Achilles Tendonitis Rehab Protocol

Achilles Tendonitis Rehab Protocol

Achilles tendonitis can cause pain when you stand, walk, or run, and it may be mild to severe! Most cases of Achilles tendonitis can be treated successfully with some rehab Protocol. And in this article, we have shared the rehab protocol for Achilles tendonitis!

Achilles tendonitis is the inflammation of the Achilles tendon that leads to pain along the back of the heel or ankle. Most people with Achilles tendonitis are active, from weekend warriors to professional athletes, and Achilles tendonitis is high in runners, soccer players, and rock climbers.

The Achilles tendon is the largest tendon in the body. It carries much weight when we run, jump, or even walk. This tendon connects the calf muscles to the heel assisting with force transmission, and acts like a spring when you push your foot off the floor.

Achilles Tendonitis

Achilles tendonitis is an irritation of the Achilles tendon, which is one of the most common causes of pain. It occurs behind the heel and upward back of the ankle when walking and running!

Achilles tendonitis can happen to both active and inactive people, but 24% of athletes get it, and about 50% of runners will have Achilles tendon pain at some point in their careers.

Achilles Tendonitis can make it hard for anyone to walk, climb stairs, or participate in recreational activities. Physical therapists help people with Achilles Tendonitis reduce pain in the affected area, get the injured tendon back to its normal strength, flexibility, and mobility, and eliminate any swelling.

Physical therapists know a lot about how people move. They improve the quality of life by giving hands-on care, teaching patients, and telling them how to proceed. For an evaluation, you can talk to a physical therapist directly.

Achilles Tendonitis Pathology

When you use your Achilles tendon too much or as you age, the tendon may weaken or can break down. Over time, some of the individual stands of the tendon can fray, other fibers break, and the tendon begins to lose strength. The body tries to heal the tendon, so scar tissue forms on the tendon, making it thicker.

This process can result in the formation of a tender nodule within the tendon. Tendonitis or tendinosis is the name for this condition. Tendonitis makes the tendon weaker and more painful than it would be otherwise. If treated after symptoms start, this injury can heal completely.

A tendon that is weakened by inflammation or fraying can rupture. However, if the tendonitis is painful, the person usually avoids activities that cause pain. So, if you treat a painful Achilles tendonitis correctly, it won’t usually rupture.

In sports like tennis, squash, racquetball, and basketball, an Achilles tendon rupture can happen when you suddenly jump or push off with a lot of force. Rupture is more common in men than women in their third to the fifth decade.

Achilles Tendonitis Rehab Protocol

Activity modification is essential right after an injury. Especially if the tendon is injured due to overusing. When tendon pain is at its worst, it is important to keep moving. It would be best to remember that complete rest for tendon injury is not a good idea. Moving the foot and ankle will keep the lower leg flexible. Rest is bad for tendons and bad for their health. Tendons need to be loaded to keep their shape. It is important to load the Achilles tendon to make it stiffer so it can act like a spring again. This article will help you how to know the various exercises or the rehab protocol for Achilles Tendonitis. And we have divided this rehab protocol in some phases. Keep reading to know the phases!

Phase 1: Weeks 1-2

When the patient has pain, difficulty with all activities and difficulty performing ten 1‐legged heel raises, we will follow this phase. In this phase, we will try to understand the injury using the pain-monitoring model and then start the exercises. We will do isometric exercises in this phase. Not isotonic! The isometric exercises in this phase are…

Calf Mobilization Using the Foam Roller

Process: Place the affected legs and calf muscles on a foam roller. Use your hands to lift your buttocks into the air. On the foam roll, roll your calf back and forth. To increase the pressure, put the leg that isn’t being worked on top of the leg. Move slowly and take more time on the areas that hurt. Make sure to move your whole calf; if you feel like you need to, you can also work on other parts of your leg that feel tight or limited. 

Perform: Do this for one to two minutes per calf.

Check: If this hurts, don’t make it hurt more than a little or a little bit.

Supine Calf Isometric With Band

Process: Put a band around the ball of your foot while you’re sitting down, and then pull it toward your body. Pull your calves tight and push your foot into the band as hard as possible. For this exercise, you can bend your knee or keep it straight. You can use a resistance band or a towel to put the same external load on your calves and Achilles tendon.

Achilles Tendonitis Rehab Protocol

Perform: Hold for 5 seconds with 15 repetitions, twice per day.

Check: When you do this exercise, you will feel your calf muscles work. Do not let your ankle “rollout.” The inside and outside of the ball of your foot should feel the same amount of pressure.

Single Leg Heel Raise Isometric Hold

Process: Set yourself up in front of a wall or other stable object. Start by lifting yourself up with both calf muscles. Shift your weight to one leg and keep your heel as high as possible. Hold the end position and lean on the wall with your arms if necessary. You can start by using your glutes and quadriceps.

