Part of Achilles tendinopathy
How long does Achilles tendonitis last? Months, and what shortens it
Warning signs, and when to get help
How long does Achilles tendinopathy take to heal?
Two figures are worth holding together. Guy's and St Thomas' NHS Foundation Trust tells patients that most people need 6 to 9 months of rehabilitation before they can go back to full activities without pain. Silbernagel and colleagues, in a clinical guide for clinicians, say full recovery can take a year or longer in some people and that the pain often returns when the return to sport is rushed (Silbernagel and colleagues, 2020).
Set against that, the trials that established the main programs ran for 12 weeks and showed clear improvement inside them. Alfredson and colleagues had 15 recreational athletes whose Achilles pain had not settled with other treatment do slow heel lowering twice a day for 12 weeks, after which all were back to running (Alfredson and colleagues, 1998). Beyer and colleagues randomized 58 people with midportion pain lasting more than 3 months to that approach or to heavy slow resistance, which is heavy calf raises done slowly with weight added in fewer, heavier sessions: both groups improved by 12 weeks and held it at 1 year, with no difference between them (Beyer and colleagues, 2015).
Those two sets of numbers are not in conflict. Twelve weeks is roughly how long it takes to see the program working. Six to nine months is roughly how long it takes to get back to everything you want to do without the tendon complaining afterward.
What did the 5 year follow-ups find?
They are the best answer to whether it really goes away, and they are more honest than most recovery timelines.
Silbernagel and colleagues went back to 34 people who had been treated with exercise alone, 5 years after they started. Twenty-seven, 80 percent, had fully recovered from the initial injury. Of those, 22 had no symptoms and 5 had had a new episode of symptoms. Seven, 20 percent, had continued symptoms throughout. Only 2 people had sought another treatment in those 5 years (Silbernagel and colleagues, 2011).
Van der Plas and colleagues followed up 46 people, 58 tendons, 5 years after a 3 month heel-drop program. Their average score on the VISA-A questionnaire rose from 49.2 at the start to 83.6 at 5 years, and most of that rise had happened by the 1 year mark. At the end, 39.7 percent were completely pain free, and 48.3 percent had received one or more other treatments somewhere along the way (van der Plas and colleagues, 2012).
Put the two studies side by side and the picture is an honest one. The direction is good, most people end up with a tendon they can use, and a fair minority still have some symptoms years later. Being told six months and still feeling it at eighteen is disappointing, and it is also common enough that it does not mean anything has gone wrong.
What actually changes the timeframe?
Load, and how consistently you apply it. No trial has measured whether exercise shortens the whole course of a tendinopathy, so this is about what the recovery is built on rather than a stopwatch. The Dutch multidisciplinary guideline starts treatment for both the midportion and insertional kinds with patient education, loading advice and progressive calf muscle strengthening exercises for at least 12 weeks, and lets the pain score and muscle fatigue set how fast that progresses (de Vos and colleagues, 2021). The 2024 US clinical practice guideline makes tendon loading the first-line treatment on strong evidence, with loads as high as the tendon tolerates, and asks for it at least 3 times a week (Chimenti and colleagues, 2024). Silbernagel and colleagues (2020) rate exercise as having the strongest evidence of any treatment here, put the floor lower at twice a week, and warn that complete rest and unloading the tendon can be harmful and prolong recovery. None of that evidence was gathered on tendons anybody suspected of being weakened by a medicine, which is why the warning list below tells anyone whose tendon pain started on a fluoroquinolone antibiotic to hold off the calf exercises until they have been checked.
Several kinds of loading have worked. Silbernagel and colleagues (2020) report positive results from programs built on slow lowering, on lifting and lowering together, and on isometric holds, with no current evidence that one type of contraction beats another for this tendon. How a heel drop is done, and how it compares with heavy calf raises goes through both of those programs. That is good news for anyone trying to fit this around a life: the exact flavor matters less than doing it. In the Beyer trial, the group doing fewer, heavier calf raise sessions completed 92 percent of the sessions it was set against the daily heel drop group's 78 percent, and both ended in the same place, which is its own kind of argument.
Carrying on with activity does not seem to cost you time. In a trial of 38 people, those who kept running and jumping during their program, guided by a pain-monitoring rule, did as well as those who stopped those activities for 6 weeks, and the researchers found no negative effects from continuing (Silbernagel and colleagues, 2007). The rule was pain no higher than 5 out of 10 during and after activity, settled by the next morning, and not building week to week. Deciding whether to run while the tendon is sore works through that call and the signs that mean stopping, and Achilles pain when running covers how to apply the rule to a training week.
