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Achilles Tendinopathy — Exercises Studied in Research

Research has examined 57 approaches for this condition. This page shows what the studies found and where clinical guidelines landed — with a source behind every claim.

1.See what science says2.Open the exercises3.Get the Literature Review (PDF)

Clinical guidelines support 16 of the 57 approaches studied for this condition.

Compiled and reviewed by: Nikola Orlandić — Specialist in Applied Physiotherapy — Neurorehabilitation · Bachelor — Technology, pharmaceutical module · L0104 · Milena Orlandić — Specialist in Applied Physiotherapy — Neurorehabilitation · L0105

Evidence last updated:

Partner of the Chamber of Physiotherapists of Montenegro

What studies found

Each approach below was tested in clinical research. Sorted by where clinical guidelines stand.

📋

Combined Loading (Silbernagel Protocol)

Evidence supports it

clinicians can confidently use both programs in the rehabilitation of their patients with AT

Studied atonce daily · 3 sets of 15 repetitions for each exercise · home-based, concentric-eccentric loading. Various heel-raising exercises were performed once daily, with 3 sets of 15 repetitions for each exercise. Progression was made from bipedal to uni- pedal exercises, from floor level to the edge of a stair, by increasing weight in 5-kg increments and increasing speed (plyometrics) in the last phase.

Source: PubMed 34722783

📋

Return-to-Sport Progression Criteria

Evidence supports it
Studied at3 high-intensity rehabilitation sessions per week · multifactorial exercise program comprising of bilateral and unilateral kinetic chain strength, calf strength and plyometric training as well as running drills

Source: PubMed 34391384

📋

Eccentric Heel Drop (Alfredson Protocol)

Evidence supports it

clinicians can confidently use both programs in the rehabilitation of their patients with AT

Studied attwice daily · 3 sets of 15 repetitions with a straight knee, and 3 sets of 15 repetitions with a bent knee · home-based, heavy-load, eccentric heel-lowering exercises on the edge of a stair, using the noninjured limb to concentrically return to the starting position. 3 sets of 15 repetitions with a straight knee, and 3 sets of 15 repetitions with a bent knee

Source: PubMed 34722783

🔒Heavy Slow Resistance (Home)Evidence supports it
🔒Patient Education & Load ManagementEvidence supports it
🔒Progressive Calf StrengtheningEvidence supports it
🔒Telehealth Exercise ProgramEvidence supports it
🔒Balance & Proprioception (Home)May help
🔒Isometric Calf Exercise (Home)May help
🔒Cryotherapy (Self-Applied)
🔒Pain-Monitored Loading
🔒Night SplintScience does not support it

How these exercises and approaches were done in the studies — all in one document

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Exercises from the studies — how they were done

Which exercises, how often, for how long and how they were progressed — as published studies describe them, in one PDF document.

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See a sample report — Achilles Tendinopathy (PDF)
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What this document does not do

  • It does not examine anyone or make a diagnosis.
  • It does not make a plan for one person — it describes what published studies found in people with this condition.
  • It does not replace a visit to a physician or a physiotherapist.
  • It is written from published studies, not from your medical records.

Delivery language: the document is written in your selected language. Verbatim quotations from the source studies stay in their original language — translating them is not permitted, and it also lets you check every quote against the source.

See a sample report — Achilles Tendinopathy (PDF) →

What science does not support

These approaches are widely offered, but published research found they do not help for this condition. Listed so you know before spending money — not as advice about any individual case.

  • Night SplintNot supported by research

    Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) · Dutch multidisciplinary guideline on Achilles tendinopathy · Physical therapies for Achilles tendinopathy: systematic review and meta-analysis

  • Night SplintNot supported by research

    Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) · Dutch multidisciplinary guideline on Achilles tendinopathy · Physical therapies for Achilles tendinopathy: systematic review and meta-analysis

  • Therapeutic UltrasoundNot supported by research

    UK Defence Rehabilitation consensus agreement for the conservative management of Achilles and patellar tendinopathy: a modified Delphi approach · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) · Dutch multidisciplinary guideline on Achilles tendinopathy

  • Eccentric Exercise + LLLTNot supported by research

    Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) · Current Clinical Concepts: Conservative Management of Achilles Tendinopathy (Silbernagel 2020)

Whether any of this applies to your situation is something your physiotherapist or doctor can assess after examining you.

Does it work? — what research found

Every approach studied for this condition, sorted by where clinical guidelines stand. Not by popularity or marketing — by published research.

