That nagging pain at the back of your heel won’t fix itself with rest alone. If you’ve been diagnosed with Achilles tendinopathy, you already know the frustration of a condition that lingers, and worsens, without proper intervention. A structured Achilles tendinopathy physical therapy protocol gives your tendon exactly what it needs: progressive loading that stimulates healing rather than further breakdown.
At Achilles Foot and Ankle Center, we treat patients across Central Virginia who come to us after months of failed home remedies and generic stretching routines. The difference between recovery and chronic dysfunction often comes down to following an evidence-based, phased approach, one that matches your current tissue capacity and advances at the right pace. Our specialists see firsthand how patients who commit to a proper protocol regain function, while those who skip steps or rush the timeline end up back at square one.
This guide breaks down each phase of rehabilitation, from initial pain management through return-to-sport criteria. You’ll find specific exercises, loading parameters, and progression benchmarks used in clinical practice. Whether you’re working with a physical therapist or supplementing professional care, this protocol provides the framework for lasting recovery.
What Achilles tendinopathy is and why it happens
Your Achilles tendon doesn’t simply become inflamed and swell up like an acute injury. Tendinopathy represents a failed healing response within the tendon’s structure, where collagen fibers become disorganized, blood vessel patterns change, and the tissue loses its normal ability to handle load. This isn’t a short-term inflammatory process that resolves with ice and rest. The condition involves structural changes at the cellular level that require specific mechanical loading to reverse.
The difference between tendinitis and tendinopathy
Most people arrive at our clinic using the term "tendinitis," but that label rarely fits what’s actually happening inside your tendon. True tendinitis involves acute inflammation that typically resolves within two to three weeks with appropriate rest. You might experience tendinitis after a single unusual event, like a sudden sprint to catch a bus after months of inactivity. Your body sends inflammatory cells to the area, the tissue heals, and you move on.
Tendinopathy develops over weeks or months through repeated microtrauma that exceeds your tendon’s capacity to repair itself between loading sessions. Biopsies of chronically painful Achilles tendons show minimal inflammatory cells. Instead, researchers find disorganized collagen, increased ground substance, and neovascularization (abnormal new blood vessel formation). Your pain comes from this structural disruption and the sensitized nerve endings that develop within the degraded tissue, not from ongoing inflammation. This distinction matters because anti-inflammatory medications and complete rest address the wrong problem. An Achilles tendinopathy physical therapy protocol targets the underlying structural issues through progressive mechanical loading that stimulates proper collagen remodeling.
Rest alone won’t reorganize disorganized collagen fibers or restore normal tissue architecture. Your tendon needs the right mechanical stimulus to heal.
What causes the tendon to break down
Your Achilles tendon functions like a biological spring, storing and releasing energy during walking, running, and jumping. The tissue can handle enormous forces when you apply load gradually and allow adequate recovery between sessions. Problems arise when you exceed your current tissue capacity through one of several mechanisms: sudden increases in training volume, changes in training intensity, inadequate rest periods, or altered movement patterns that shift stress to vulnerable areas.
Each loading cycle creates microscopic damage at the cellular level. Your body normally repairs this damage during rest periods, actually making the tendon stronger through the remodeling process. Tendinopathy develops when damage accumulates faster than your repair mechanisms can address it. The tendon’s blood supply naturally decreases about 2-6 centimeters above the heel bone insertion, creating a watershed zone with limited healing capacity. This mid-portion area becomes the most common site of breakdown, though insertional tendinopathy at the heel bone attachment also occurs frequently.
Why some people develop it and others don’t
Two runners following identical training plans don’t carry identical risk. Your individual biomechanics create specific loading patterns that either distribute stress evenly across the tendon or concentrate it in vulnerable areas. Excessive foot pronation (rolling inward), limited ankle dorsiflexion (upward ankle movement), and weakness in your hip or calf muscles all alter how force travels through the kinetic chain and into your Achilles tendon.
