in Achilles tendinopathy found no additional benefit of adding isometric exercises to eccentric exercises over a 3-month period.

The practical takeaway: Isometrics are a reasonable bridge exercise for the first 1 to 2 weeks when pain is too high for eccentric or HSR loading — but they should not be the long-term program. Transition to eccentric or HSR training as soon as tolerable.

Which One Should You Choose?

Factor	Eccentric Heel Drops	Heavy Slow Resistance	Isometric Holds
Evidence level	Strong — most studied	Strong — level 1 RCT	Limited
Frequency	Twice daily, 7 days/week	3 times/week	2–3 times daily
Equipment needed	A step or stair	Gym or calf-raise machine	A step or stair
Compliance rate	78%	92%	High initially, declines
Best for	Patients who prefer home exercise	Patients who prefer gym-based training	Acute flares, very irritable tendons
Time commitment	~20 min/session	~30 min/session	~10 min/session

The bottom line: both eccentric and HSR programs produce equally good, lasting results. Choose the one that fits your lifestyle and that you will actually complete for 12 weeks.

The Best Exercises for Insertional Achilles Tendinopathy

This is where the approach must change — and where most generic internet advice gets it wrong.

Exercise 1: Modified Heel Raises on Flat Ground

How to do it:

1. Stand on flat ground (NOT on a step).

2. Rise up onto your toes as high as you can.

3. Slowly lower back to neutral (floor level) over 3 to 5 seconds.

4. Do NOT let your heel drop below the floor. This is the critical difference.

5. Use both legs to rise, single leg to lower (or both legs if too painful initially).

The protocol:

- 3 sets of 15 repetitions with the knee straight

- 3 sets of 15 repetitions with the knee slightly bent

- Twice daily, 7 days per week, for 12 weeks

- Add weight progressively once bodyweight is easy

What the research says:

A pilot study found that only 32% of patients with insertional tendinopathy had good results with the standard painful eccentric protocol that loaded into dorsiflexion. When the protocol was modified to avoid dorsiflexion past neutral — performing heel raises on flat ground only — satisfaction improved to 67%.

A landmark 2025 randomized clinical trial in the British Journal of Sports Medicine provided the strongest evidence to date. Forty-two sport-active patients with chronic insertional Achilles tendinopathy were randomized to either a low tendon compression rehabilitation (LTCR) program — which limited ankle dorsiflexion during exercise, eliminated calf stretching, and incorporated heel lifts — or a high tendon compression rehabilitation (HTCR) program. The results were striking:

- At 12 weeks: LTCR improved VISA-A by 24.4 points vs 12.2 for HTCR (between-group difference 12.9, exceeding the minimal clinically important difference)

- At 24 weeks: LTCR improved by 29.0 vs 19.3 (between-group difference 10.4, p < 0.001)

The authors concluded that low tendon compression rehabilitation should be considered in the treatment of insertional Achilles tendinopathy.

Exercise 2: Seated Calf Raises (Weighted)

How to do it:

1. Sit on a chair or bench with your feet flat on the floor.

2. Place a weight across your thighs (a barbell, dumbbell, or heavy book).

3. Rise up onto the balls of your feet, lifting your heels off the ground.

4. Slowly lower back to the floor (not below).

5. Repeat.

This exercise targets the soleus muscle specifically and keeps the ankle in a safe range of motion for insertional disease. It can be performed as part of an HSR-style program with progressive loading.

Exercise 3: Bilateral Heel Raises with Heel Lift

For patients with very irritable insertional pain, placing a small heel lift (1 to 2 cm) inside the shoe or under the heel during exercise further reduces the dorsiflexion angle and decreases compression at the insertion. This can make the exercise tolerable when flat-ground raises are still too painful.

The Key Rule for Insertional Tendinopathy

A 2025 Delphi consensus study of international experts confirmed that range of ankle dorsiflexion is the single most important exercise parameter for insertional Achilles tendinopathy rehabilitation — more important than load, speed, or number of repetitions. Controlling dorsiflexion is not optional; it is the foundation of the entire program.

Exercises to Avoid (and Why)

Not all exercises are helpful for Achilles tendon pain. Some can actively set you back. Here's what to avoid — and the reasoning behind each one.

1. Eccentric Heel Drops Off a Step (If You Have Insertional Pain)

This is the single most important exercise to avoid if your pain is at the heel bone. Dropping the heel below the step forces the ankle into dorsiflexion, compressing the tendon against the calcaneus. The 2025 randomized trial confirmed that high-compression rehabilitation produced significantly worse outcomes than low-compression rehabilitation for insertional disease.