Progression is judged the next morning, not during the session. The staged program moves from holds to calf raises on both feet to single leg heel raises to weighted calf raises and hopping, and each step up waits until the tendon is no worse the day after. Hopping is the last stage, and the program page sets out how to build up to it.
Jumping and hopping also load the joints, the bones and the pelvic floor. If you have osteoporosis or have had a fall in the past year, ask your physio before you do any hopping. If you have had a hip or knee replacement, get the go-ahead from your surgeon before you try hopping. Many surgeons advise against jumping and hopping after a joint replacement for good, not just for the first months, because each landing sends high impact through the new joint. If you are pregnant, have had a baby in the past year, or leak urine when you jump, cough or sneeze, check with your midwife or physio before you start this stage. Stop the hopping and speak to your physio if urine leaks while you are doing it, or if you feel pressure or heaviness low in your pelvis. After having a baby, postnatal guidance usually leaves jumping and hopping until at least 3 months after the birth, once a pelvic floor check shows you are ready. With a heart condition or high blood pressure, check with your doctor before you start.
Where the pain sits changes what you load and how. The heel-drop programs in the studies above were tested in midportion pain, the kind you feel in the cord of the tendon a few centimeters above the heel bone, and the 2024 US physical therapy clinical practice guideline states its own scope as the midportion too (Chimenti and colleagues, 2024), so the strongest recommendations in this field were not written about pain on the heel bone. If your pain is at the back of the heel (insertional), keep heel raises on a flat floor or at step level, and skip any exercise that lets the heel drop below a step until your physio says otherwise.
What does getting better feel like along the way?
Not like a steady slide from sore to fine. The first thing that usually changes is how long the morning stiffness lasts, before the pain itself gets any milder. That first spell out of bed shortens from twenty minutes to ten, then to a couple of minutes, and people often miss it happening. Heel pain in the morning goes through that pattern and the other things that cause it.
Function comes back before comfort does. You will manage a long walk, then a hill, then stairs two at a time, while the tendon still grumbles after a busy day. Toe walking is in the program partly because it rebuilds the push off that people quietly stop doing on the sore side.
Set your checkpoints a month apart. Compare this month with last month, because the tendon has too much daily noise in it to read any faster than that.
When to see a physio or doctor
See someone if the pain is severe, stops you walking normally, keeps getting worse, or has not improved after a few weeks of looking after it yourself. A physio can confirm whether it is the midportion or the insertion that is sore, since that changes what you avoid early on, and can set your starting point rather than leaving you to guess.
Go back if 3 months of consistent loading has changed nothing, because that is a different conversation from a slow but moving recovery, and the reasons a loading program stalls are worth going through before that appointment. If you felt a sudden pop or snap at the back of the ankle, or rising onto your toes on that leg suddenly became weak, that is a possible Achilles tendon rupture and the first line in the warning list below tells you what to do. If what is on your mind is the slower worry, whether a tendon that has ached for months can give way, the chance of that happening is answered on its own page with the study the figure comes from. Everything on that list needs acting on at the timing its own line gives.
Related exercise programs
Warning signs
Get emergency help now
- You felt a sudden pop or snap at the back of your ankle, it felt as if someone hit or kicked you in the calf, or walking or rising onto your toes on that leg suddenly became weak or difficult. Stop exercising and go to an urgent care center or emergency department the same day, even if you can still walk, as this can be a torn (ruptured) Achilles tendon. This page does not cover a rupture.
Get help now, day or night
- Your tendon pain or swelling started while you were taking a fluoroquinolone antibiotic, such as ciprofloxacin or levofloxacin, or in the months after a course. Contact your doctor straight away. The UK medicines regulator (MHRA) advises stopping the antibiotic at the first sign of tendon pain or swelling and talking to your doctor. Hold off the calf exercises until you have been checked.
Get help today
- A calf or thigh that is newly swollen or getting more swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.
- The tendon or heel is hot, red and swollen, or you have a fever or feel unwell. Get medical help the same day, and go to an emergency department if you feel very unwell. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
- The pain started with a fall or a blow to the back of the ankle, and there is bruising or you cannot put weight on the foot. Get it checked the same day.
- The pain is there at night or at rest as well as with activity and keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Your heel or Achilles pain comes with back pain and stiffness that is worse in the morning and at night, or with painful, swollen joints elsewhere, or both heels became painful without an obvious reason. The same applies if you also have psoriasis, Crohn's disease or ulcerative colitis, or have had a red, painful, inflamed eye (iritis). This is not an emergency, but see your doctor in the next week or two, as it can be a sign of an inflammatory arthritis such as ankylosing spondylitis.