Perform: Hold for 5 seconds with 15 repetitions, twice per day. 

Check: Make sure your knees don’t bend when you perform this.

Phase 2: Weeks 2-5

When the patient has pain with exercise, morning stiffness, and pain when performing heel raises, this phase will be start at 2-5 weeks! In this phase, we will perform all the exercises from phase one and other exercises, as well as those, are listed below!

Plantar Fascia Mobilization using a Ball

Procedure: Tightness in the foot can lead to changes in ankle and leg mechanics. In cases of Achilles tendinitis, this area is frequently restricted. Use a tennis, lacrosse, or golf ball to mobilize the plantar fascia. The amount of pressure should not exceed a mild amount of pain. Roll the ball across the bottom of your foot. Slow down and concentrate on the more painful spots. 

Achilles Tendonitis Rehab Protocol

Perform: Perform each foot for 2-3 minutes.

Check: Make sure to move the entire foot.

Single Leg Heel Raise Weight Shift

Procedure: Shift your weight from side to side while keeping your heel up as comfortably as you can. This will begin to burn the calves! Toe walks are another option. Toe walks are a wonderful alternative as they allow you to carry more weight.

Perform: 15 repetitions, twice per day. 

Check: Make sure you are not in a sleepy surface!

Heel Raises Standing on Edge of Stair

Procedure: Stand before the stairs. Step up your injured leg on the edge of your stair. Stand up there and raise your heel!

Perform: Hold for 5 seconds with 15 repetitions, twice per day.

Check: Make sure you have supported your body by your hand.

Phase 3: Weeks 3-12

If the patient can handle phase 2 of the exercise program, has no pain where the tendon attaches to the bone, and has either less or more stiffness in the morning, we will start this phase. We will begin heavier strength training with added weight!

Isotonic Loading: Seated calf Raises

Procedure: You will need to go to a gym to do this exercise. At first, sit before a weight tool. Place your foot under the weight and on an upper edge. Gently push up the weight by your knee, hold for three seconds, and then back to your foot in a normal position on the surface.

Credit: PogoPhysio

Perform: Do this seated calf raising exercise 15 time with 3-6 seconds hold.

Check: Don’t perform the repetitions too quickly.

Isotonic Loading: Standing Calf Raises

Procedure: It also will need to go to a gym to do this exercise. For this exercise, you should start with 10-15% of your body weight. A “one size fits all” approach to prescribing these exercises isn’t always the best way to go, but we usually start all runners off with three sets of 8 reps. This prescription of reps and sets can be changed to fit the needs of a specific sport, activity, or person.

Credit: PogoPhysio

Perform: Slowly do the same thing repeatedly (3-6 seconds per repetition). Start with 3s reps and work your way up to 6s reps.

Check: Check your tendon that it is highly irritable or not! If it is highly irritable then you shouldn’t do this exercise!

Phase 4: Weeks 12 – 6 Months

During this phase, the patient will have few symptoms. For example, morning stiffness will not happen much like before, and they’ll be able to play sports without much trouble. So, in this phase, we will continue all the exercises from phase three, and the rest are described below!

Single-Leg Hops Wall Supported/Without Supported

Procedure: The lower leg’s role is to act like a spring. When you work faster, you put a lot more stress on your Achilles tendon. Every time we walk, hop, or jump, our Achilles tendon stores, and releases energy. The one-leg hop is a great way to make a tendon less stiff. Building strength is essential for people who want to get back into sports or other high-level activities. Do this exercise as shown in the video below!

Credit: PogoPhysio

Perform: Perform this 30 seconds with 15 reps.

Check: Make sure the surface is not wet!

Double Leg Jump Protocol

Procedure: It is almost same as Single-Leg Hops Wall Supported exercise. The first one need to use a wall support and that was for single leg. And this one don’t need wall support and need perform with double leg. To better understand check the video!

Credit: PogoPhysio

Procedure: Perform this 30 seconds with 15 reps.

Check: Make sure the surface is not wet!

Final Thoughts about the Rehab Protocol of Achilles Tendonitis

It is essential to clarify that Achilles tendinopathy rehab protocol needs to be carefully conducted. Rehabilitating a tendon is not at all “easy.” It will take time for the tendons to get used to the loads listed above.

There requires adequate time between rehab exercises for the tendon matrix to break down net protein (collagen, a building block of tendons) 24-36 hours after a strength exercise session.

If you have pain in your Achilles tendon, you should see a sports physiotherapist to help you through the different stages of recovery. The above is just a guide and doesn’t consider any specifics.



"Hasan", I am a physiotherapy Doctor. I have completed my B.S.c course (4 years) under Rajshahi University, Faculty of Medicine, Rajshahi. Currently I am working as a clinical physiotherapist at a renowned physiotherapy center and I am continuing my MPT (Master's of physiotherapy) degree at CRP, Savar.

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