Training errors remain the most common trigger we see in clinical practice. You might increase your weekly mileage by 30% in a single week, add hill repeats without prior preparation, or switch from cushioned shoes to minimalist footwear too quickly. These changes overwhelm your tendon’s current capacity before it has time to adapt. Age plays a role too. Your tendon’s metabolic activity and collagen turnover slow after your third decade, reducing your ability to repair microtrauma quickly. Previous injury, fluoroquinolone antibiotic use, and certain systemic conditions like diabetes or rheumatoid arthritis further compromise tendon health. Genetic factors influence your baseline collagen structure and inflammatory response patterns, explaining why some people develop tendinopathy despite seemingly reasonable training practices while others tolerate enormous loads without issue.
Before you start: safety checks and key terms
You can’t safely follow any Achilles tendinopathy physical therapy protocol without first ruling out conditions that require immediate medical attention or modified approaches. Self-guided rehabilitation works only when you’re dealing with actual tendinopathy, not a partial tear, complete rupture, or systemic issue masquerading as simple tendon pain. Your symptoms provide critical clues about whether this protocol fits your situation, and understanding specific terminology helps you execute each phase correctly.
When to skip this protocol and see a specialist first
Stop and schedule an evaluation if you heard or felt a sudden pop in your Achilles tendon, especially during a pushoff movement or jump. Complete ruptures require surgical consultation within days to optimize outcomes. You should also seek immediate care if you notice significant swelling that developed rapidly (within hours), severe bruising that extends down your foot, or an inability to rise onto your toes even with assistance. These signs suggest acute structural damage beyond the scope of a standard rehabilitation protocol.
Certain chronic symptoms also warrant professional assessment before you begin loading exercises. If your pain persists at the same intensity despite three months of modified activity, you might have underlying issues like Haglund’s deformity (bony prominence at the heel), insertional calcifications, or other anatomical factors that require imaging and specialist input. Red flag symptoms include constant pain unrelated to activity, night pain that wakes you from sleep, fever or systemic symptoms accompanying your tendon pain, or pain that spreads up your calf rather than staying localized to the tendon. At Achilles Foot and Ankle Center, we frequently see patients who spent months following generic protocols while missing these warning signs, delaying appropriate treatment.
If your pain behavior doesn’t match the typical pattern of mechanical tendinopathy (pain with loading that improves with warm-up), you need a proper diagnosis before starting progressive rehabilitation.
Key terms you need to know
Understanding specific terminology helps you execute exercises correctly and recognize which phase you belong in. These definitions appear throughout any evidence-based Achilles tendinopathy physical therapy protocol:
| Term | What It Means |
|---|---|
| Eccentric contraction | Your muscle lengthens while producing force. During heel drops, your calf contracts as your heel lowers below your toes. |
| Isometric contraction | Your muscle produces force without changing length. Holding a calf raise position without moving. |
| Concentric contraction | Your muscle shortens while producing force. Pushing up onto your toes during the lifting phase of a heel raise. |
| Insertional tendinopathy | Pain and structural changes where the tendon attaches to your heel bone. |
| Mid-portion tendinopathy | Pain and structural changes 2-6 cm above the heel bone insertion, the most common location. |
| Load management | Adjusting activity volume and intensity to match your current tissue capacity. |
| Reactive tendinopathy | Acute overload response with potential reversibility through appropriate load reduction. |
Time under tension refers to how long your tendon experiences force during each exercise repetition. Slower movements create longer tension periods, which matter more in certain protocol phases than pure weight lifted.
How to monitor pain and adjust your plan
Pain during tendon rehabilitation doesn’t automatically mean you’re causing harm, but you need specific guidelines to distinguish between productive discomfort and destructive overload. Every Achilles tendinopathy physical therapy protocol requires active monitoring because your tendon’s tolerance changes week to week as it remodels. You can’t simply follow a printed program without adjustment. The protocol works only when you respond to your body’s feedback and modify intensity, volume, or exercise selection accordingly.
