Midportion Achilles tendinopathy · Athlete progression

Achilles Tendinopathy Return to Running, Jumping, and Basketball

This continuation builds heavy calf strength, faster loading, plyometrics, running, and basketball court exposure after the midportion Achilles foundation plan. It uses symptoms, calf capacity, and practice tolerance to guide progression without treating one test as clearance.

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Clinically reviewed August 28, 2026

Written and clinically reviewed by Jeremy Swisher, MD

Board-certified primary care sports medicine physician. Reviewed August 28, 2026.

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Jeremy Swisher, MD

Evidence-informed home exercise program

Achilles Tendinopathy Return-to-Sport Program

Name: __________________________________

Affected side: ______________

Start date: __________________

Review date: _________________

Clinician or PT: ______________________________

Before you start

This advanced program is for an athlete with a clinically established midportion Achilles tendinopathy who has completed the starter loading phase. It is not for insertional symptoms without modification, a suspected rupture, or postoperative recovery.

This program may fit

Walking pain is minimal, morning symptoms are stable from week to week, repeated straight-knee and bent-knee single-leg heel raises are controlled, and basic two-leg pogo work is tolerated without a next-morning flare.

Get assessed first

Pain directly at the heel attachment, sudden injury, suspected partial or complete rupture, substantial calf swelling, recent surgery, new weakness or loss of push-off, or systemic inflammatory or metabolic contributors. Stop Achilles-loading exercise and contact the prescribing clinician promptly for new tendon pain, swelling, or weakness during fluoroquinolone treatment or in the months afterward. Follow the medication guide and do not resume high-load work until assessed.

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, a sudden pop, new bruising, a palpable gap, substantial acute swelling, or inability to push off or perform a heel raise.

Check the next morning

A published pain-monitoring model used a ceiling of 5 out of 10 during, after, and the next morning; this was not an ideal pain target or a return-to-sport test. For this self-guided plan, keep symptoms tolerable and movement controlled. Check symptoms and function the next morning and again over 24 to 72 hours after a demanding session. Next-morning worsening means do not increase the next exposure; recovery time is not permission to progress through a flare.

Fit and safety

Confirm this is the right diagnosis.

This advanced program is for an athlete with a clinically established midportion Achilles tendinopathy who has completed the starter loading phase. It is not for insertional symptoms without modification, a suspected rupture, or postoperative recovery.

This program may fit

Walking pain is minimal, morning symptoms are stable from week to week, repeated straight-knee and bent-knee single-leg heel raises are controlled, and basic two-leg pogo work is tolerated without a next-morning flare.

Get assessed first

Pain directly at the heel attachment, sudden injury, suspected partial or complete rupture, substantial calf swelling, recent surgery, new weakness or loss of push-off, or systemic inflammatory or metabolic contributors. Stop Achilles-loading exercise and contact the prescribing clinician promptly for new tendon pain, swelling, or weakness during fluoroquinolone treatment or in the months afterward. Follow the medication guide and do not resume high-load work until assessed.

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, a sudden pop, new bruising, a palpable gap, substantial acute swelling, or inability to push off or perform a heel raise.

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

Separate strength, spring, running, and court load.

Maintain heavy straight-knee and bent-knee loading while faster work is added. Classify sport sessions as light, medium, or high tendon load and allow more recovery after the harder sessions. These are exercise categories, not separate sessions to stack. Combine or substitute fast calf work, plyometrics, running, and court work within a planned week, and count running, court work, and jumping as tendon-loading sessions. Do not increase external load, running, jump contacts, and court minutes in the same step.

Frequency
Heavy loading at least 3 days weekly; plyometrics and high-load sport 1 to 2 days weekly initially
Equipment
External weight, stable step or calf machine, floor markers, and court or running space
First checkpoint
Review weekly morning symptoms, heel-raise quality, and sport exposure
Primary goal
Restore running speed, braking, repeated jumping, and full basketball practice
  1. Exercise 1

    Heavy straight-knee calf raise

    At least 3 days per week

    Dose3 to 4 sets of 6 to 10 repetitions

    Use one leg and external load when controlled. Rise through a consistent height, pause briefly, and lower over two to three seconds while keeping the knee straight. Choose a load that makes the final two repetitions challenging while heel height and control remain consistent, usually with about one to three repetitions still possible.