Instead: Do modified heel raises on flat ground, stopping at neutral.

2. Aggressive Wall Stretches and Deep Calf Stretching

The classic runner's wall stretch — leaning into a wall with the back leg straight and heel on the ground — forces the ankle into deep dorsiflexion. For insertional tendinopathy, this creates the same compressive problem as below-step heel drops. Research measuring intratendinous pressure confirmed that pressures rise significantly beyond neutral dorsiflexion.

For midportion tendinopathy, gentle stretching is generally safe, but aggressive or prolonged stretching has not been shown to add benefit beyond loading exercise alone. A systematic review found low-level evidence that eccentric exercise was not superior to stretching for pain or quality of life — suggesting stretching alone is insufficient.

Instead: Focus on loading exercises. If you want to maintain ankle mobility, use gentle, short-duration ankle circles and range-of-motion movements.

3. Jumping and Plyometrics (Too Early)

Jumping, hopping, and bounding exercises generate enormous Achilles tendon forces. Research measuring tendon loading during rehabilitation exercises found that peak Achilles tendon loads varied more than 12-fold — from 0.5 bodyweights during a seated heel raise to 7.3 bodyweights during a forward single-leg hop. Introducing these forces before the tendon has adapted through a progressive loading program risks flare-ups or, in severe cases, rupture.

When to add them: Plyometrics belong in the late stages of rehabilitation — typically after 8 to 12 weeks of successful progressive loading, when pain is minimal and strength is approaching symmetry with the uninjured side. For more on returning to sport, see Returning to Running, Pickleball, Tennis, and Sports After an Achilles Injury.

4. Uphill Running and Stair Repeats

Both activities force the ankle into dorsiflexion under high load — problematic for insertional tendinopathy and often provocative even for midportion disease during the early treatment phase. These should be among the last activities reintroduced.

5. Complete Rest

This may seem counterintuitive, but doing nothing is one of the worst things for a degenerative tendon. Tendons need mechanical loading to maintain their structure and stimulate repair. A living network meta-analysis confirmed that every active treatment class was superior to wait-and-see at three months. Complete rest leads to tendon deconditioning, making it more vulnerable when you eventually return to activity.

Instead: Modify your activity to a level that keeps pain manageable (2 to 5 out of 10), and begin a structured loading program.

6. High-Repetition, Low-Load "Ankle Pumps"

Simple ankle pumps and resistance-band exercises are often prescribed as "Achilles exercises," but they provide insufficient load to stimulate tendon adaptation. The evidence consistently shows that contraction intensity — how heavy the load is — is a key driver of tendon remodeling. Light resistance-band work may be appropriate in the first few days after an acute flare, but it should not be the long-term program.

Quick Reference: Exercises to Do vs. Exercises to Avoid

Exercise	Midportion Tendinopathy	Insertional Tendinopathy
Eccentric heel drops off a step	✅ First-line — strong evidence	❌ Avoid — worsens compression
Modified heel raises on flat ground	✅ Effective alternative	✅ First-line — best evidence
Heavy slow resistance (gym-based)	✅ Equally effective as eccentric	✅ Reasonable — limit dorsiflexion
Seated calf raises (weighted)	✅ Good soleus exercise	✅ Safe — ankle stays in neutral
Isometric holds	⚠️ Bridge exercise for acute pain only	⚠️ Bridge exercise for acute pain only
Deep wall stretches	⚠️ Not harmful but not proven beneficial	❌ Avoid — compresses insertion
Jumping/plyometrics	⚠️ Late-stage only (after 8–12 weeks)	⚠️ Late-stage only (after 8–12 weeks)
Uphill running/stair repeats	⚠️ Reintroduce gradually, late stage	❌ Avoid until pain-free
Complete rest	❌ Weakens the tendon	❌ Weakens the tendon
Light resistance-band ankle pumps	❌ Insufficient load for adaptation	❌ Insufficient load for adaptation

How to Progress Your Exercises: A Practical Framework

Rehabilitation is not just about doing the right exercise — it's about progressing at the right pace. Research has established a clear loading continuum for Achilles tendon rehabilitation, with peak tendon loads varying more than 12-fold across different exercises.

Phase 1: Pain Reduction and Load Introduction (Weeks 0–2)

Goal: Reduce morning stiffness and establish a tolerable baseline load.