The 24-hour pain rule
Your pain response during and immediately after exercise tells you less than how you feel the next morning. A 0-10 pain scale provides your primary monitoring tool, where 0 represents no pain and 10 represents the worst pain you can imagine. You can tolerate up to 5/10 discomfort during exercises without concern, as long as your pain returns to baseline (or improves) within 24 hours. This temporary provocation actually signals appropriate mechanical stimulus to your healing tendon.
Pain that remains elevated 24 hours later indicates you exceeded your current capacity. Your tendon needs more recovery time, less load, or both. Track your pain levels using this simple framework each day:
| Time Point | Acceptable Response | Red Flag |
|---|---|---|
| During exercise | Up to 5/10 pain that plateaus or decreases | Pain rising above 5/10 or continuously climbing |
| Immediately after | Returns to pre-exercise level within minutes | Remains elevated 30+ minutes |
| Next morning | Back to baseline or improved | Higher than pre-exercise baseline |
If your pain stays elevated the next day, you pushed too hard. Scale back rather than push through.
How to scale exercises when pain increases
You have three adjustment levers when your pain response exceeds acceptable limits: reduce repetitions, decrease load, or modify the exercise selection. Start by cutting your repetition count by 50% while maintaining the same weight. If that still produces excessive next-day pain, reduce the load by 25% and return to your previous repetition scheme. These adjustments let you maintain training stimulus without overwhelming damaged tissue.
Sometimes you need to step back an entire phase rather than just tweaking numbers within your current exercises. If double-leg heel raises consistently provoke pain above 5/10, return to isometric holds instead. You lose no ground by spending an extra week at a lower intensity level. Progressive loading means matching your current capacity, not forcing yourself through arbitrary timelines. Consider this decision tree when exercises provoke excessive pain: first reduce volume by half, then reduce load by 25%, then modify the exercise to a less demanding variation, and finally, drop back to the previous protocol phase if none of these adjustments control your symptoms adequately.
Phase 1: Settle symptoms and manage daily load
Your first goal involves reducing pain to manageable levels while identifying which daily activities currently exceed your tendon’s capacity. This phase doesn’t mean complete rest or eliminating all discomfort. You need to find the sweet spot where you maintain enough activity to prevent deconditioning without repeatedly aggravating your already compromised tissue. Most people spend 1-3 weeks in this phase, though severely reactive tendons might require longer before progressing to structured loading exercises.
Identify your current pain triggers
Start by tracking which specific activities provoke your symptoms throughout a typical day. Your pain might spike during morning walks, climbing stairs at work, or standing in dress shoes during evening events. Write down each activity that increases your pain above 3/10 and note the intensity, duration, and footwear involved. This information reveals your current capacity threshold and guides your modification strategy.
Common culprits include prolonged standing, walking on hard surfaces, and shoes with inadequate heel elevation. Activities that load your Achilles in a stretched position (walking uphill or wearing flat shoes) typically cause more irritation than those with slight heel lift. Your morning pain often relates to overnight tissue stiffness rather than the walking itself.
Your tendon tolerates activity better when you spread loads throughout the day rather than cramming everything into one session.
Modify activities without stopping them completely
Replace high-load activities with lower-intensity alternatives that serve the same purpose. Instead of a 30-minute continuous walk, take three 10-minute walks with rest breaks. Swap flat casual shoes for athletic shoes with cushioning and a slight heel drop (8-12mm). Use an elevator instead of stairs when your tendon already feels irritated from earlier activities. These swaps maintain your activity level while respecting your current tissue capacity.
