Rehabilitation Exercises to Prevent Achilles Tendinitis Re-Injury
5 crucial steps to properly rehabilitate Achilles tendinitis and make your Achilles stronger than it’s ever been.
by Brad Walker | First Published July 14, 2004 | Updated September 28, 2018
In this issue we’re going to cover 5 crucial steps for completely rehabilitating the Achilles tendon and entire lower leg complex. We’ll look at the rehabilitation and conditioning exercises needed to get your Achilles back to 100% and better.
If you’ve followed the advice from the previous two issues, you’ve come over 80% of the way. You may even feel that your Achilles is fully recovered. Your treatment so far may have stopped the swelling and bleeding, and it may have reduced the amount of scar tissue in the Achilles and calf muscles.
However, fixing your Achilles tendinitis is as much about treating the condition as it is about preventing it from re-occurring. If you’ve ever suffered from any sporting injury in the past, you’ll know how annoying it is to think you’re recovered, and then out-of-the-blue, you’re injured again and back to where you started. It can be one of the most frustrating and heart-breaking cycles an athlete, or anyone else for that matter, can go through.
Most people will refer to this phase of your recovery as the active rehabilitation phase, because during this phase you will be responsible for the rehabilitation process. You will be doing the exercises and activities required to speed up your full recovery.
The aim of this phase of your rehabilitation is to regain all the fitness components that were lost because of the injury. Regaining your flexibility, strength, power, muscular endurance, balance, and co-ordination will be the primary focus. Without this phase of your rehabilitation there is no hope of completely and permanently making a full recovery.
The first point to make clear is how important it is to keep active. Often, the advice from doctors and similar medical personnel will simply be; rest. This can be one of the worst things you can do. Without some form of activity the injured area will not receive the blood flow it requires for recovery. An active circulation will provide both the oxygen and nutrients needed for the injury to heal.
Never, never, never do any activity that hurts your Achilles. Of course you may feel some discomfort, but never push yourself to the point where you’re feeling pain. Be very careful with any activity you do. Pain is the warning sign; don’t ignore it. One of the worst things you can do is start this phase of your rehabilitation too early. If you have any doubts about performing the exercises in this article, please refer to part 1 or part 2 of this article below.
In part 1, we looked at what Achilles Tendinitis is. We had a look at the muscles and tendons that make up the Achilles; what happens when Achilles Tendinitis occurs; and the major causes and risk factors that contribute to Achilles Tendinitis.
In part 2, we outlined a detailed strategy for the initial treatment of Achilles tendinitis. Firstly, we reviewed the importance of the immediate treatment (the first 48 to 72 hours), and then we outline the ongoing treatment necessary for a full recovery.
Please note: The order of the exercises listed below is very important. The exercises start with gentle easy movements and progress to intense dynamic exercises. Please start with the range of motion exercises listed below and only move onto the next set of exercises when these can be performed pain free.
1. Range of Motion Exercises
Regaining a full range of motion of your Achilles, ankle joint and lower leg is the first priority. A full range of motion is extremely important, as it lays the foundation for more intense and challenging exercises later in the active rehabilitation process.
As you work through the initial stages of recovery and your Achilles begins to heal, start to introduce some very gentle movements. First bending and straightening your ankle, then as you get more comfortable with this simple movement, start to incorporate some rotation exercises. Turn your ankle from side to side, and rotate clockwise and anti-clockwise.
When you feel comfortable with these range of motion exercises and can perform them relatively pain free, it’s time to move onto the next phase of the active rehabilitation process.
2. Strength Exercises
Now it’s time to add some intensity to the range of motion exercises. The aim here is to gradually re-introduce some strength back into the injured muscles, ligaments and tendons.
When attempting to increase the strength of your Achilles, be sure to approach this in a gradual, systematic way of lightly over-loading the muscles and tendons. Be careful not to over-do this type of training. Patience is required.
An effective and relatively safe way to start is to begin with isometric exercises. These are exercise where the ankle joint itself does not move, yet force is applied and the calf muscles and Achilles are contracted.
For example: imagine sitting in a chair while facing a wall and then placing the ball of your foot against the wall. In this position you can push against the wall with your foot and at the same time keep your ankle joint from moving. The muscles contract but the ankle joint does not move. This is an isometric exercise.
The above example can be used to strengthen the Achilles and ankle joint in all directions. Pushing your foot to the left or right against something immovable, and pushing down (as above) and pulling up.
3. Stretching Exercises
It’s also important at this stage to introduce some gentle Achilles and calf stretching exercises. These will help to further increase your range of motion and prepare your Achilles for more strenuous activity to come. While working on increasing the flexibility of your Achilles, it’s also important to increase the flexibility of the muscle groups around the injured area. These include the calf muscles, and the anterior muscles of your shin (anatomical names listed below).