ApproachWhat science says
Combined Loading (Silbernagel Protocol)you can do this at homeStudies: 1 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +3Evidence supports it
Eccentric Exercise (Alfredson Protocol)done with a specialistStudies: 40 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +3Evidence supports it
Eccentric Heel Drop (Alfredson Protocol)you can do this at homeStudies: 40 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +3Evidence supports it
Heavy Slow Resistance (Home)you can do this at homeStudies: 7 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +2Evidence supports it
Heavy Slow Resistance Trainingdone with a specialistStudies: 9 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +2Evidence supports it
Patient Education & Load Managementyou can do this at homeStudies: 4 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +2Evidence supports it
Progressive Calf Strengtheningyou can do this at homeStudies: 11 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +2Evidence supports it
Progressive Loading Programdone with a specialistStudies: 10 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +2Evidence supports it
Combined Loading (Silbernagel Protocol)done with a specialistStudies: 4 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Dutch multidisciplinary guideline on Achilles tendinopathy +1Evidence supports it
Isotonic Calf Exercisedone with a specialistStudies: 1 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final)Evidence supports it
Telehealth / Web-Based Exercisedone with a specialistStudies: 3 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final)Evidence supports it
Telehealth Exercise Programyou can do this at homeStudies: 1 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final)Evidence supports it
Show all 57 approaches ↓
ApproachWhat science says
Criteria-Based Rehabilitationdone with a specialistStudies: 3 · Current Clinical Concepts: Conservative Management of Achilles Tendinopathy (Silbernagel 2020)Evidence supports it
High Tendon Compression Rehabilitationdone with a specialistStudies: 1 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024Evidence supports it
Low Tendon Compression Rehabilitationdone with a specialistStudies: 1 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024Evidence supports it
Return-to-Sport Progression Criteriayou can do this at homeStudies: 1 · Current Clinical Concepts: Conservative Management of Achilles Tendinopathy (Silbernagel 2020)Evidence supports it
Isometric Calf Exercisedone with a specialistStudies: 9 · UK Defence Rehabilitation consensus agreement for the conservative management of Achilles and patellar tendinopathy: a modified Delphi approach, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 +3May help
Isometric Calf Exercise (Home)you can do this at homeStudies: 7 · UK Defence Rehabilitation consensus agreement for the conservative management of Achilles and patellar tendinopathy: a modified Delphi approach, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 +3May help
Deep Friction Massage (Cyriax)done with a specialistStudies: 6 · UK Defence Rehabilitation consensus agreement for the conservative management of Achilles and patellar tendinopathy: a modified Delphi approach, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 +2May help
Dry Needlingdone with a specialistStudies: 4 · UK Defence Rehabilitation consensus agreement for the conservative management of Achilles and patellar tendinopathy: a modified Delphi approach, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 +2May help
Extracorporeal Shockwave Therapy (ESWT)done with a specialistStudies: 19 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +2May help
Foot Orthosesdone with a specialistStudies: 2 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +2May help
Heel Liftsdone with a specialistStudies: 3 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +2May help
Acupuncturedone with a specialistStudies: 2 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +1May help
Balance & Proprioception (Home)you can do this at homeStudies: 2 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +1May help
Eccentric Exercise + ESWTdone with a specialistStudies: 3 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +1May help
Prolotherapydone with a specialistStudies: 1 RCT; 1 prospective case series · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +1May help
Sensorimotor / Balance Trainingdone with a specialistStudies: 1 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +1May help
Eccentric Exercise + Soft Tissue Treatment (Astym)done with a specialistStudies: 1 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final)May help
Eccentric Plus Modalitiesdone with a specialistStudies: 1 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final)May help
Eccentric Plus Vibrationdone with a specialistStudies: 1 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final)May help
Eccentric Exercise + PRP Injectiondone with a specialistStudies: 1 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final)May help
Hyaluronic Acid Injectiondone with a specialistStudies: 1 · Dutch multidisciplinary guideline on Achilles tendinopathyMay help
Eccentric Exercise + High-Volume Injectiondone with a specialistStudies: 1 · not yet reviewedMay help
Eccentric Plus Myofascialdone with a specialistStudies: 1 · not yet reviewedMay help
Corticosteroid Injectiondone with a specialistStudies: 6 · UK Defence Rehabilitation consensus agreement for the conservative management of Achilles and patellar tendinopathy: a modified Delphi approach, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 +2Not enough research yet
Fluoroquinolone-Associated Tendinopathydone with a specialistStudies: eight studies · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +2Not enough research yet
High-Volume Injection (HVI)done with a specialistStudies: 6 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +2Not enough research yet
Platelet-Rich Plasma (PRP)done with a specialistStudies: 4 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +2Not enough research yet
Eccentric Exercise + Cryotherapydone with a specialistStudies: 1 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final)Not enough research yet
Glyceryl Trinitrate (GTN) Patchdone with a specialistStudies: 3 · Dutch multidisciplinary guideline on Achilles tendinopathyNot enough research yet
Blood Flow Restriction Trainingdone with a specialistStudies: Thirteen studies were included, three on tendinopathy, two on tendon ruptures, and eight on healthy Achilles, patellar, and supraspinatus tendons · not yet reviewedNot enough research yet
Cryotherapy (Self-Applied)you can do this at homeStudies: 1 · not yet reviewedNot enough research yet
Diathermy / TECAR Therapydone with a specialistStudies: 1 · not yet reviewedNot enough research yet
Eccentric + Dietary Supplementdone with a specialistStudies: 1 · not yet reviewedNot enough research yet
Eccentric Exercise + Corticosteroid Injectiondone with a specialistStudies: 1 · not yet reviewedNot enough research yet
Eccentric Exercise + PEMFdone with a specialistStudies: 1 · not yet reviewedNot enough research yet
Eccentric Plus Splintingdone with a specialistStudies: 1 · not yet reviewedNot enough research yet
Electroacupuncturedone with a specialistStudies: 1 · not yet reviewedNot enough research yet
Intramuscular Stimulation (Gunn IMS)done with a specialistStudies: 1 · not yet reviewedNot enough research yet
Pain-Monitored Loadingyou can do this at homeStudies: 1 · not yet reviewedNot enough research yet
Whole Body Vibration Trainingdone with a specialistStudies: 3 · not yet reviewedNot enough research yet
Low-Level Laser Therapy (LLLT / PBM)done with a specialistStudies: 2 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +3Science does not support itdepends on the stage of recovery
Night Splintdone with a specialistStudies: 3 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +2Science does not support it
Night Splintyou can do this at homeStudies: 3 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final) +2Science does not support it
Therapeutic Ultrasounddone with a specialistStudies: 3 · UK Defence Rehabilitation consensus agreement for the conservative management of Achilles and patellar tendinopathy: a modified Delphi approach, Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 +2Science does not support it
Eccentric Exercise + LLLTdone with a specialistStudies: 1 · Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final), Current Clinical Concepts: Conservative Management of Achilles Tendinopathy (Silbernagel 2020)Science does not support it

