Conditioning: Phase 1

The following is the first of four phases that will guide you from Achilles Tendonitis/osis toward healthy running. Progress from each phase as instructed, applying rehabilitation modalities such as taping where needed.

Duration: 1 Week (at least)
Goal: Reduce pain through unloading. If you suspect tendonitis, start here with Phase 1. If you suspect tendinosis, start with Phase 2.
Frequency of Exercises: Daily (Phases 1a & 1b: twice per day; Phase 1c: once per day)

a. HIGH PAIN

START HERE if pain is >7/10 with walking and/or double leg calf raises
Goal: Reduce inflammation. Do not run or exercise into pain.

Taping/Heel Lift: Taping the Achilles tendon may assist in offloading. If you need to put less pressure on the tendon, you can also insert a heel lift in the back of your shoe to reduce tension. Purpose: offload calf to decrease tensile strain.
Ankle Pumps: 2 x 20 reps. On your back or sitting, bring your ankle slowly up and down without going into significant pain. The principle is to reduce inflammation and fluid build up, and to help with fluid exchange in the Achilles tendon. Purpose: reduce swelling and improve circulation.
Biking (Light Resistance): Walking may be too painful at this point, though if it feels okay then walk. Light stationary biking can be a good alternative as it places less stress on the recovering Achilles tendon.
Cross Fiber Massage: 3-5 minutes. Lying down or sitting, gently massage the Achilles tendon. Pretend that it is a sponge, and you are gently squeezing some of the fluid out to reduce inflammation build up. It should not be painful, and the motion should be up the leg. Purpose: reduce swelling and improve circulation in order to reduce pain and improve healing.
Ice: 10 minutes on calf muscle to reduce pain and inflammation.

b. MODERATE PAIN

START HERE if pain is 4-6/10 with walking and/or with double leg calf raise
Goal: Continue to reduce pain. Do not run.

Taping/Heel Lift: (see videos above) l lift in the back of your shoe to reduce tension. Purpose: offload tendon force to decrease tensile strain.
Double Leg Bridges: 3 x 10 reps. Place your legs shoulder width apart with knees bent. Bring your hips up and down. You should feel your hip and thigh muscles working. Purpose: increase hip strength to reduce pressure on Achilles tendon and prevent knee caving in.
Towel Ankle Pumps: 2 x 20 reps (lying down). On your back or sitting, bring your ankle slowly up and down without going into significant pain. Use a towel or a Resistance Band to increase resistance. Purpose: reduce swelling, pain, and improve circulation.
Calf Raises (Isometric Hold): 2 x 45 seconds, 6-10 times per day. Like a calf raise, except hold the position at the top or a point that causes minimal pain. Purpose: increase strength and reduce pain.

Clamshells: 3 x 16 reps. Lying on your side with your knees bent (hips to 45 degree angle), bring your top knee up and hold for 3 seconds, and then back down. Repeat until 16 reps or fatigue. You should feel your hip muscles working. If this is too easy, add a Resistance Band around your knees. Purpose: increase strength in glutes to reduce knee caving in and Achilles stress.
Walking and/or Biking (Light Resistance): Walk on flat surfaces as tolerated.
Cross Fiber Massage: 3-5 minutes. Get a sore spot on the tendon and rub back and forth. Purpose: decrease adhesions and stimulate healing.
Ice: 10 minutes to calf muscles to reduce pain and inflammation.

c. MILD PAIN

START HERE if pain is <3/10 with double leg calf raises and/or walking)
Goal: Continue to reduce pain. Do not run.

Single Leg Glute Bridges: 3 x 10 reps. On your back with one knee up, bring your hips up and down slowly. You should feel your thigh and hip muscles working. Purpose: increase demand on the hip to reduce knee from caving in and mildly stressing the Achilles.
Squats (With Band): 3 x 8-10 reps. With knees shoulder width apart, slowly come down into mild pain and come back up. If able, place a resistance band around your knees to recruit your glutes with the squat. Purpose: increase the load on your tendon, while also increasing hip/leg strength.

Single Leg Calf Raises (Eccentric): 3 x 12 reps. Stand with your toes near the edge of the step. Come up with both legs, and then slowly (3 count) come down on the involved side. Next, bring yourself back up with two feet. You should expect mild discomfort. If this is too easy, add weight. Purpose: Gradually load the tendon eccentrically to promote healing and strength.
Single Leg Balance: 3 x 30 seconds (each leg). Ideally, complete this in front of a mirror. Stand with both hands on your hips while your feet are directly under you. Keeping your pelvis as stable as possible, bring one leg up without causing your pelvis to tilt or rotate. Hold that position. Purpose: improve hip, knee, and ankle joints stability.
Cross Fiber Massage: 3-5 minutes. Get a sore spot on the tendon and rub back and forth. Purpose: decrease adhesions and stimulate healing.
Walking and/or Biking (Light Resistance): Slight discomfort is okay, but if pain is too much after exercise or lingers for awhile, then you have done too much.
Ice: 10 minutes to calf muscles to reduce pain and inflammation.

TO GRADUATE TO PHASE 2

Required: Pain is < 3/10; and when aggravated, pain does not linger for more than 1 minute
Required: Complete 3 x 12 single leg calf raises (eccentric) with only mild pain (<3/10) for 2 consecutive exercise sessions
Required: No noticeable redness and very minimal swelling, if at all
Note: If you began at Phase 1a, before graduating to Phase 2, be sure to progress in turn through Phases 1b and 1c

Principles of Achilles Tendonitis/osis: A Review

CAUSE – overloading of the tendon
NEED – reduce pain and Achilles tendon tension
PLAN – once pain is managed, gradually reload the tendon to increase strength

Still Need Help?

You are welcome to meet virtually with our PT for additional feedback and assessment. Otherwise, continue to the next step to learn how best to manage the pain from your injury.