Achilles tendonitis: symptoms, treatment, and exercises

If you’re a sports fan, you’re probably familiar with Achilles tendon injuries because at some point your favorite player has been affected by them. Top athletes like Aaron Rogers, David Beckham, and Tiger Woods have all been sidelined after tearing their Achilles tendons. While these types of injuries make headlines, average adults are at greater risk for an Achilles injury than pro athletes, according to the American Podiatric Medical Association.

Achilles tendonitis is one of those injuries. So whether you’re a sports buff or not, it’s important to understand how to keep this tendon healthy — and what to do if you injure it. Thankfully, a condition like Achilles tendonitis can often be managed with at-home treatment, especially exercises that increase calf strength and flexibility and protect you from other injuries. 

Take it from this Hinge Health member who found relief after physical therapy: “I love doing the Hinge Health exercises because they’ve helped me so much. Strength training has been key to managing knee, Achilles, and ankle pain and helping to prevent future injuries. I’m training for a half marathon, and because of the Hinge Health exercises, I’m feeling confident about my training.”

Read on to learn what Achilles tendonitis is, what causes it, and how to manage it, including exercises recommended by our Hinge Health physical therapists.

What is achilles tendonitis?

Achilles tendonitis is inflammation of the fibers that form the Achilles tendon. Tendons are strong, flexible cords of connective tissue that attach muscles to bones. The Achilles tendon, one of the largest and strongest tendons in the body, extends from the gastrocnemius and soleus muscles in the calf and attaches to the calcaneus, or heel bone. It’s responsible for pointing your foot and pushing off the ground when walking, climbing stairs, running, and jumping. As you land, your Achilles tendon controls your foot and absorbs some of the impact. It also provides bursts of power if you play sports that call for quick reaction times, like pickleball, volleyball, tennis, basketball, football, or soccer.

Achilles tendonitis develops when the collagen fibers that form the tendon become irritated and inflamed. The result is pain along the back of the calf, ankle, or heel. The pain can range from sharp and shooting to dull and achy. Other Achilles tendonitis symptoms include:

• Localized pain or tenderness when touching the back of your heel

• Thickening of the tendon, or a bulge

• Tenderness in the morning with walking

• Pain or discomfort during or after activities like walking

• Pain along any part of the tendon

Achilles tendonitis can affect ankle and foot mobility and function, making everyday movements like walking, climbing stairs, and even standing uncomfortable or painful. It can also interfere with your ability to exercise and participate in recreational activities, like hiking or playing sports. The good news: You can manage and rehab Achilles tendonitis in many ways, and movement is a crucial component. “It can get better,” says Gwen Smith, PT, DPT, a physical therapist at Hinge Health. “You can work through it.”

Causes of achilles tendonitis

Unlike an Achilles tendon tear resulting from a specific injury, Achilles tendonitis usually develops over time. There are steps you can take — including strengthening and stretching exercises like the ones below — to reduce your risk of developing Achilles tendonitis or to manage symptoms if you already have it.

Doing too much too soon. Your Achilles tendon is resilient and designed to take a lot of stress, but it still needs time to adjust to increased demands. In other words, it can be too much on your Achilles tendon if you haven’t exercised in a while and decide to jump into a pickleball game with your friends, for instance, with no warm-up. To avoid problems, you want to gradually build up the amount and intensity of exercise you do and stay active regularly. Even if you’re an avid exerciser, ease into new activities or higher levels of your current workouts.

Improper training choices. Skipping a warm-up. Not stretching. Wearing worn-out shoes. Sudden increases in activity. All of these factors can contribute to Achilles tendinitis. By following simple training principles, like warming up before activity, stretching afterward, and choosing proper footwear, you’ll reduce your risk of Achilles tendonitis and other issues.

Repetitive motions. Repetitive activities, like running and jumping, are often implicated in Achilles tendonitis. But not everyone who runs or plays basketball develops the condition. The real problem isn’t the stress; it’s doing these types of activities without proper strengthening and stretching to prepare your body for them.

Tight calf muscles. “A lack of flexibility limits ankle mobility,” says Dr. Smith. “When you don’t have a full range of motion, the ankle joint doesn’t move properly, and can cause compensatory walking strategies that can place more stress on the Achilles tendon over time.” 

Weak calves. Every time your foot lands on the ground, forces are absorbed throughout your body. When your calf muscles are weak, your Achilles tendons take more impact. The stronger your calves are, the better they absorb shock, so your Achilles tendons don’t get overworked.

Flat feet. When your feet are flat, they can be more mobile, which, in turn, can require your Achilles tendon to work harder to control motion, leading to inflammation and injuries. But having flat feet doesn’t mean you’ll automatically get Achilles tendonitis. Proper training, strengthening and stretching, and supportive footwear can help to keep you healthy. 

Poor circulation. People with medical conditions like diabetes and hypertension are at greater risk because they don’t have as much blood flow to their lower legs and feet. Managing these conditions can help to prevent problems.

Achilles tendonitis: a Hinge Health perspective

Learning about conditions that cause foot and ankle pain can be alarming. We know from Hinge Health members and research studies that anatomical labels like these can backfire when it comes to your treatment and recovery. When people hear they may have a condition like tendinitis, it can cause feelings of panic, like you have something "wrong" with your ankle that needs to be fixed. This way of thinking about pain is largely outdated, says physical therapist Dylan Peterson, PT, DPT. 