- Tibialis Posterior
- Flexor Hallucis Longus
- Flexor Digitorum Longus
- Peroneus Longus and Brevis
Standing Heel-Back Achilles Stretch (1:19) Stand upright and take one big step backwards. Bend your back leg and push your heel towards the ground. Make sure the toes of your back leg are facing forward. Letting your toes point to one side will cause this stretch to put uneven tension on the calf muscles. Over an extended period of time, this could lead to a muscle imbalance. Regulate the intensity of this stretch by lowering your body. Hold the stretch position for a minimum of 20 seconds and then repeat with the opposite leg.
Leaning Heel-Back Achilles Stretch (1:17) Stand upright while leaning against a wall and place one foot behind the other. Make sure that both toes are facing forward and your heel is on the ground. Bend your back leg and lean towards the wall. Make sure the toes of your back leg are facing forward. Letting your toes point to one side will cause this stretch to put uneven tension on the calf muscles. Over an extended period of time, this could lead to a muscle imbalance. Regulate the intensity of this stretch by lowering your body. Hold the stretch position for a minimum of 20 seconds and then repeat with the opposite leg.
Kneeling Achilles Stretch (1:27) Kneel on one foot and place your body weight over your knee. Keep your heel on the ground and lean forward. This stretch can put a lot of pressure on the Achilles. Ease into this stretch by slowly leaning forward. Hold the stretch position for a minimum of 20 seconds and then repeat with the opposite leg.
Standing Calf Stretch (1:20) Stand with one knee bent and the other leg straight out in front. Point your toes towards your body and lean forward. Keep your back straight and rest your hands on your bent knee. Make sure your toes are pointing upward. Letting your toes point to one side will cause this stretch to put uneven tension on the calf muscles. Over an extended period of time, this could lead to a muscle imbalance. Hold the stretch position for a minimum of 20 seconds and then repeat with the opposite leg.
Leaning Heel-Back Calf Stretch (1:19) Stand upright and lean against a wall. Place one foot as far from the wall as is comfortable and make sure that both toes are facing forward and your heel is on the ground. Keep your back leg straight and lean towards the wall. Make sure the toes of your back leg are facing forward. Letting your toes point to one side will cause this stretch to put uneven tension on the calf muscles. Over an extended period of time, this could lead to a muscle imbalance. Hold the stretch position for a minimum of 20 seconds and then repeat with the opposite leg.
Standing Heel-Back Calf Stretch (1:18) Stand upright and then take one big step backwards. Keep your back leg straight and push your heel to the ground. Make sure the toes of your back leg are facing forward. Letting your toes point to one side will cause this stretch to put uneven tension on the calf muscles. Over an extended period of time, this could lead to a muscle imbalance. Hold the stretch position for a minimum of 20 seconds and then repeat with the opposite leg.
4. Balance and Proprioception Exercises
This phase of the rehabilitation process is often overlooked and is one of the main reasons why old injuries keep re-occurring. Once you feel some strength returning to your Achilles it’s time to incorporate some balancing drills and exercises.
When muscles and tendons are torn, nerves are also damaged. These nerves send vital information to the brain about the specific position and location of the Achilles tendon and ankle joint in relation to the rest of your body.
Without this information the muscles, tendons and ligaments are constantly second-guessing the position of the Achilles and ankle joint. This lack of awareness about the position of the lower leg can lead to a re-occurrence of the same injury long after you thought it had completely healed.
Balancing exercises are important to help re-train the damaged nerves around your lower leg and ankle joint. Start with simple balancing exercises like walking along a straight line, or balancing on a beam. Progress to one-leg exercises like balancing on one foot, and then try the same exercises with your eyes closed.
When you’re comfortable with the above activities, try some of the more advanced exercises like wobble or rocker boards, Swiss balls, stability cushions and foam rollers.
5. Plyometrics and Sports Specific Exercises
This last part of the rehabilitation process will aim to return your Achilles to a pre-injury state. By the end of this process your Achilles should be as strong, if not stronger, than it was before you injured it.
This is the time to incorporate some dynamic or explosive exercises to really strengthen up your Achilles tendon and improve your proprioception. Start by working through all the exercises you did above, but with more intensity.
For example, if you were using light isometric exercises to help strengthen your Achilles and calf muscles, start to apply more force, or start to use some weighted exercises.
From here, gradually incorporate some more intense exercises. Exercises that relate specifically to your chosen sport are a good place to start. Things like skill drills and training exercises are a great way to gauge your fitness level and the strength of your Achilles and lower leg.
To put the finishing touches on your Achilles recovery, I always like to do a few plyometric drills. Plyometric exercises are explosive exercises that both lengthen and contract a muscle at the same time. These are called eccentric muscle contractions and involve activities like jumping, hoping, skipping and bounding.
These activities are quite intense, so remember to always start off easy and gradually apply more and more force. Don’t get too excited and over-do-it, you’ve come too far to do something silly and re-injure your Achilles.
About the Author: Brad is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 100's of testimonials. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.