Preventing Achilles Tendon Injuries: Stretches, Strengthening & the Latest Evidence

Introduction

The Achilles tendon is the largest tendon in the body, connecting your calf muscles to your heel bone. It plays a vital role in walking, running, and jumping. Unfortunately, it's also one of the most commonly injured tendons, especially among active individuals. Achilles tendonitis and tendon tears can be painful and debilitating—but with the right preventative strategies, these injuries are often avoidable.

In this blog post, we’ll cover how Achilles tendon injuries occur, who’s most at risk, and, most importantly, how to prevent them using the latest evidence-based techniques in stretching, strengthening, and lifestyle habits.

Understanding Achilles Tendon Injuries

Achilles tendon injuries typically fall into two categories:

Achilles Tendonitis – inflammation due to overuse or poor biomechanics.
Achilles Tendon Rupture – a partial or complete tear, often due to sudden force or chronic degeneration.

Risk factors include:

Sudden increases in training volume or intensity
Poor ankle mobility
Weak calf muscles
Inadequate warm-ups
Improper footwear
High arches or flat feet

1. Stretching for Achilles Tendon Health

Regular stretching maintains tendon flexibility and reduces tension buildup that can lead to strain or microtears.

✅ Top Evidence-Based Stretches

a. Standing Calf Stretch (Gastrocnemius Focus)

Stand facing a wall, step one foot back, and press the heel down.
Keep back leg straight and lean into the wall.
Hold for 30 seconds, repeat 2–3 times per leg.

b. Soleus Stretch (Bent Knee Calf Stretch)

Similar setup, but with the back knee bent.
Focuses on the deeper soleus muscle, important for tendon health.
Hold 30 seconds, 2–3 reps per leg.

c. Eccentric Heel Drops (also a stretch and a strengthening move)

Stand on a step with your heels off the edge.
Raise up on both feet, then slowly lower down on one.
Do 3 sets of 15 reps daily.
Proven effective for mid-portion Achilles tendonitis (Alfredson protocol).

2. Strengthening Exercises

Strong, resilient muscles reduce stress on the Achilles tendon. Focus on eccentric loading (slow, controlled lengthening), which has the most research support.

✅ Top Strengthening Exercises

a. Eccentric Calf Raises (Alfredson Protocol)

Performed daily, gradually increasing resistance (e.g., backpack with weights).
Shown to reduce pain and improve tendon structure in 12 weeks.

b. Seated Calf Raises (Soleus Strength)

Use a machine or hold dumbbells on your knees while lifting heels.
Key for improving soleus strength, especially for runners and jumpers.

c. Isometric Heel Raise Holds

Stand on tiptoes and hold for 30–45 seconds.
Improves tendon stiffness and neuromuscular control.
Helpful in early rehab and injury prevention.

3. The Latest Evidence: What Science Says

Recent studies reinforce the importance of eccentric loading and progressive tendon loading. Here’s what the research shows:

Eccentric loading improves tendon remodeling and collagen alignment.
Isometrics can reduce pain during the early reactive stages of tendonitis (Rio et al., 2015).
FOOT IN NEUTRAL ISOMETRICS ON A STEP
High-load, slow resistance training (HSR) is equally effective as eccentric loading and may improve function better in some athletes.
Tendon health thrives on consistency — 2–3 days per week of progressive loading is key.
Dry needling may be helpful adjuncts, but exercise remains the cornerstone.

4. Preventative Strategies Beyond Exercise

Warm Up: Dynamic movements (e.g., leg swings, light jogging) before activity.
Gradual Progression: Increase training loads by no more than 10% per week.
Footwear: Choose shoes with proper heel support and cushioning.
Cross-Training: Reduce repetitive strain by mixing running, cycling, swimming, etc.
Listen to Pain Signals: Early discomfort can prevent a full-blown injury if addressed.

Final Thoughts

Achilles tendon injuries are common but preventable. Through consistent stretching, smart strengthening, and evidence-based practices, you can keep your Achilles tendon strong, flexible, and injury-free. If you're experiencing persistent pain or tightness, consult with a licensed physical therapist to develop a tailored program.

Need Help with Achilles Pain?

Our clinic specializes in sports rehab and tendon health. Book an assessment with one of our physical therapists and get back on your feet—stronger than ever.

References

Alfredson, H., et al. (1998). Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. The American Journal of Sports Medicine, 26(3), 360–366.[This study introduced the widely used Alfredson protocol for Achilles rehab.]
Rio, E., et al. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal of Sports Medicine, 49(19), 1277–1283.[While focused on patellar tendon, this research highlighted the role of isometric loading in tendon pain.]
Beyer, R., et al. (2015). Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: A randomized controlled trial. The American Journal of Sports Medicine, 43(7), 1704–1711.[Showed that heavy slow resistance training can be equally effective as eccentric training.]
Silbernagel, K.G., et al. (2007). Loading of the Achilles tendon during rehabilitation exercises: Application of a rehabilitation-specific force-time curve analysis. British Journal of Sports Medicine, 41(6), e8.[Explored optimal loading and progressions in rehab.]
Malliaras, P., et al. (2013). Achilles and patellar tendinopathy loading programmes: A systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Medicine, 43(4), 267–286.[A comprehensive review of tendon loading protocols.]
Magnusson, S.P., et al. (2010). The pathogenesis of tendinopathy: Balancing the response to loading. Nature Reviews Rheumatology, 6(5), 262–268.[Explains the importance of load management in preventing and treating tendon injuries.]