Jeremy Swisher, MD
Evidence-informed home exercise program
Midportion Achilles Tendinopathy Home Exercise Program
Name: __________________________________
Affected side: ______________
Start date: __________________
Review date: _________________
Clinician or PT: ______________________________
Before you start
This starter program is intended for adults who have already been evaluated and told midportion Achilles tendinopathy is the likely diagnosis. It is not for postoperative recovery, a suspected rupture, or insertional pain without modification.
This program may fit
Gradual-onset, load-related pain about 2 to 6 centimeters above the heel attachment, often with morning stiffness and sometimes with localized thickening.
Get assessed first
Pain directly at the heel attachment, a sudden injury, substantial swelling, inability to perform a heel raise, recent surgery, uncertainty about rupture, or a known inflammatory, endocrine, or metabolic disorder. Stop tendon-loading exercise and contact the prescribing clinician immediately for new Achilles pain, swelling, or weakness during fluoroquinolone treatment. FDA-approved fluoroquinolone medication guides direct patients to stop the medicine at the first tendon symptoms and obtain prompt medical guidance. If symptoms begin after the course has ended, seek prompt assessment. Age over 60, systemic corticosteroid treatment, or a kidney, heart, or lung transplant increases concern.
Stop signs
Call 911 for chest pain, trouble breathing, fainting, or another medical emergency. Seek same-day urgent assessment for new one-sided calf warmth or swelling, or for a sudden pop, bruising, a palpable gap, inability to push off or perform a heel raise, acute major swelling, or other signs of tendon rupture.
Check the next morning
Some tendon discomfort during loading can be acceptable when mechanics remain controlled and next-morning pain or stiffness does not increase. Complete rest is usually unnecessary.
Fit and safety
Confirm this is the right diagnosis.
This starter program is intended for adults who have already been evaluated and told midportion Achilles tendinopathy is the likely diagnosis. It is not for postoperative recovery, a suspected rupture, or insertional pain without modification.
This program may fit
Gradual-onset, load-related pain about 2 to 6 centimeters above the heel attachment, often with morning stiffness and sometimes with localized thickening.
Get assessed first
Pain directly at the heel attachment, a sudden injury, substantial swelling, inability to perform a heel raise, recent surgery, uncertainty about rupture, or a known inflammatory, endocrine, or metabolic disorder. Stop tendon-loading exercise and contact the prescribing clinician immediately for new Achilles pain, swelling, or weakness during fluoroquinolone treatment. FDA-approved fluoroquinolone medication guides direct patients to stop the medicine at the first tendon symptoms and obtain prompt medical guidance. If symptoms begin after the course has ended, seek prompt assessment. Age over 60, systemic corticosteroid treatment, or a kidney, heart, or lung transplant increases concern.
Do not self-start with these warning signs
Call 911 for chest pain, trouble breathing, fainting, or another medical emergency. Seek same-day urgent assessment for new one-sided calf warmth or swelling, or for a sudden pop, bruising, a palpable gap, inability to push off or perform a heel raise, acute major swelling, or other signs of tendon rupture.
This is a diagnosis-specific home program, not a substitute for an examination. A clinician may change the exercise, dose, range, or timeline based on your history.
Your home program
Use two calf angles and one clear progression.
Perform the straight-knee and bent-knee loading exercises on the same day. Use the isometric hold as an entry option on more painful days, not as mandatory extra volume. When you reach the single-leg heel-raise progression, use it in place of the slow straight-knee heel raise rather than as extra volume. Keep all work on a flat floor for this midportion starter plan.
- Frequency
- Loading at least 3 days per week
- Equipment
- Wall or counter, chair, optional backpack or dumbbell
- First checkpoint
- Commit to at least 12 weeks
- Primary goal
- Stronger push-off, walking, stairs, running, and jumping
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Exercise 1On more painful days
Optional calf-raise isometric hold
Dose4 holds of 20 to 30 seconds
Stand on a flat floor facing a counter and use it for balance. Rise onto both forefeet to a comfortable height, keep pressure even across the forefoot, and hold without bouncing. Lower gently when the hold ends.
