Rehabilitation exercises for injuries such as heel pain, Achilles tendon discomfort, and calf pain pave the way for a successful recovery journey. However, the crucial determinant lies in ensuring you are using the right type of exercise at the right phase of recovery — and in the right dose.
1. Isometric Exercise
An isometric exercise involves a timed, sustained tissue contraction without joint movement — for example, a body-weighted calf raise hold. This controlled strain force prompts the tendon and muscle to recondition at a tolerable load for sustainable periods.
When to use: Reactive and early dysrepair phase. Isometrics are the safest way to load a painful tendon — they build capacity without the micro-trauma of dynamic loading, and have been shown to provide acute pain relief in tendinopathy.
Example protocol: 3 sets of 45-second holds, 2-minute rest between sets, once to twice daily.
2. Eccentric Exercise
Eccentric exercise involves a slow lengthening of tissue while it contracts against force — for example, lowering your heels down from a calf raise position. This places greater strain on the tissue than isometric exercises, prompting greater remodelling and collagen organisation.
When to use: After isometric tolerance is established. The Alfredson protocol — 3 sets of 15 slow eccentric lowering repetitions on a step, twice daily — remains the most evidence-supported exercise intervention for mid-portion Achilles tendinopathy.
Example protocol: 3 sets of 15 repetitions, 2-minute rest, once to twice daily.
3. Concentric Endurance Exercise
The shortening phase of tissue contraction, used over many repetitions, aims to build endurance and oxygen utilisation in the tissue. Standard protocols involve three sets of 15 calf raises on a flat surface.
When to use: Mid to late rehabilitation, to build the endurance capacity needed for return to sport or sustained occupational activity.
4. Plyometric Exercise
Plyometric exercises involve a rapid stretch and rebound contraction — such as jumping from a box to the ground and immediately jumping forward. They build neuromuscular power, reactive stiffness in the tendon, and tolerance to high-speed loading.
When to use: Only when the tendon can tolerate the high load and speed of plyometric activity without pain — typically the final 4–6 weeks of rehabilitation for a sport-specific return. Single-leg hop symmetry of greater than 90% compared to the uninjured side is a reasonable criterion before introducing plyometrics.
5. Proprioceptive and Balance Exercise
Proprioception — the body's sense of joint position — is often disrupted following lower-limb injury, increasing the risk of re-injury. Balance exercises on unstable surfaces, single-leg stance progressions, and wobble board training rebuild proprioceptive acuity.
Proprioceptive training is most critical for ankle injuries, Achilles tendinopathy, and any condition where the athlete has altered their gait mechanics during recovery. It should be introduced early in rehabilitation, not saved for the end.
When to use: Throughout all phases of rehabilitation, from early single-leg stance work on a flat surface to advanced reactive balance training in the final stages of return to sport.
From Pain to Performance — The Orthopaedic Sleeve Society (TOSS)