Achilles tendon pain often improves with daily eccentric heel drops plus managed training load. Tendinopathy means a degenerative overuse injury of the tendon, not sudden inflammation. Runners often develop it after a sudden rise in running, jumping, or stair activity. The American Academy of Orthopaedic Surgeons describes this repetitive-stress pattern in the AAOS OrthoInfo guide.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- How do you do eccentric heel drops?
- How do eccentrics compare with other exercise?
- Can you keep running during recovery?
- When does location change the plan?
How do you do eccentric heel drops?
Eccentric means the calf contracts while it lengthens. You rise on both feet, then lower slowly on the sore leg. The American Academy of Orthopaedic Surgeons says this loading can help noninsertional cases, but poor form can injure the tendon, so get instruction first.
The classic Alfredson program uses straight-knee and bent-knee heel drops. The peer-reviewed OrthoVellum summary presents it as first-line care in the 2026 OrthoVellum review. The prescription is 3 sets of 15 repetitions, twice daily, for 12 weeks.
- Rise with both heels, shift weight to the sore leg
- Lower below step level over three seconds
- Use straight knee for one session block, bent knee for the next
- Stop and seek coaching if sharp pain or limping starts
How do eccentrics compare with other exercise?
For midportion pain, eccentrics have strong support. A 2023 systematic review and meta-analysis found them more effective than other exercise types for pain and function, as reported in the BMC review summary.
Heavy slow resistance is another reasonable option. In a 12-week trial of 58 chronic midportion patients reported by Healio, both programs improved symptoms through 52 weeks. Heavy slow resistance earned higher early satisfaction, while eccentrics remained effective long term.
Can you keep running during recovery?
Complete rest is often unnecessary. A pain-monitoring model studied by Silbernagel allowed running and jumping when pain stayed at or below 5 out of 10. Pain also had to settle by the next morning and not climb week to week, with results matching rest, as detailed in the sports physical therapy study.
Practical load control means pausing high-impact running and jumping for a period. The Hospital for Special Surgery advises low-impact swimming, pool running, or cycling to hold fitness. Raise mileage, hills, and speed only when morning pain stays stable.
When does location change the plan?
Midportion pain sits a few centimeters above the heel. Insertional pain sits at the heel bone attachment. Eccentric protocols work best for midportion disease.
Insertional disease carries a worse outlook. Both OrthoVellum and the American Academy of Orthopaedic Surgeons frame standard eccentrics around noninsertional cases. Ask a clinician to confirm whether your pain is midportion or insertional before doing drops below step level.