    Make it easier

    Use both legs, more hand support, or less external load.

    Progress it

    Add load while preserving heel height and control across the final repetitions.

    My starting dose or notes

  2. Exercise 2

    Heavy bent-knee or seated soleus raise

    At least 3 days per week

    Dose3 to 4 sets of 6 to 10 repetitions

    Keep the knee bent and lift the heel through the largest controlled range. Use a seated machine, weighted knee, or supported bent-knee standing variation with secure equipment. Choose a load that makes the final two repetitions challenging while heel height and control remain consistent, usually with about one to three repetitions still possible.

    Make it easier

    Use both legs or reduce the external load.

    Progress it

    Progress load independently from the straight-knee raise while maintaining heel height.

    My starting dose or notes

  3. Exercise 3

    Fast calf raise or rebounding heel raise

    2 days per week

    Dose3 sets of 8 to 15 repetitions

    Rise with a controlled faster upward phase and lower under control. Begin without leaving the floor before progressing toward a small rebound.

    Make it easier

    Use two legs or a quick heel raise without a rebound.

    Progress it

    Progress toward one-leg fast raises, then a low rebound when height and rhythm stay consistent.

    My starting dose or notes

  4. Exercise 4

    Plyometric ladder

    1 to 2 days per week initially

    Dose2 to 3 sets of 10 to 20 contacts

    Begin with bilateral pogos, then unilateral pogos, forward hops, lateral hops, and selected repeated or multidirectional contacts. Keep the rhythm quiet and the rebound height consistent.

    Make it easier

    Use fast calf raises, marching, or lower two-leg contacts.

    Progress it

    Increase one variable: single-leg demand, direction, height, distance, or total contacts.

    My starting dose or notes

  5. Exercise 5

    Return-to-running intervals

    Leave at least 48 hours between running exposures initially; use closer to 72 hours after a high-load session or delayed tendon reaction

    DoseStart near 1 minute of easy running and 1 minute of walking for about 20 minutes

    Use flat ground and a conversational pace. Track running minutes and the response over the next 24 to 72 hours. Build easy duration before speed, hills, sprinting, or consecutive days.

    Make it easier

    Shorten the run interval, lengthen the walk, or use tolerable cycling.

    Progress it

    Lengthen continuous easy running, then add one later variable at a time.

    My starting dose or notes

  6. Exercise 6

    Basketball return-to-court exposure

    1 to 2 court sessions per week initially

    DoseBegin with 15 to 25 minutes of low-intensity skill work and record court minutes and jump contacts

    Start with shooting, easy jogging, and controlled shuffling. Add closeouts, planned deceleration, submaximal layups and jumps, planned cutting, repeated jumping, and sprint efforts before modified and full practice.

    Make it easier

    Use stationary shooting, walking patterns, fewer contacts, or shorter court time.

    Progress it

    Increase intensity, jump contacts, or court minutes one at a time, then move from modified to full practice.

    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)

Third-party educational resource

YouTube content does not load until you choose this button.

A visual overview of Achilles-tendinopathy load monitoring, heavy calf loading, energy-storage work, and return to sport.

Watch on YouTube (opens in a new tab)

Use with this program

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. This page is specifically for midportion Achilles tendinopathy; the video also discusses insertional disease. Do not use step-deficit loading for insertional symptoms or stack the video’s exercises on top of the written program. It is not basketball clearance or a court-exposure plan.

Symptom response

Let the next day guide the dose.

A published pain-monitoring model used a ceiling of 5 out of 10 during, after, and the next morning; this was not an ideal pain target or a return-to-sport test. For this self-guided plan, keep symptoms tolerable and movement controlled. Check symptoms and function the next morning and again over 24 to 72 hours after a demanding session. Next-morning worsening means do not increase the next exposure; recovery time is not permission to progress through a flare.

Continue

Green light

Activity pain remains tolerable, heel height and mechanics stay controlled, and next-morning pain, stiffness, and function remain at the usual baseline. After a demanding session, also check the delayed 24- to 72-hour response. Increase the next exposure only when symptoms and function are at the usual baseline and are not worsening from week to week.