Apply these specific modifications to common daily scenarios:
| Activity | Instead of This | Do This |
|---|---|---|
| Morning routine | Walking barefoot on tile | Wear supportive slippers with cushioning |
| Work commute | Standing on the train | Sit when possible or shift weight frequently |
| Exercise | Running or jumping | Cycling, swimming, or upper body resistance training |
| Evening activities | High heels or flat dress shoes | Shoes with 1-2 cm heel elevation and arch support |
What to eliminate temporarily
Stop all explosive movements like jumping, sprinting, and cutting motions during this initial phase. Your tendon can’t handle rapid force loading when the tissue structure remains disorganized. Activities combining stretch and load (like lunging or hill walking) also need temporary elimination. This doesn’t mean avoiding stairs completely, but you should minimize stair use and take them slowly rather than bounding up two at a time. The achilles tendinopathy physical therapy protocol builds back to these activities systematically once your tissue demonstrates adequate capacity through the progression criteria outlined in later phases.
Phase 2: Start loading with isometric calf work
Isometric exercises apply controlled tension to your tendon without lengthening or shortening movements, making them the safest entry point into direct tendon loading. Your Achilles experiences force in a static position, which stimulates collagen remodeling while minimizing the risk of excessive microtrauma. This phase typically lasts 2-3 weeks before you progress to more challenging movement-based exercises. The key difference from Phase 1 lies in deliberately stressing your tendon rather than avoiding all provocation. You’re teaching your tissue to handle sustained loads again.
When to progress to this phase
You’re ready for isometric loading when your daily pain remains below 3/10 most of the time and you’ve successfully modified activities that previously spiked your symptoms. Your tendon should tolerate 20-30 minutes of continuous walking without significant next-day flare-ups. Morning stiffness might still occur, but it should resolve within 10-15 minutes of movement rather than persisting throughout your day.
The transition into Phase 2 requires stable baseline symptoms, not complete pain elimination. If your pain fluctuates wildly from day to day (ranging from 0/10 to 7/10 with no clear pattern), spend another week in Phase 1 before adding isometric work. You need predictable tissue behavior before introducing structured loading exercises.
Your tendon doesn’t need to feel perfect before you start loading it. Consistent, manageable symptoms signal readiness better than waiting for zero pain.
The basic isometric calf hold protocol
Stand on the affected leg with your heel raised approximately 2-3 inches off the ground, holding this position without moving up or down. You can use a wall or chair for balance support with your fingertips only. Begin with 5 holds of 45 seconds each, resting 2 minutes between holds. Perform this routine once per day, ideally at the same time to track your response consistently. Your calf will fatigue and potentially burn during holds, but your Achilles pain should stay at or below 5/10.
Progress by increasing hold duration before adding sets or weight:
| Week | Hold Duration | Sets | Rest Between |
|---|---|---|---|
| Week 1 | 45 seconds | 5 | 2 minutes |
| Week 2 | 60 seconds | 5 | 2 minutes |
| Week 3 | 45 seconds | 5 | 90 seconds |
How to position yourself correctly
Your ankle angle determines how much load reaches your Achilles tendon during isometric holds. Start with your heel lifted just 2-3 inches (about the height of a standard textbook), which places your ankle in slight plantarflexion and reduces stretch on the tendon. Keep your knee completely straight throughout each hold, as any knee bend shifts work toward your soleus muscle and away from your Achilles. Your weight should center over your big toe and second toe rather than rolling toward your little toe side.
Common positioning errors include rising too high onto your toes (which increases difficulty prematurely) or allowing your heel to drift inward or outward during the hold. Film yourself from behind to check that your heel stays aligned with your second toe throughout the entire 45-60 seconds. This achilles tendinopathy physical therapy protocol phase builds the foundation for everything that follows, so proper execution matters more than rushing through to the next phase.
Phase 3: Build strength with slow heavy heel raises
Eccentric loading forms the cornerstone of tendon rehabilitation once your Achilles tolerates static holds without excessive flare-ups. Unlike isometric exercises that maintain constant muscle length, eccentric work requires your calf to control your body weight as your heel lowers below your toes. This lengthening-under-load creates the mechanical stimulus your tendon needs to reorganize collagen fibers and build true strength. Research consistently shows eccentric protocols produce better outcomes than stretching or concentric exercises alone for midportion Achilles tendinopathy. You’ll spend 6-8 weeks in this phase, gradually increasing resistance as your tendon capacity improves.