- Begin with isometric holds if pain is above 5/10 during loading

- Transition to eccentric heel drops (midportion) or flat-ground heel raises (insertional) as soon as tolerable

- Use both legs if single-leg loading is too painful

- Ice after exercise if needed for comfort (ice does not impair tendon healing)

Pain rules:

- Pain during exercise should stay at 2 to 5 out of 10

- Pain should return to baseline within 24 hours

- Morning stiffness the next day is your best guide — if it's worse than the previous morning, you did too much

Phase 2: Progressive Loading (Weeks 2–8)

Goal: Systematically increase tendon load to stimulate remodeling.

- Progress to single-leg exercises if not already doing so

- Add external weight progressively (backpack, weighted vest, dumbbells, or gym machines)

- For HSR: follow the weekly progression from 3 × 15 to 4 × 6 with increasing weight

- For eccentric: add weight once bodyweight repetitions are no longer painful

- Continue to monitor morning stiffness as your primary guide

Phase 3: Energy Storage and Release (Weeks 8–12)

Goal: Prepare the tendon for higher-speed, higher-impact activities.

- Introduce faster-tempo calf raises (2 seconds up, 2 seconds down)

- Add bilateral hopping in place (low amplitude)

- Progress to single-leg hopping if bilateral is pain-free

- Begin walk-jog intervals on flat ground if returning to running is a goal

Phase 4: Sport-Specific Return (Weeks 12+)

Goal: Return to full activity with confidence.

- Progress running volume gradually (no more than 10% per week)

- Reintroduce hills, speed work, and sport-specific movements

- Continue maintenance calf strengthening 2 to 3 times per week indefinitely

- Achieve symmetrical calf strength (within 10% of the uninjured side) before returning to competitive sport

For a detailed return-to-sport guide, see Returning to Running, Pickleball, Tennis, and Sports After an Achilles Injury.

How to Use Pain as Your Guide

One of the most common questions patients ask is: "Should I exercise through the pain?"

The answer is nuanced. Research on tendinopathy rehabilitation has established a practical framework:

Acceptable pain during exercise:

- Pain between 2 and 5 out of 10 during the exercise is acceptable and does not indicate harm

- Limiting sports activity to a self-monitored pain scale of 2 to 5 out of 10 has been found not to limit improvement in tendinopathy symptoms during strength training treatment

Warning signs to reduce load:

- Pain above 5/10 during exercise

- Pain that does not return to baseline within 24 hours

- Morning stiffness that is worse than the previous day

- Swelling that increases progressively

- A sharp, sudden pain (stop immediately — this could indicate a partial tear or rupture)

When to stop and seek evaluation:

- A sudden pop or snap in the tendon

- Inability to rise onto your toes

- Visible bruising at the back of the ankle

- Pain that is consistently worsening despite 4 weeks of appropriate exercise

These signs may indicate a more serious injury. Read Can You Walk on a Torn Achilles Tendon? and Achilles Tear vs. Achilles Tendinitis for more on recognizing a rupture.

What About Other Treatments Combined with Exercise?

Shockwave Therapy (ESWT)

Extracorporeal shockwave therapy may be a useful adjunct to exercise — not a replacement. A meta-analysis of 8 randomized trials found ESWT was associated with greater improvement in AOFAS and VISA-A scores, and the APTA guideline supports ESWT when combined with eccentric exercise for chronic midportion tendinopathy. However, for insertional tendinopathy, a double-blinded randomized trial found no added benefit of shockwave over sham when combined with eccentric exercise.

NSAIDs

Neither naproxen nor piroxicam showed significant benefit over placebo when added to physical therapy, and topical diclofenac showed no benefit over placebo. NSAIDs may provide temporary comfort but do not address the underlying tendon degeneration and should not be relied upon as a treatment strategy.

PRP Injections

Well-controlled studies have shown no significant effect of PRP treatment for Achilles tendinopathy. PRP should not replace a loading program.

Orthotics and Night Splints

A systematic review found high to moderate level evidence of no difference in pain or function between orthoses and control. Adding a night splint to an eccentric exercise program showed no significant benefit. Neither is recommended as a primary treatment.

Heel Lifts

While not a treatment per se, a small heel lift (1 to 2 cm) can reduce dorsiflexion strain and is particularly useful for insertional tendinopathy — both during exercise and in daily shoes.

Frequently Asked Questions

How long does it take for exercises to work?

Plan on a minimum of 12 weeks of consistent exercise before judging whether the program is working. Most patients notice meaningful improvement by 6 to 8 weeks, but full recovery often takes 3 to 6 months. Research shows that improvement in tendinopathy recovery is faster the shorter time the condition has been present — so starting early matters.

