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Stretches for Achilles tendonitis / tendinopathy
Stretches for achilles tendinopathy/tendonitis
Maryke Louw
Maryke Louw
Jul 21, 2021
In this article I’ll explain why stretches can often make Achilles tendonitis feel worse and what exercises you should do instead.

Examples of calf and Achilles stretches

Any movement that takes the ankle into dorsiflexion (bending the toes up towards your shin) will stretch the calf and Achilles tendon. Common examples include the typical runner’s calf stretch, pulling your foot back with a band, dropping your heels over the side of a step, and the downward dog in yoga.

Examples of stretches people do for Achilles tendonitis

Passive stretches, where you take it into that position and maintain it for a period of time, are usually more problematic than active stretches, where you just gently move in and out of the position.

Variation of stretches for achilles tendinopathy: Downward facing dog

Tight calves do not cause Achilles tendinopathy

The research is very clear that Achilles tendinopathy/tendonitis is caused by an overload of the tendon. 

Everytime we exercise, our tendons sustain micro-damage. This is normal and part of the process of how we grow stronger. Our bodies then have to repair that micro-damage before your next training session. But if you don’t allow for enough recovery time after a training sessions or you do too many hard sessions in a row, the body isn’t able to repair it fully. The micro-damage then accumulates and eventually causes an overuse injury like an Achilles tendinopathy.

Your calves and Achilles tendons may feel very tight and stiff when you have Achilles tendonitis/tendinopathy. But this stiffness/tightness isn’t the same as the tight muscles that you get when you’ve exercised. You can’t stretch this type of tightness out of it. This tightness is caused by excess fluid in the tendon as a result of the injury and it will only go away once your tendon is healed. The injured tendon also irritates the calf muscles which then makes them feel tight and sore.

Cause or result?

The tightness in your tendon and calf is as a result of the injury, not the cause of the injury.

Excessive stretching can CAUSE Achilles tendonitis/tendinopathy

When you do a calf/Achilles stretch, the lower part of the Achilles tendon gets compressed against the heel bone. This is normal and usually not a problem. However, if this compression becomes excessive (either too forceful or sustained for a long time) then it can injure that part of the tendon. Excessive compression is thought to be one of the main causes for insertional Achilles tendonitis/tendinopathy.

Calf stretches causes compression of the Achilles tendon on the heel bone and can make insertional Achilles tendonitis worse.

This is why it’s better to do your strength training exercises (heel lifts/drops) only to floor level, rather than over the side of a step, when you have insertional Achilles pain. If you do them over the side of a step, it increases the compression between the tendon and the heel bone and usually causes it to flare up. For this reason the Exakt Health app contains two separate rehab plans for insertional and mid-portion Achilles tendinopathy.

Calf / Achilles stretches can cause a delayed pain response

Sometimes doing a calf/Achilles stretch can feel really good, but watch out for the delayed pain response. Sensitive tendons don’t like being stretched and they will often end up hurting more several hours later, despite it feeling good at the time.

What can you do instead of stretches?

Foam rolling or massage

Foam rolling or massage can provide a good alternative to doing stretches. Focus on the calf muscles but avoid deep or very strong pressure on the injured tendon itself.

Movement

Doing gentle repetitive movements (like double leg heel raises) improves the circulation in the tendon and relieves that tight feeling. It’s often especially useful first thing in the morning.

When can I start doing Achilles/calf stretches?

That will depend on how sensitive your tendon is. It’s usually best to avoid them until you’ve built some strength and the acute pain has settled down. The Exakt Health app guides you through this process and uses your feedback to decide when it’s safe for you to include stronger stretches. It’s available to download for free on both Android and Apple.

What exercises should I be doing for Achilles tendonitis?

Exercises that strengthen you tendon are the most important ones to do. There are quite a few different options for these and they have to be progressed in intensity and level of difficulty as your tendon grows stronger. We’ll discuss these in detail in future blog posts, but check out our app and have a look at the free Achilles tendonitis/tendinopathy rehab plans for mid-portion and insertional.

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Maryke Louw
Maryke Louw
Lead Physical Therapist at Exakt Health. Injury treatment doesn't have to be complicated - your body just needs the right combination of rest and exercise to allow it to heal. I love all sports but much prefer to exercise outside and off-road.
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