Exercises for Achilles tendinopathy need to be read alongside the plan prescribed for you. Use this guide to separate movement instructions, dose questions and your running record.
Keep the prescribed calf session and the rest of your day in the same record. The fictional example below shows how to prepare a follow-up question without inventing a cause or a rehabilitation schedule.
By Chris Pruitt, WorkoutHealthy Insider
Confirm the Achilles problem before choosing exercises
The 2024 clinical practice guideline recommends tendon-loading exercise as a first treatment for midportion Achilles tendinopathy, excluding presumed frailty of the tendon structure. Its scope does not establish a routine for every painful heel, a recent rupture or recovery after surgery.
The guideline also notes that much of the research involved physically active people with symptoms lasting more than three months. Results cannot simply be transferred to a new injury or someone with a different starting capacity.
Ask the treating clinician to write down the diagnosis, the affected side and any movement restrictions. A specific answer is more useful than trying to match a sore spot to a photograph online.
Seek urgent medical assessment for a sudden injury with a snap or pop, severe heel pain, or inability to walk or rise onto your toes. The NHS heel-pain guidance identifies these as reasons for urgent help; trying a calf raise is not a way to rule out a serious injury.
Read the movement instructions
Have your physiotherapist select and dose these illustrated UHCW examples.
1. Seated heel lift
- Sit on a chair.
- Lift your heels by pressing through your big-toe pads, with toes relaxed.
- Pause three seconds; lower slowly.
2. Standing heel lift
- Hold a stable counter, table or wall for balance.
- Share weight equally; lift both heels through your big-toe pads.
- Keep knees straight without leaning forward; lower.
3. Single-leg heel lift
- Maintain that support.
- Lift one foot; raise the other heel through its big-toe pad.
- Keep that knee straight without leaning forward; lower.
4. Controlled lowering
- Rise onto both forefeet.
- Shift onto the affected leg and lift the other foot.
- Pause two seconds; lower slowly, then replace that foot.
Step restriction: No off-step versions for insertional tendinopathy. Otherwise stay on flat ground unless your physiotherapist directs step versions.
These are options to discuss, rather than a circuit containing all four. A written plan should identify which exercise you are doing now and what would justify changing it.
Exercise names do not tell you the dose
“Calf raises” can describe quite different tasks. Seated or standing, one leg or two, external weight, movement range, repetition speed and total repetitions all need to be specified before two sessions can be compared.
The Dutch multidisciplinary guideline recommends education, loading advice and progressive calf strengthening suited to the individual, with at least 12 weeks of strengthening. That is a treatment framework, not a promise of recovery by week 12.
It also advises considering a flat surface initially for insertional symptoms. The same exercise name on two leaflets does not make their movement range or intended audience interchangeable.
Copy these fields from the actual plan before starting: exercise, side, surface, support, resistance, repetitions, sets, speed, rest and weekly frequency. Leave an unanswered field marked “ask” rather than borrowing a number from a different program.
Also record the symptom instructions given by the clinician: what is acceptable, what warrants stopping and who to contact if symptoms change. This article does not supply a universal pain score or a next-morning pass mark.
A runner’s record: keep exercise and running in the same view
An exercise tally alone leaves out much of a runner’s day. Use the record below to bring the prescribed calf session, other activity and your observations to the same appointment.
This is a communication worksheet, not a validated clinical score or a formula for increasing load. Do not combine its entries into an invented “safe load” number.
| Record | Useful detail | Avoid guessing |
|---|---|---|
| Assigned exercise | Name, side, surface, resistance and completed sets and repetitions | “Same calf workout” when the weight or range changed |
| Running | Whether you ran, duration or distance, terrain and any pace changes | Calling a hill session equivalent to an easy flat run |
| Other activity | Unusual stairs, prolonged standing or an activity you want to ask about | Assuming exercise repetitions describe the entire day |
| Symptoms | Your observations before, during, after and the next morning, using any scale already agreed | Converting an online pain threshold into personal permission |
| Follow-up | The question to raise and the clinician’s actual adjustment | Writing an automatic progression rule yourself |
Fictional example: A runner records the same prescribed standing calf session on Monday and Thursday, but Thursday also includes a hilly run and extra stairs. Friday’s stiffness is greater.
The record shows several differences worth discussing; it cannot identify which caused the change. “The calf exercise failed” and “the hills caused it” would both go beyond what this example establishes.
If a session is missed or shortened, record what happened rather than quietly rewriting the plan. An honest account gives the clinician clearer information than a perfect-looking checklist.
Returning to running needs a separate conversation
The Dutch guideline advises discussing the pace of return and building sport loading gradually. Its broad guidance does not establish an individual return date.
A completed heel-raise set and a return to running are different goals. Ask the clinician to explain what they want to assess and how the next running step connects to the existing exercise plan.
- Which activity restrictions apply now, and what should prompt a call?
- What observations or functional assessments will inform a change?
- If running is included, what exact amount and terrain have we agreed?
- Which other training or work demands should be considered?
- When will the plan be reviewed if progress stalls?
Bring the answers back to the record rather than adding a second, unrelated running calendar. This keeps the agreed plan visible without treating a generic week-by-week schedule as medical clearance.
What an ultrasound can and cannot settle
The feature image shows a knee ultrasound assessment, not an Achilles scan or an exercise demonstration. The Achilles-specific imaging point is that a scan and a loading plan answer different questions.
The Dutch guideline advises against using imaging to predict the course of Achilles tendinopathy or monitor treatment response. Ask what clinical question a proposed scan would answer rather than assuming an image can provide a return-to-running date.
Put the instructions and the context together
A useful exercise plan names the movement, specifies the dose and range, and explains how follow-up will work. A useful runner’s record adds what happened around that plan without pretending to diagnose the response.
The exercises above provide concrete examples to recognize and discuss. The personal choice, progression and return to running belong in the treatment plan for the diagnosed problem.
Sources
- University Hospitals Coventry and Warwickshire NHS Trust. Achilles tendinopathy, pages 6 to 9. Updated June 2023.
- Chimenti and colleagues. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024.
- De Vos and colleagues. Dutch multidisciplinary guideline on Achilles tendinopathy. British Journal of Sports Medicine, 2021.
- NHS. Heel pain, including urgent assessment advice.
Medical disclaimer: This article is general fitness information, not medical advice or a personal treatment plan for Achilles pain. If you have an injury, ongoing pain, or a medical condition, talk to a doctor or physical therapist before changing how you exercise.