Can I keep running while doing these exercises?

Often yes, with modification. Reduce your volume, eliminate hills and speed work, and run on flat surfaces. Use the pain monitoring framework: keep pain at 2 to 5 out of 10 during the run, and check your morning stiffness the next day. If it's worse, you ran too much. In elite athletes, simply adding strength training on top of current training without reducing sport load does not produce benefit.

Should the exercises hurt?

Mild to moderate pain (2 to 5 out of 10) during exercise is acceptable and expected, especially in the first few weeks. The original Alfredson protocol was specifically designed to be performed "with pain." However, pain should not be severe, should not worsen progressively over days, and should return to baseline within 24 hours.

How do I know if I'm doing the right exercise for my type?

Feel the back of your ankle. If the tender spot is right at the heel bone — especially if there's a bump — you have insertional tendinopathy and should do flat-ground heel raises, NOT heel drops off a step. If the tender, thickened area is a few centimeters above the heel, you have midportion tendinopathy and can safely do heel drops off a step. When in doubt, see a specialist.

Is it better to do exercises at home or at the gym?

Both work equally well based on the evidence. Eccentric heel drops can be done at home on a stair. Heavy slow resistance training requires gym equipment but has higher compliance rates. Choose the option you'll stick with for 12 weeks.

What if the exercises make me worse?

First, confirm you're doing the right exercise for your type of tendinopathy. If you have insertional pain and are doing heel drops off a step, switch to flat-ground raises immediately. If you're doing the correct exercise and symptoms are worsening after 3 to 4 weeks, reduce the load (use both legs instead of one, remove added weight) and see a specialist for evaluation.

Can I do other workouts while rehabbing my Achilles?

Yes. Swimming, cycling, upper-body strength training, and other non-impact activities are generally safe and encouraged. Maintaining overall fitness supports recovery. Avoid activities that heavily load the Achilles (jumping, sprinting, hill running) until your loading program is well established.

Do I need to do exercises forever?

Not at the rehabilitation intensity, but maintenance calf strengthening should continue indefinitely — at least 2 sessions per week. This is the best way to prevent recurrence. Approximately half of patients with Achilles tendinopathy will experience either symptom persistence or recurrence, and ongoing strength maintenance reduces that risk.

What about yoga and Pilates?

Both can be beneficial for overall flexibility and core strength, but be cautious with poses that force deep ankle dorsiflexion (like downward dog with heels pressed to the floor). For insertional tendinopathy, modify these poses to keep the heels elevated. For midportion tendinopathy, gentle stretching positions are generally safe.

When should I see a surgeon?

If your symptoms have not improved after 3 to 6 months of the correct exercise program, if you have a visible bump at the heel with worsening pain, or if you suspect a partial or complete tear, it's time for evaluation by a foot and ankle specialist. Surgery is effective but reserved for patients who have genuinely failed appropriate conservative care.

Is there a difference between "tendinitis" and "tendinopathy"?

Yes. "Tendinitis" implies inflammation, but chronic Achilles tendon pain is actually a degenerative process — disorganized collagen fibers, not active inflammation. That's why anti-inflammatory medications don't work well and why loading exercise (which stimulates tendon remodeling) is the primary treatment. The correct term is tendinopathy. For more, see Achilles Tear vs. Achilles Tendinitis.

Can exercises prevent Achilles tendon problems?

Yes. Regular calf strengthening — particularly heel raises performed 2 to 3 times per week — is the best preventive strategy. Maintaining calf strength, progressing training gradually, and managing body weight and metabolic health all reduce risk.

Myth vs. Fact

Myth	Fact
"Just do heel drops — they work for everyone."	Standard heel drops off a step can worsen insertional tendinopathy. The exercise must match the location of pain.
"Rest is the best treatment for Achilles pain."	Complete rest weakens the tendon. Every active treatment was superior to wait-and-see in a network meta-analysis of 29 trials.
"No pain, no gain — push through it."	Some pain (2–5/10) is acceptable, but pain above 5/10 or worsening morning stiffness means you're doing too much.
"You need special equipment to rehab your Achilles."	A staircase is sufficient for eccentric heel drops. Gym equipment helps for HSR but isn't strictly necessary.
"Stretching is the most important thing."	Loading exercise — not stretching — is the cornerstone of treatment. Stretching alone is insufficient and can worsen insertional disease.
"If exercises don't work in 2 weeks, they've failed."	Tendon remodeling takes time. Commit to 12 weeks before judging effectiveness.
"Anti-inflammatory pills will fix the problem."	NSAIDs showed no significant benefit over placebo. The condition is degenerative, not inflammatory.
"PRP injections are better than exercise."	PRP showed no difference from saline when combined with eccentric training. Exercise remains the gold standard.
"You should ice your Achilles constantly."	Ice can help with comfort after exercise but does not treat the underlying tendon degeneration. Loading is the treatment.
"Once you have Achilles tendinopathy, you'll always have it."	Most patients improve significantly with the right exercise program. The key is doing the correct exercise consistently for long enough.