Make it easierHold lower or shift more weight to the less painful side.
Progress itKeep the same comfortable heel height and shift more weight toward the involved side. Use this as an entry option on a more painful day; it does not replace the later slow-strength progression.
My starting dose or notes
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Exercise 2At least 3 days per week
Slow straight-knee heel raise
Dose3 sets of 8 to 15 repetitions
Stand on a flat floor with both feet pointing forward and a counter within reach. Keep the knees straight, rise onto the forefeet for two to three seconds, then lower the heels to the floor for two to three seconds. Keep the ankles centered and use both legs to start.
Make it easierUse more hand support or a smaller range.
Progress itOnce both-leg raises are controlled and morning pain and stiffness stay stable, move to the single-leg progression below in place of this exercise. Add a backpack or dumbbell only while heel height and control remain consistent.
My starting dose or notes
-
Exercise 3At least 3 days per week
Slow bent-knee heel raise
Dose3 sets of 8 to 15 repetitions
Stand on a flat floor with a counter for balance. Keep a small, steady bend in both knees as you slowly lift and lower the heels. Keep the knees over the middle toes and hold the knee bend throughout the movement.
Make it easierUse the supported wall-sit position with a smaller heel lift, keeping both feet on the flat floor.
Progress itKeep the knee bend steady and shift more weight toward one leg, or add external load. Choose one change while heel height, control, and next-morning symptoms remain stable.
My starting dose or notes
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Exercise 43 days per week when ready
Single-leg heel raise progression
Dose3 sets of 6 to 12 repetitions
Use this in place of the slow straight-knee heel raise when ready. Stand on the involved leg on a flat floor with a counter for balance. Rise and lower slowly with the knee straight, ankle stable, and similar heel height across repetitions.
Make it easierUse the other foot lightly for assistance.
Progress itAdd a backpack or dumbbell while preserving heel height and control. Hold the current level if next-morning pain or stiffness increases.
My starting dose or notes
-
Exercise 52 to 3 days per week when ready
Initial two-leg pogo readiness
Dose2 sets of 10 to 15 contacts
Add this only after walking, stairs, and repeated single-leg heel raises are tolerated. On a flat, clear surface, make small springing contacts with both feet and land quietly in the same spot. Keep the rhythm and jump height controlled; this is an entry check for the athlete progression.
Make it easierUse brisk marching or quick heel raises without leaving the floor.
Progress itFor single-leg plyometrics, running, repeated jumping, and court exposure, use the athlete return-to-sport program and its entry criteria. Keep this starter drill small while slow strength, daily activity, and morning symptoms remain stable.
My starting dose or notes
Optional video companion
See the movement principles in context.
The written program above remains the prescription. This independent third-party video adds a visual explanation of the condition and common exercise options.
E3 Rehab video
Achilles Tendinopathy / Tendinitis / Tendinosis | Heel Pain Rehab (Education, Myths, Exercises)
YouTube content does not load until you choose this button.
A visual overview of Achilles tendinopathy, load monitoring, calf strengthening, and staged return to faster activity.
Watch on YouTube (opens in a new tab)Use this video for education and technique, not as a second exercise program. Follow the exercises, dose, progression, and symptom rules on this page. Video examples are options, not additions. Links or promotions inside the video are provided by E3 Rehab and are not part of this program. The video discusses both midportion and insertional Achilles tendinopathy. This page is specifically for midportion pain. Keep early loading on a flat floor, and do not add step-deficit raises or hopping before slow strength and daily activity are stable.
Symptom response
Let the next day guide the dose.
Some tendon discomfort during loading can be acceptable when mechanics remain controlled and next-morning pain or stiffness does not increase. Complete rest is usually unnecessary.
Green light
Tolerable discomfort, good heel-raise control, and morning pain or stiffness that is unchanged or improving.
Yellow light
Next-morning pain or stiffness increases, the heel-raise height falls, or running and strengthening together create a cumulative flare. Reduce load or total contacts.
