Achilles Loading Programme: Heel Raises Done Right

The Achilles is the strongest tendon in the body and it is remarkably good at telling you it is unhappy while still letting you carry on. That is the trap. It hurts for the first ten minutes of a run, warms up, feels fine, and then stiffens the following morning so badly that the first few steps out of bed are done on tiptoes. People run on that pattern for months.

Autumn is peak season for it around Liverpool — darker evenings, colder starts, and a lot of people either building towards a spring marathon or coming back after a summer of not much. Cold tendons and enthusiastic mileage increases are a reliable combination.

Achilles exercises are the treatment. Not rest, not stretching, not a support. Tendons respond to load — that is the single most robust finding in tendon research over the past two decades — and the programme below is how to deliver that load properly.

First: which Achilles problem do you have?

This changes the programme, so establish it before you start.

Midportion tendinopathy. Pain and often a palpable thickening two to six centimetres above the heel bone. The more common of the two, and the more straightforward to treat.

Insertional tendinopathy. Pain right at the back of the heel where the tendon attaches to the bone. Crucially, this type dislikes compression — which means dropping the heel below a step, and aggressive calf stretching, often make it worse. If your pain is at the very bottom, keep every exercise below on flat ground rather than off a step, at least for the first six weeks.

Press along the tendon with your thumb and forefinger. Wherever it is most tender tells you which you are dealing with.

The rules before the exercises

Pain is allowed. Up to about 5 out of 10 during the exercise is acceptable and does not indicate damage. What matters is the next morning: if your usual first-steps stiffness is clearly worse than baseline twenty-four hours later, the load was too much. Reduce it by around a third.

Slow is the point. Every repetition below is three seconds up and three seconds down. Tendons adapt to time under tension, not to how many reps you can rattle through.

Heavy matters, eventually. By the middle of the programme you should be adding weight — a loaded rucksack is perfect — until the last two or three repetitions are genuinely hard.

Stop on sharp pain. Aching and burning are fine. Sharp, sudden or catching pain is not.

This takes three months. Not three weeks. Tendon remodelling is slow, and the most common reason a programme fails is that somebody stopped at week five because it felt better.

Stage one: settling it down (weeks 1–2)

1. Isometric heel raise hold

Stand on both feet, rise onto your toes, then shift most of your weight onto the painful leg and hold that position.

Dose: 5 holds of 45 seconds, two minutes' rest between. Once daily. Cue: stay tall through the ankle; do not let the heel sink gradually. Fingertips on a wall for balance only. Why: isometric loading gives the tendon meaningful stimulus and often reduces pain for a few hours afterwards, which makes it a useful thing to do before work or before walking.

2. Double-leg heel raise

Both feet flat on the floor, hip-width. Rise up over three seconds, pause at the top, lower over three seconds.

Dose: 3 sets of 15, every other day. Cue: push through the big toe. Watch your heels in a mirror — if they drift outward as you rise, you are avoiding the load rather than taking it.

Stage two: building strength (weeks 3–8)

3. Single-leg heel raise

The core exercise of the whole programme. Midportion tendinopathy: perform off the edge of a step, letting the heel drop below the step at the bottom. Insertional: perform flat on the floor, stopping when the heel touches down. No further.

Dose: 3 sets of 12, three times a week, with a two-minute rest between sets. Add weight in a rucksack once you can complete all three sets comfortably — start with 5kg and build. Cue: three seconds up, three seconds down, and get all the way to the top. Partial range is the most common fault I see, and it trains the tendon through the part of the range that matters least. Progression: when 12 reps with 10kg feels manageable, move to 3 sets of 8 with heavier load rather than adding reps.

4. Seated calf raise

Sit with your knee bent to roughly ninety degrees, a weight resting on your thigh just above the knee. Rise onto the ball of the foot and lower slowly.

Dose: 3 sets of 15, three times a week. Why: bending the knee shifts the work onto the soleus, which contributes a large share of the Achilles' load during running and is routinely under-trained. Skipping this is why some people plateau.

Stage three: return to running and sport (weeks 8–12+)

5. Bilateral hopping

Only once single-leg heel raises are strong and your morning stiffness has largely resolved.

Dose: 3 sets of 20 small, quick hops on both feet, twice a week. Progress to single-leg hopping once bilateral is comfortable for a fortnight. Cue: quiet, springy, minimal ground contact time. This trains the tendon's elastic function, which heavy slow work alone does not.

6. Graded return to running

Continue the strength work while you return to running — do not swap one for the other. Start with a short, flat, easy run, keep it every other day, and increase either duration or intensity, never both in the same week. Save hills and speed work until last; both load the Achilles heavily.

What to do if it is not improving

If you are eight to ten weeks in, doing the work consistently and honestly, and nothing has changed, the issue is usually one of three things: insufficient load, the wrong diagnosis, or a plantaris tendon or bursa contributing alongside the Achilles. That is a good point to have it assessed properly rather than to push harder.

Seek urgent medical attention if you felt a sudden snap or blow to the back of the ankle, cannot push off at all, or have an obvious gap in the tendon — that suggests a rupture and needs same-day assessment. Also see a doctor for calf pain with swelling, redness and warmth, which needs a clot excluded.

I see a lot of runners and racket sport players across Liverpool and Merseyside with exactly this problem, and most of them were doing sensible exercises at insufficient load. There is more on sports injury physiotherapy in Liverpool and on musculoskeletal physiotherapy if you want the wider picture, and structured sports injury rehabilitation if you are aiming at a specific event.

If you would like this tailored to your tendon and your goals, book at /portal/book or call me on +44 7553 370300. Home visits across Merseyside are £90; online consultations at £60 work particularly well for tendon programmes, where the value is in the progression rather than the hands-on work.