Best Exercises for Achilles Tendon Pain (and Which Ones to Avoid): An Evidence-Based Guide

Research Summary in Plain English

Loading exercise is the best treatment for Achilles tendinopathy — period. A living network meta-analysis of 29 randomized trials found every active treatment class was superior to doing nothing, but no single active treatment was clearly better than another. The practical conclusion: start with a calf-muscle exercise program because it is easy to prescribe, low cost, and has few harms.

For midportion tendinopathy, eccentric heel drops and heavy slow resistance training are equally effective. A level-1 randomized trial of 58 patients found no difference in pain or function at 12 or 52 weeks, though compliance was significantly higher with HSR (92% vs 78%) and patient satisfaction trended higher.

For insertional tendinopathy, limiting dorsiflexion during exercise is critical. A 2025 randomized trial of 42 patients confirmed that low tendon compression rehabilitation — which limits ankle dorsiflexion, eliminates calf stretching, and uses heel lifts — produced significantly better outcomes than high compression rehabilitation at both 12 and 24 weeks, with between-group differences exceeding the minimal clinically important difference.

Contraction intensity is the most important exercise variable for midportion disease; range of ankle dorsiflexion is the most important variable for insertional disease. A 2025 Delphi consensus of 17 international experts established these priorities, providing a clear framework for exercise prescription.

Popular adjuncts have limited evidence. NSAIDs showed no benefit over placebo. PRP showed no benefit over saline when combined with eccentric training. Orthotics and night splints showed no difference from control. Shockwave therapy may add benefit for midportion disease when combined with exercise, but a randomized trial found no added benefit for insertional disease.

Isometric exercise has weaker support than previously thought. A 2026 systematic review of 13 randomized trials found limited evidence for the superiority of isometrics over other modalities. Isometrics remain a reasonable bridge for acute pain but should not be the long-term program.

The Bottom Line

The right exercise for your Achilles tendon depends on where your pain is and what stage of recovery you're in. Getting this wrong is one of the most common reasons people don't get better.

Here's the simplest way to remember it:

- Pain 2 to 6 cm above the heel bone (midportion)? → Eccentric heel drops off a step OR heavy slow resistance training. Both work. Pick the one you'll do for 12 weeks.

- Pain right at the heel bone (insertional)? → Modified heel raises on flat ground. Do NOT drop your heel below the floor. Avoid deep calf stretches.

- Too painful for either? → Start with isometric holds for 1 to 2 weeks, then transition to loading.

- Feeling better? → Don't stop. Progress to heavier loads, then faster movements, then sport-specific activities. Continue maintenance strengthening indefinitely.

Exercise is not just one part of the treatment plan — it IS the treatment plan. Everything else — shockwave, PRP, medications, orthotics — is either an adjunct or has been shown to add little benefit. The tendon needs to be loaded to heal.

If you've been doing exercises for more than 3 months without improvement — or if you're not sure whether you have the right diagnosis — it's time to see a foot and ankle specialist. Sometimes what feels like tendinopathy is actually a partial tear, a Haglund's deformity, or another condition that needs a different approach.

Related reading: Achilles Tear vs. Achilles Tendinitis · Insertional vs. Midportion Achilles Tendinopathy · Why Does My Achilles Hurt in the Morning? · When Do You Need Surgery for an Achilles Tear? · Achilles Surgery Recovery Timeline · Returning to Sports After an Achilles Injury · Haglund's Deformity vs. Achilles Tendinitis

About the Author

Dr. Sarang Desai is a fellowship-trained orthopedic surgeon specializing in foot and ankle surgery and sports medicine in Dallas, Texas. He treats everyone from recreational athletes to elite competitors using the latest evidence-based surgical and nonsurgical techniques.

Schedule an appointment with Dr. Desai at OINT.org or call 972-591-6468.