Before exercising, minimize the pain! It is ok to exercise with pain, but the pain should not increase to the point where it’s unbearable.
You should be able to walk normally without a limp.
The next morning, the pain should not be worse than the previous morning.
If you cannot walk without a limp, it is advisable to either rest, or use a heel lift, which helps to decrease the tensile load on the tendon.
As the acute inflammation decreases, try to wean off the heel lift.
1. Calf & Soleus Stretch
This is the first and easiest step. Loosen the gastrocnemius and soleus with these stretches. Make sure to drive your heel down as you bring the rest of your leg forward. By bending the knee, you can focus on stretching the ankle and soleus more.
Maintain the alignment of your foot with doming, and potentially orthotics. The doming exercise (also known as short foot) teaches you how to maintain your arch using your foot muscles. If you are unable to do this, then supplement this with arch support. You should be able to maintain this position whenever you stand.
3. 3 Position Single-Leg Balance
Challenge your balance (with proper foot mechanics) to help strengthen your foot muscles. Start with simply standing tall and balancing on one foot. Once you can do 10 seconds consistently, also try these two other positions: single leg squat and single leg hip hinge (pics). And then once you can do 3 of those consistently, grab a weight and perform halos while maintaining your balance.
4. Eccentrics & Time Under Tension
These are the most important exercises for rehabbing Achilles tendinopathy. When there is pain in the Achilles, most people are told to rest. This is good advice at first, however the calf muscles AND the tendon will also begin to atrophy. To avoid this, practice isometric and eccentric exercises.
Introduce isometric exercises first, where you load the tendon without movement. Just stand on one leg, and lean forward so that the weight is on the ball of your foot (heel should still be touching the floor). Hold this for 10 seconds at a time. Repeat for sets of 10. You should feel your calf working as you lean forward. This is a very physiologically safe exercise as there is no movement to the tendon. Ideally, you would perform this throughout the day for multiple sets of 10.
This exercise is generally considered the gold standard for tendon rehab. After you are comfortable with isometrics, transition to eccentrics, which add in motion mostly in only one direction.
Also known as negatives, you will rise onto the ball of your feet using the strength of both legs. Then, put all of your weight on your injured side, and SLOWLY lower yourself. Take at least 4 seconds to get back to the start position. You can even do this on a step and allow your heel to go lower than your forefoot (unless you have insertional pain at the heel bone). Once you hit bottom, use both legs to press back up, and then repeat.
Parameters: As this is your main exercise, perform as many sets as you can.
3 sets of 15 repetitions with a straight leg.
3 sets of 15 repetitions with a bent knee.
Repeat everything again at night for a total of 240 reps/day.
As your strength increases and you can do 3 sets of 15 without too much fatigue, you can wear a backpack with weights (or hold dumbbells). However, if this causes too much soreness the next day, decrease the weight.
5. Foam Roll
Lastly, help the calf muscle relax by spending a few minutes rolling it out with a foam roller. Try to get both the medial and lateral sides of your calf, and be patient – the more weight you apply to the calf, the slower you should roll.