Adjust

Yellow light

Morning pain or stiffness increases, the delayed 24- to 72-hour response worsens, heel-rise height or rebound quality falls, or running plus strength creates a cumulative flare. Do not increase the next exposure. Allow recovery and repeat or reduce the previous dose; reduce total contacts, external load, running, or court exposure rather than changing everything at once. Progress only once symptoms and function have returned to the usual baseline.

Stop

Red light

Stop and seek same-day urgent assessment for a sudden pop, new bruising, a palpable gap, loss of push-off, inability to heel raise, substantial acute swelling, or new one-sided calf warmth or 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.

  1. Stage 1: establish heavy calf capacity

    Progress straight-knee and bent-knee loading while walking and morning symptoms remain stable. External load should rise without loss of heel height.

  2. Stage 2: restore faster force

    Add fast calf raises, then low bilateral and unilateral contacts. Allow 36 to 72 hours after higher tendon-load sessions when needed for recovery.

  3. Stage 3: rebuild running and jumping exposure

    Use flat run-walk intervals and a counted plyometric ladder. Build duration and contacts before speed, direction, or repeated high-intensity efforts.

  4. Stage 4: restore basketball workload

    Progress court skills, braking, cutting, repeated jumping, and sprinting, then modified practice, full practice, limited competition, and unrestricted participation through a shared decision.

Signs you are ready for the next stage

  • Morning pain and stiffness are stable and are not increasing from week to week.
  • Single-leg heel-rise height and endurance are controlled for the athlete's current phase.
  • Fast calf work and hopping maintain consistent height, rhythm, and confidence.
  • Running speed, acceleration, braking, and repeated jumps can be progressed without a next-day flare.
  • Court minutes, jump contacts, and intensity have been tracked rather than increased together.
  • Modified practice and then full practice are tolerated at the required intensity and volume.
  • Questionnaires and objective tests can inform the decision, but imaging, one percentage, or one home test does not independently clear competitive basketball.

When to schedule an evaluation

Schedule a reassessment for insertional pain, worsening morning symptoms, loss of heel-raise height, inability to progress impact, new calf swelling, an uncertain diagnosis, or difficulty returning to high-speed or repeated-jump sport. Competitive return should be a shared decision with a qualified clinician and rehabilitation team.

Call UCLA Orthopedics at 310-319-1234

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.

WeekKey sessionsDaily or most-day workNotes
123
1MTWTFSS
2MTWTFSS
3MTWTFSS
4MTWTFSS
5MTWTFSS
6MTWTFSS

Questions? Call UCLA Orthopedics at 310-319-1234.

Full guide and references: https://jeremyswishermd.com/achilles-tendinopathy-return-to-sport-exercises/

Clinical review: August 28, 2026. Independent professional site; not an official UCLA Health website. UCLA Health manages appointments and clinical communication.

Optional video: An E3 Rehab technique companion is available in the full online guide listed above.

General education only, not individualized medical advice. For a medical emergency, call 911.

Common questions

Questions about this program

How is this different from the starter Achilles program?

The starter establishes slow straight-knee and bent-knee loading and initial impact readiness. This page adds heavy loading, faster force, structured running, repeated jumping, cutting, court minutes, and full-practice exposure.

Can I keep running during rehabilitation?

Often yes, when running stays within the pain-monitoring rule and next-morning symptoms and function remain at the usual baseline. After a demanding session, also check the delayed 24- to 72-hour response. If symptoms or function worsen, do not increase the next exposure; allow recovery and repeat or reduce the previous dose.

How should I schedule hard tendon sessions?

Light tendon activity can occur more often, while moderate or high-load running, jumping, or court sessions commonly need 36 to 72 hours of recovery. This recovery interval does not override next-morning worsening: do not increase the next exposure until symptoms and function have returned to the usual baseline. The exact schedule should reflect the athlete's response rather than a rigid calendar.

Does a normal scan mean I am ready?

No. Imaging appearance does not determine sport readiness. Symptoms, calf capacity, fast loading, confidence, sport exposure, and full-practice tolerance matter more for progression.

Does completing the page clear me for basketball?

No. It develops capacity and documents exposure. Unrestricted competitive return remains an individualized, shared medical and sport decision.

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.

Evidence and recommendations can change. Last clinical review: August 28, 2026.

Related care

Build the base firstStarter midportion Achilles program Open guide All athlete pathwaysSports injury return-to-sport hub Open guide Other basketball tendon planPatellar tendinopathy for athletes Open guide

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