The shift from static holds to eccentric movement represents a significant jump in tissue demand, so progression criteria matter more here than in earlier phases. Your tendon must demonstrate readiness before you introduce this new mechanical stress, or you risk regressing back to reactive symptoms that require additional weeks of load management.
Progression criteria from Phase 2
You’re ready for eccentric heel drops when you can perform 5 sets of 60-second isometric holds with pain consistently at or below 3/10 during and after the exercise. Your morning stiffness should last less than 10 minutes, and you should tolerate 30-40 minutes of continuous walking on flat surfaces without next-day symptom increase. These markers indicate your tendon has adapted to sustained loading and can handle the additional challenge of lengthening contractions.
Wait another week if your symptoms remain unpredictable or if you needed to reduce your isometric hold duration or frequency in the past week. Forcing progression too early typically results in a painful setback that costs you more time than staying at your current level for a few extra days.
Your tendon gains strength through consistent, progressive loading, not through pushing past warning signals.
The eccentric heel drop technique
Stand on a step or raised platform with the ball of your affected foot, letting your heel hang off the edge. Use your unaffected leg to push up into a tiptoe position (the concentric phase). Transfer your weight to your affected leg only, then slowly lower your heel below the level of the step over a 3-second count. Your affected leg controls the entire descent while your unaffected leg remains lifted. Use your unaffected leg to push back up to the starting position, then repeat.
Perform 3 sets of 15 repetitions twice daily (morning and evening) for the first week. Your Achilles pain can reach 5/10 during the exercise but must return to baseline within 24 hours. Execute each repetition with these specific parameters:
| Phase Component | Specification |
|---|---|
| Lowering speed | 3-4 seconds per repetition |
| Range of motion | Heel drops below step level |
| Sets x Reps | 3 sets of 15 reps |
| Frequency | Twice daily (12 hours apart) |
| Rest between sets | 2-3 minutes |
Adding external load safely
Week 3 of eccentric work marks the point where you introduce additional resistance through a weighted backpack or vest. Start with 5-10 pounds and maintain your 3 sets of 15 repetitions twice daily. Add 5 pounds every 4-5 days as long as your 24-hour pain rule stays satisfied. Some patients eventually work up to 40-50 pounds of external load, though individual progression varies based on body weight, activity goals, and tissue response. This achilles tendinopathy physical therapy protocol phase builds the strength foundation needed for energy storage exercises and eventual return to running.
Phase 4: Add energy storage work and plyometrics
Your tendon now needs to handle rapid force application and release, the type of loading you experience during running, jumping, and athletic movements. Phase 4 introduces exercises where your Achilles stretches quickly then contracts explosively, storing and releasing energy like a spring. This phase typically spans 4-6 weeks and bridges the gap between controlled strength work and full sport participation. You’re teaching your tendon to tolerate the ballistic loads it will face during actual running or jumping activities, not just slow, predictable movements in your living room.
When you’re ready for this phase
You must complete 6-8 weeks of heavy slow resistance work with at least 30 pounds of added load before starting plyometric exercises. Your Achilles should tolerate double-leg calf raises with external weight at pain levels consistently below 3/10, and you should perform single-leg eccentric lowering without flare-ups for at least two weeks. Morning stiffness should last less than 5 minutes, and you should walk 45-60 minutes on varied terrain without next-day symptom increase.
Test your readiness with 20 consecutive double-leg calf raises (no added weight, normal speed). If this produces pain above 4/10 or significant next-day soreness, continue Phase 3 exercises for another week before attempting plyometrics.
Your tendon needs proven capacity for repeated loading before you ask it to handle explosive forces.