Pain is more complex than simply what may or may not be happening in your ankle joint. Other factors, like life stressors, can also play a big role in how you experience pain. And for most common musculoskeletal conditions, regardless of what may or may not be contributing to pain in your tissues, the solution is often the same. 

Movement — through physical and exercise therapy — builds strength, flexibility, and resilience to pain. And that often means doing exercises to keep your ankle and foot moving to stretch and strengthen your Achilles tendon along with the muscles and ligaments that support it. (More on that in a moment.)

Treatments for achilles tendonitis

Achilles tendonitis can weaken the tendon, setting you up for further problems if you ignore the pain.

Even though it may seem counterintuitive, rest is often not best when rehabbing your Achilles. In fact, a review of 29 studies in the British Journal of Sports Medicine found that all types of exercise therapy improved symptoms compared to a wait-and-see approach. Many cases of Achilles tendonitis respond well to self-care strategies. Here are some treatments you can try at home.

Focus on PEACE & LOVE. The RICE method (rest, ice, compression, and elevation) has been a longstanding model for injury recovery, but PEACE & LOVE offers a new, more comprehensive approach to pain relief that prioritizes movement.

Adjust your footwear. If your Achilles tendonitis pain is low on your leg, select shoes carefully so they don’t rub on the area and cause further irritation to the tendon. If you have flat feet or overpronate or roll in too much, look for shoes with good arch support to keep your foot more stable and reduce stress on the Achilles tendon. And avoid zero-drop shoes, which have a flat sole and can put more pressure on the Achilles tendon.

Find your pain buffer zone. Movement helps to reorganize the collagen fibers in the Achilles tendon to ease pain and promote healing. However, you will likely experience some discomfort as you exercise, and it’s natural to shy away from activities that hurt. “You’ll need to monitor how much you’re walking or loading the tendon while managing pain levels,” says Dr. Smith. “It’s a dance. It’s okay to feel a little bit of pain, but not too much.”

That’s where your pain buffer zone comes in. Assess your pain on a scale of zero to 10, with zero being no pain at all and 10 being so painful that you’d go to the emergency room. If your pain level goes higher than a five, you want to back off a bit. Keeping pain below five ensures you get the healing benefits of exercise without further irritating your tendon. “Pain is not a bad thing, says Dr. Smith. “It’s there to be a reminder, like ‘Hey, this is a little too much.’ It’s your body’s awareness system to keep you from injuring yourself.”

Stay level. While rehabbing your Achilles tendon, take care to notice how you feel when walking uphill. You may need to ease up if it’s causing you more pain than feels comfortable for you. “Hills increase the tension on the Achilles tendon,” says Dr. Smith. That doesn’t mean hills are off-limits forever. You can get back to running or walking hills after you recover by continuing to strengthen and stretch the muscles in your lower legs, warming up before activity, and wearing supportive shoes. The added stress of hills doesn’t have to cause problems if you prepare properly.

Cross train. Alternate impact activities like walking and running with non-impact cycling or swimming to avoid aggravating your Achilles tendon as you recover.

Try shoe inserts. Heel lifts or orthotics that elevate the heel have been found to reduce pain and improve function in people with Achilles tendonitis.

Movement helps Achilles tendonitis by preventing stiffness, increasing strength, and improving range of motion. The above exercises are recommended for rehabilitating and relieving Achilles tendonitis symptoms. Begin with the first three Achilles tendonitis exercises, working in your pain buffer zone. As your pain eases and your recovery progresses, you can add the other exercises to help prevent future pain and reinjury.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT tip: Rotate calf exercises

“Cycling through various calf raise exercises provides ‘muscle confusion,’ which is a good thing,” says Dr. Smith. “There are different parts to the calf, and if you do the same thing every time, you may not get the same strength gains.” Switching up which exercises you do will allow you to target different parts of the muscles and tendons in various ways to maximize benefits. 

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Average American Male Adult More at Risk for Achilles Tendon Injury than Pro Athletes. (n.d.). American Podiatric Medical Association. Retrieved from https://www.apma.org/content.cfm?ItemNumber=44668 

2. Tendon. (2021, August 10). Cleveland Clinic. https://my.clevelandclinic.org/health/body/21738-tendon

3. Achilles Tendinitis. (2021, September 3). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/achilles-tendinitis/symptoms-causes/syc-20369020 

4. van der Vlist, A. C., Winters, M., Weir, A., Ardern, C. L., Welton, N. J., Caldwell, D. M., Verhaar, J. A. N., & de Vos, R.-J. (2020). Which treatment is most effective for patients with Achilles tendinopathy? A living systematic review with network meta-analysis of 29 randomised controlled trials. British Journal of Sports Medicine, 55(5), 249-256. doi:10.1136/bjsports-2019-101872

5. Rabusin, C. L., Menz, H. B., McClelland, J. A., Evans, A. M., Malliaras, P., Docking, S. I., Landorf, K. B., Gerrard, J. M., & Munteanu, S. E. (2020). Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (HEALTHY): a randomised trial. British Journal of Sports Medicine, 55(9), 486-492. doi:10.1136/bjsports-2019-101776