Red light
Stop. Call 911 for chest pain, trouble breathing, fainting, or another medical emergency. Seek same-day urgent assessment for new one-sided calf warmth or swelling, a sudden pop, new bruising, a palpable gap, or inability to push off or perform a heel raise, or acute major swelling.
Change one variable at a time
When symptoms are too reactive, first reduce range, resistance, repetitions, or frequency. When the current dose feels controlled for several sessions, progress only one of those variables.
Progression
Build capacity in stages.
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Stage 1: establish a tolerable load
Use two-leg slow raises and optional isometric holds. Continue general activity within pain tolerance rather than resting completely.
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Stage 2: increase tendon strength
Progress from two legs to one leg, then add external load. Choose a resistance that makes the final repetitions challenging while controlled.
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Stage 3: establish initial impact readiness
Add fast calf work and a small dose of two-leg pogo contacts after slow strength and daily activities are stable. Use the separate athlete progression for running volume, single-leg plyometrics, repeated jumping, speed, and court exposure.
Signs you are ready for the next stage
- You have completed the progressive loading stage needed for the activity you plan to resume.
- Keep symptoms tolerable, movement controlled, and morning function at the usual baseline. A published pain-monitoring model used 5 out of 10 as a ceiling, not a pain target or a stand-alone readiness test. Do not increase the next exposure if symptoms or function worsen the next morning or trend worse from week to week.
- Pain and stiffness are not increasing from week to week.
- Walking, stairs, and repeated heel raises are controlled without a sustained flare.
- These markers guide progression but do not independently clear high-demand or competitive sport.
When to schedule an evaluation
Schedule a visit if the pain is at the heel attachment, the diagnosis is uncertain, symptoms are worsening, a rupture is possible, or a consistent twelve-week loading trial does not improve function.
Call UCLA Orthopedics at 310-319-1234Progress tracker
Use this tracker through the first checkpoint above. Mark up to three key sessions each week, check weekdays for frequent work, and note symptoms, resistance, duration, or activity gains. Continue through a longer condition-specific trial when useful.
| Week | Key sessions | Daily or most-day work | Notes | ||
|---|---|---|---|---|---|
| 1 | 2 | 3 | |||
| 1 | MTWTFSS | ||||
| 2 | MTWTFSS | ||||
| 3 | MTWTFSS | ||||
| 4 | MTWTFSS | ||||
| 5 | MTWTFSS | ||||
| 6 | MTWTFSS | ||||
Common questions
Questions about this program
Should I stretch the tendon over the edge of a step?
Not automatically. This midportion starter plan uses a flat floor. Heel drops below a step can aggravate insertional Achilles pain and should be matched to the diagnosis.
Do I need eccentric heel drops specifically?
No. Eccentric, concentric, heavy slow resistance, and combined loading can all work. The important principle is progressive tendon loading at a challenging, tolerated intensity.
Must I stop running completely?
Usually not. Continue activity within pain tolerance when the next-morning response is stable. Reduce running volume or intensity if it repeatedly drives a flare.
How long does recovery take?
Commit to at least a twelve-week loading trial. Recovery commonly takes three to six months, and return to higher-demand sport may take longer.
Evidence
Guidelines, reviews, and clinical studies
This plan translates current clinical guidance into a practical home program. The cited sources support the treatment principles, but they do not establish one universal exercise recipe for every patient.
- Swisher, Waldrop, and Sitton: Achilles Tendinopathy in Basketball, 2026 (opens in a new tab)
- JOSPT Clinical Practice Guideline: Midportion Achilles Tendinopathy, 2024 (opens in a new tab)
- Beyer et al.: Heavy Slow Resistance Versus Eccentric Training, 2015 (opens in a new tab)
- Silbernagel et al.: Pain-Monitoring Model and Continued Activity, 2007 (opens in a new tab)
- Bern Consensus Statement on Return to Sport, 2016 (opens in a new tab)
- Achilles Tendinopathy Diagnostic and Medical-Attention Delphi Consensus, 2025 (opens in a new tab)
- FDA-Approved Ciprofloxacin Label and Medication Guide, Current DailyMed Label (opens in a new tab)
Evidence and recommendations can change. Last clinical review: August 28, 2026.