Energy storage hopping progression
Start with bilateral (both legs) hopping in place on a forgiving surface like a gym mat or grass. Perform 3 sets of 10 small hops, focusing on landing softly with your heels touching the ground briefly between each hop. Your Achilles loads during the landing phase and pushes off, creating the stretch-shortening cycle that defines energy storage work. Keep ground contact time brief (less than half a second) rather than pausing between hops.
Progress through these movements over 4-6 weeks, advancing only when pain stays at or below 3/10:
| Week | Exercise | Sets x Reps | Frequency |
|---|---|---|---|
| 1-2 | Double-leg hops in place | 3 x 10 | 3x per week |
| 2-3 | Forward double-leg hops | 3 x 10 | 3x per week |
| 3-4 | Single-leg hops in place | 3 x 5 | 3x per week |
| 4-6 | Single-leg forward hops | 3 x 8 | 3x per week |
Building to sport-specific movements
Introduce lateral movements and direction changes once you tolerate single-leg hopping without flare-ups. Side-to-side hops, diagonal bounds, and skipping drills prepare your tendon for the unpredictable forces of actual sport participation. Perform these exercises on rest days from your continued heavy eccentric work, maintaining that base loading throughout Phase 4. This achilles tendinopathy physical therapy protocol phase doesn’t replace your strength work but adds explosive capacity on top of your existing foundation. Schedule plyometric sessions at least 48 hours apart to allow tissue recovery between ballistic loading sessions.
Return to running and sport without flare-ups
The transition back to running requires the same systematic approach you used during rehabilitation, not a sudden return to your pre-injury training volume. Your tendon completed the heavy lifting and plyometric work, but running introduces sustained, repetitive loading that differs from structured exercise sessions. Most runners fail during this phase by restarting at their old pace and distance, assuming six weeks of rehabilitation translates to full capacity. Your tissue needs gradual exposure to running-specific forces through a controlled walk-run progression that builds tolerance over 6-8 additional weeks.
The walk-run progression protocol
Start with intervals that alternate walking and easy jogging on flat, forgiving surfaces like a track or groomed trail. Your first session should feel almost too easy, with more walking than running. Perform these sessions every other day (three times per week) to allow recovery between efforts. Track your pain during and 24 hours after each session, using the same 0-10 scale from earlier protocol phases.
Follow this progression structure, advancing only when pain stays below 3/10:
| Week | Run Interval | Walk Interval | Total Time | Frequency |
|---|---|---|---|---|
| 1 | 1 minute | 2 minutes | 20 minutes | 3x per week |
| 2 | 2 minutes | 2 minutes | 24 minutes | 3x per week |
| 3 | 3 minutes | 2 minutes | 25 minutes | 3x per week |
| 4 | 5 minutes | 2 minutes | 28 minutes | 3x per week |
| 5 | 8 minutes | 2 minutes | 30 minutes | 3x per week |
| 6 | 10 minutes | 1 minute | 33 minutes | 3x per week |
Repeat any week where symptoms exceed 3/10 during the run or increase the next morning. Your pace should allow conversation throughout running intervals. Speed comes later, after your tendon tolerates volume without flare-ups.
Your achilles tendinopathy physical therapy protocol builds capacity through gradual exposure, not aggressive pushing through discomfort.
Sport-specific loading criteria
Return to cutting sports like basketball or soccer requires additional preparation beyond straight-line running tolerance. You need demonstrated capacity for repeated single-leg hops (3 sets of 15 without pain increase), lateral bounds (10 per side), and deceleration drills. Schedule sport-specific movement practice separate from your running sessions during weeks 4-6 of your walk-run progression, allowing 48 hours between demanding sessions.
Tennis players should master split-step landings and lateral shuffles before returning to full court play. Start with groundstroke practice only (no serving) for 2-3 sessions, then add gentle serves before attempting competitive matches. Soccer players need ball control drills with direction changes before small-sided games or full matches.