Prevention

Factors that published studies link to higher or lower risk for this condition.

Maintenance Exercise Program (Eccentric/HSR)

Risk factor in studies

This study suggested that calf-muscle exercise therapy may be worth continuing even after symptoms of Achilles tendinopathy have resolved.

Source: PubMed 34187784

Training Load Management

Risk factor in studies

This study describes tracking complaints tied to (sports) activities with a pain scale and modifying those activities according to what the scale showed.

Source: PubMed 34187784

Patient Education & Load Management

Risk factor in studies

This study suggested that basic management span at least 12 weeks and combine three components: education for the patient, management of load, and exercise therapy for the calf muscles.

Source: PubMed 34187784

Show all 8 prevention factors ↓

Balance & Proprioception Training

Risk factor in studies

sensorimotor training combined with education showed improvements in VISA-A scores

Source: PubMed 39119510

Footwear / Heel Lifts / Orthoses

Risk factor in studies

This systematic review describes orthoses as not recommended for improving pain and function in Achilles tendinopathy.

Source: PubMed 30170996

Fluoroquinolone & Statin Risk Awareness

Risk factor in studies

This study reported that taking fluoroquinolones carries a heightened risk of tendon disorders.

Source: PubMed 38949172

Gradual Return-to-Sport Progression

Risk factor in studies

According to this study, resuming sport within days is linked to a higher chance of recurrence.

Source: PubMed 34187784

Calf Stretching & Flexibility

Risk factor in studies

passive static stretching of the gastrocnemius and soleus muscles

Source: PubMed 39195578

Frequently asked

What works for Achilles Tendinopathy according to research?

Research supports: Combined Loading (Silbernagel Protocol), Eccentric Exercise (Alfredson Protocol), Eccentric Heel Drop (Alfredson Protocol), Heavy Slow Resistance (Home), Heavy Slow Resistance Training, Patient Education & Load Management. Based on Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024; Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final); Dutch multidisciplinary guideline on Achilles tendinopathy.

What does not work for Achilles Tendinopathy according to research?

Research found no benefit from routine use of: Night Splint, Night Splint, Therapeutic Ultrasound, Eccentric Exercise + LLLT. Based on Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024; Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024 (Final); Dutch multidisciplinary guideline on Achilles tendinopathy.

How much research is this based on?

For Achilles Tendinopathy, 57 approaches were evaluated, of which 44 have been reviewed by research bodies. Every data point traces to a published source.

Why do so many approaches say 'not enough research yet'?

Because that is the honest state of the research. 'Not enough research yet' means clinical guidelines have not taken a clear position, or few controlled trials exist for that approach. This page shows the entire landscape — not only the flattering rows.

What if the exercises don't lead to improvement?

Studies report results at the population level — individual responses vary. The literature also describes signs that call for a medical check (listed under 'When to see a doctor'), and a clinician is the right address for an individual assessment.

🚩 When to see a doctor

Some symptoms call for a medical check before any exercise: severe pain after an injury, numbness or tingling, weakness, fever with pain, night pain that does not ease, or bladder/bowel changes. If any of these are present, see a doctor first.

More safety signs →

Healthcare professional?

The professional platform adds full source traceability — every data point leads to the exact study page.

Professional evidence →

Educational Information — PhysioSense is an educational reference tool based on published research. It does NOT replace a medical examination or physiotherapy assessment. If you have severe pain, new symptoms, or are unsure — see a doctor or physiotherapist. You always make the final decision about your exercise. Pain is a signal to stop.