Heel Raises for Achilles Tendinopathy: A Complete Guide

If you've been dealing with Achilles tendon pain for any length of time, you've probably heard that you should be doing heel raises. Maybe a physio mentioned it, maybe you found it online. But nobody explained why, or exactly how to do them, or what happens if they hurt, or when you should progress.

That's what this guide is for. I want to give you a complete, practical understanding of heel raises for Achilles tendinopathy — from the first cautious bilateral raise to full single-leg loading under heavy resistance.

Why heel raises work

The Achilles tendon connects your calf muscles — primarily the gastrocnemius and soleus — to your heel bone. Its job is to store and release energy with every step, run, and jump you take. It's remarkably strong, but like any biological tissue, it needs to be progressively loaded to maintain and build that strength.

When an Achilles tendon becomes painful, it's almost always because the load placed on it has exceeded what it can currently tolerate. The tissue becomes sensitised, and the nervous system starts producing pain as a signal that something needs to change.

Here's the key insight: rest doesn't fix this. Rest reduces the load below the tendon's tolerance threshold, which reduces pain — but it also reduces the tendon's capacity. So when you return to activity, the threshold hasn't changed. The pain comes back, often quickly.

Progressive loading — which is exactly what heel raises do — works differently. By gradually and systematically exposing the tendon to increasing levels of controlled stress, we stimulate the tendon to adapt, rebuild, and increase its load tolerance. The threshold goes up. Activity that used to hurt becomes manageable, then comfortable, then easy.

"The goal isn't to avoid load. The goal is to find the load the tendon can handle right now, and systematically build from there."

The four stages of heel raise progression

I think about Achilles rehab in four stages. Most protocols rush through the early stages or skip them entirely — which is usually why people stall. Each stage has a specific purpose.

Stage 1 — Isometric holds (Days 1–2 weeks)

Isometric exercises involve generating tension without changing the length of the muscle. For the Achilles, this means holding the calf in a raised position without moving up or down.

Why start here? Isometrics have good evidence for reducing tendon pain quickly — sometimes within minutes. They also allow you to load the tendon without the repetitive mechanical stress of full movement, which is useful when the tendon is very irritable.

How to do it:

• Stand on both feet at the edge of a step, or flat on the floor
• Rise up onto your toes and hold for 30–45 seconds
• Use a level of effort that you'd rate about 6–7 out of 10 — it should be effortful but not a strain
• Do 4–5 holds, twice per day
• Some mild discomfort during the hold is acceptable — aim for no more than 3–4/10 on a pain scale

Stage 2 — Bilateral heel raises (Weeks 2–4)

Once isometrics are comfortable and morning stiffness is settling, you can progress to full movement through both feet. The bilateral (two-legged) version significantly reduces the load compared to single-leg, which makes it a safe bridge between isometrics and the more demanding work ahead.

How to do it:

• Stand with both feet flat on the floor or at the edge of a step
• Rise slowly onto your toes over 3 seconds, hold briefly at the top, then lower over 3 seconds
• The slow tempo is important — it maintains tendon load through the full range of movement
• 3 sets of 15 repetitions, once daily
• If using a step, allow the heel to drop below step level on the way down — this loads the tendon through a greater range and is more effective, but only add this when pain allows

Stage 3 — Single-leg heel raises (Weeks 4–8)

This is where the real adaptation happens. Single-leg heel raises place roughly 2.5–3 times the load on the Achilles compared to bilateral, and the evidence for this stage in producing lasting tendon adaptation is excellent.

Don't rush to this stage. I see a lot of people jump to single-leg work before the tendon is ready, flare up, and then feel like rehab has failed. It hasn't — they just skipped the progressive part of progressive loading.

How to do it:

• Start with single-leg raises on the floor (no step) to control the load
• Same 3-second up, hold, 3-second down tempo
• Use a wall or chair for balance — this doesn't reduce the tendon load, it just keeps you safe
• 3 sets of 12–15 repetitions, once daily
• Progress to a step with heel drop once floor raises are comfortable and pain-free

Stage 4 — Heavy slow resistance (Weeks 6–12+)

The final stage involves adding external load to the single-leg heel raise — a weighted backpack, a barbell if you're in a gym, or resistance bands. This phase is about building genuine tendon strength and load capacity that will hold up in sport and high-demand activity.

How to do it:

• Add weight progressively — start light (5–10kg) and build over weeks
• Keep the slow tempo — 3 seconds up, 2-second hold, 3 seconds down
• 3 sets of 8–12 repetitions
• Aim to be working at 7–8/10 perceived effort by the end of each set
• Rest 2–3 minutes between sets

What about pain during the exercises?

This is the question I get most often, and it deserves a direct answer.

Some discomfort during loading is normal and acceptable. The tendon is being asked to do something it hasn't done comfortably in a while. Aim to keep pain below 4/10 during the exercise. If it's above that, reduce the load — use both legs, remove the step, or reduce the range of movement.

Monitor how you feel the following morning. This is the most reliable indicator of whether you did too much. If morning stiffness is the same or less than before, you're loading appropriately. If it's significantly worse, scale back.

Stiffness that warms up after a few minutes of walking is normal throughout this process. That's the tendon responding to the previous day's work — not a sign that you've caused damage.

How long does this take?

I want to give you an honest answer here, because I think unrealistic expectations cause more setbacks than the exercises themselves.

Most people start noticing meaningful improvement in pain and function within 6–8 weeks of consistent loading. Full tendon adaptation — the kind that lets you return to running, sport, or high-demand activity without symptoms — typically takes 3–6 months.

The Achilles tendon has a relatively poor blood supply compared to muscle, which means its metabolism and adaptation are slower. This is normal. It doesn't mean something is wrong. It means you need to trust the process and stay consistent.

Common mistakes I see

In clinical practice I see the same patterns come up repeatedly. Knowing about them in advance saves you weeks of frustration:

• Skipping stages: Jumping straight to single-leg work before the tendon has adapted to bilateral loading almost always causes a flare-up.
• Doing too much too fast: More is not better with tendon rehab. One well-executed session per day is enough — sometimes every other day is better.
• Stopping when it stops hurting: The tendon stops hurting before it's fully adapted. Stopping at the point of pain relief means the tendon still lacks the capacity to handle return to activity.
• Ignoring load outside of exercises: How much you walk, stand, and move throughout the day also counts as load. On high-volume exercise days, be mindful of total daily load.

When to seek professional guidance

This guide covers the standard progression for midportion Achilles tendinopathy — pain in the middle of the tendon, typically 2–7cm above the heel. If your pain is right at the heel bone (insertional tendinopathy), the loading protocol is somewhat different and the heel drop component of the exercises is not appropriate early on.

If you've been loading consistently for 8–10 weeks without meaningful improvement, it's worth getting a proper assessment. There are other structures around the Achilles — the paratenon, the retrocalcaneal bursa, the heel bone itself — that can mimic tendinopathy and need to be ruled out.

The research on progressive heel raises for Achilles tendinopathy is about as solid as it gets in musculoskeletal rehab. The Alfredson protocol, Silbernagel's approach, and more recent heavy slow resistance programs all point in the same direction: load the tendon, load it progressively, and give it time to adapt.

It's not complicated. But it requires consistency and patience — two things that are genuinely hard when you're in pain and just want to get back to doing what you love.

If you want a structured program that walks you through this progression week by week, with clear checkpoints and progression criteria, that's exactly what the Achilles program on this site is designed to do.