Monitoring your weekly training load
Calculate your total weekly training time and increase by no more than 10-15% from week to week. This includes your run-walk sessions, continued strength work (maintain heavy eccentric exercises twice weekly), and sport-specific practice. A sudden spike in total volume triggers setbacks even when individual sessions feel manageable.
Keep a simple log tracking three metrics: total training minutes per week, highest single-session duration, and morning Achilles stiffness rated 0-10. If any measure increases by more than 20% week-over-week, scale back your upcoming week by 10-15% to prevent overload accumulation.
Helpful add-ons and common mistakes to avoid
Your core rehabilitation work drives recovery, but specific complementary strategies can enhance tissue healing and reduce overall symptom levels during the protocol. You don’t need expensive equipment or elaborate interventions to support your progress. Most helpful additions involve simple adjustments to your daily routine that address factors beyond the exercises themselves. At the same time, recognizing common mistakes helps you avoid setbacks that send many patients back to square one after weeks of diligent work. These errors typically stem from misunderstanding how tendons respond to load or from impatience with the gradual nature of tissue remodeling.
Additions that support your recovery
Heel lifts placed inside your everyday shoes reduce the stretch demand on your Achilles during walking and standing. A 10-12mm temporary lift in both shoes (not just the affected side) helps during Phase 1 and early Phase 2, though you should remove them by Phase 3 to avoid dependence. Your tendon needs to regain full range capacity eventually. Compression sleeves or socks may reduce morning stiffness in some patients, though evidence remains mixed. Try them for a week to see if you notice consistent benefit.
Foam rolling your calf muscles (not directly on the tendon) improves tissue mobility and reduces muscle tension that can alter loading patterns. Roll for 60-90 seconds on each side daily, focusing on tender spots in your gastrocnemius and soleus. Adequate protein intake (1.6-2.0 grams per kilogram of body weight) supports collagen synthesis during active remodeling phases, though you don’t need special supplements beyond a balanced diet.
Your achilles tendinopathy physical therapy protocol works better when you address the full picture of tissue health, not just exercise execution.
Mistakes that sabotage progress
Skipping rest days between loading sessions represents the most common error we see at Achilles Foot and Ankle Center. Your tendon remodels during recovery periods, not during the exercises themselves. Loading daily prevents adequate adaptation and accumulates microtrauma. Taking anti-inflammatory medications routinely during rehabilitation may actually impair healing by suppressing the inflammatory signals that trigger collagen synthesis. Use them only for short-term symptom control during acute flare-ups, not as daily protocol support.
Stretching your Achilles aggressively creates the exact mechanical stress your damaged tendon can’t handle. Passive stretches pull disorganized collagen fibers apart rather than promoting proper reorganization. The protocol phases provide all the lengthening stimulus your tendon needs through controlled eccentric work. Switching between different shoe types throughout your day creates unpredictable loading patterns that confuse your tissue adaptation. Stick with consistent footwear that provides appropriate support and heel height for your current protocol phase, making changes only when deliberately planned as part of your progression strategy.
Next steps
You now have the complete framework for addressing your Achilles tendon pain through a structured, evidence-based progression. Your success depends on following each phase in sequence, respecting the 24-hour pain rule, and resisting the urge to skip ahead when you feel temporary improvement. This achilles tendinopathy physical therapy protocol works only when you commit to the full timeline, typically 12-16 weeks from initial symptoms through return to sport. Track your progress weekly, adjust loads based on tissue response, and maintain your heavy loading exercises even after you resume running.
Professional guidance accelerates your recovery and prevents common mistakes that lead to chronic issues. If you’ve followed Phase 1 for three weeks without symptom improvement, or if pain increases despite proper load management, you need an evaluation that includes imaging and hands-on assessment. Our specialists at Achilles Foot and Ankle Center treat patients throughout Central Virginia who require individualized protocol adjustments, gait analysis, or advanced treatment options like shockwave therapy. Schedule your consultation today to get expert oversight of your rehabilitation plan.