- You have numbness, tingling, burning or loss of feeling in the foot, often along the outer edge. Book an assessment with a doctor or physio in the next week or two. If it came on over hours or days, started after an injury, is spreading, or comes with weakness in the foot, get medical advice the same day.
- The pain is there at night or at rest as well as with activity and keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- The pain is there at night or at rest as well as with activity and keeps getting worse. See your doctor within a few days.
Common questions
How long does it take for Achilles tendinopathy to go away completely?
Longer than the programs run, for a good number of people. Silbernagel and colleagues followed 34 people treated with exercise alone for 5 years: 27 of them, 80 percent, had fully recovered from the original injury, 22 had no symptoms at all, and 7 still had continued symptoms. Only 2 had sought another treatment in those 5 years (Silbernagel and colleagues, 2011). A separate 5 year follow-up of a 3 month heel-drop program reported that 39.7 percent were completely pain free at the end, while 48.3 percent had tried one or more other treatments along the way (van der Plas and colleagues, 2012). So most people get there, and completely pain free is less universal than the word healed suggests.
How soon should I expect my Achilles to feel better?
Within the first 12 weeks you should be able to see a direction. Both of the main loading programs were tested over 12 weeks in midportion pain, and both produced clear improvement in that time, whether people did slow heel lowering twice a day or heavy calf raises in fewer, heavier sessions (Alfredson and colleagues, 1998; Beyer and colleagues, 2015). The first thing that usually changes is not the level of pain but the length of the stiff spell when you get out of bed. Judge yourself month to month, because day to day the tendon is too noisy to read.
Can Achilles tendinopathy heal on its own without exercise?
Resting it is the one approach the guidelines argue against. The Dutch multidisciplinary guideline on Achilles tendinopathy tells patients with chronic symptoms that little or no improvement is expected in the short term from a wait-and-see approach, and starts treatment with education, loading advice and progressive calf muscle strengthening for at least 12 weeks (de Vos and colleagues, 2021). The 2024 US clinical practice guideline says it as an instruction, on moderate evidence: complete rest is not indicated, and people should continue with their activities within their pain tolerance (Chimenti and colleagues, 2024). Silbernagel and colleagues (2020) say the same thing from the other side: complete rest and unloading the tendon can be harmful and can prolong recovery. None of that is written for a tendon somebody suspects has been weakened by a medicine, so if your tendon pain started while you were taking a fluoroquinolone antibiotic, the warning list on this page comes first. Tendons adapt to load, so a tendon that is given none gets weaker while the pain waits. Carrying on inside your pain tolerance is part of the plan, not a risk you are taking.
Why has my Achilles tendinopathy come back?
Most often because the return to running or jumping outran the tendon. Silbernagel and colleagues name a rushed return to sport as a common reason the pain comes back (Silbernagel and colleagues, 2020), and in their 5 year follow-up 5 of the 34 people had a new episode after recovering from the first one (Silbernagel and colleagues, 2011). Their suggested checks before running are everyday walking that causes very little pain, about 1 to 2 out of 10, and keeping weighted calf raises going 2 to 3 times a week once you are back. A tendon that has been sore once needs its strength work to continue after it stops hurting.
References
- Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision - 2024. Journal of Orthopaedic and Sports Physical Therapy. 2024;54(12):CPG1-CPG32. https://doi.org/10.2519/jospt.2024.0302
- de Vos RJ, van der Vlist AC, Zwerver J, Meuffels DE, Smithuis F, van Ingen R, van der Giesen F, Visser E, Balemans A, Pols M, Veen N, den Ouden M, Weir A. Dutch multidisciplinary guideline on Achilles tendinopathy. British Journal of Sports Medicine. 2021;55(20):1125-1134. https://doi.org/10.1136/bjsports-2020-103867
- Silbernagel KG, Hanlon S, Sprague A. Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. Journal of Athletic Training. 2020;55(5):438-447. https://doi.org/10.4085/1062-6050-356-19
- Silbernagel KG, Brorsson A, Lundberg M. The majority of patients with Achilles tendinopathy recover fully when treated with exercise alone: a 5-year follow-up. American Journal of Sports Medicine. 2011;39(3):607-613. https://doi.org/10.1177/0363546510384789
- van der Plas A, de Jonge S, de Vos RJ, van der Heide HJ, Verhaar JA, Weir A, Tol JL. A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy. British Journal of Sports Medicine. 2012;46(3):214-218. https://doi.org/10.1136/bjsports-2011-090035
- Silbernagel KG, Thomee R, Eriksson BI, Karlsson J. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. American Journal of Sports Medicine. 2007;35(6):897-906. https://doi.org/10.1177/0363546506298279
- Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. American Journal of Sports Medicine. 1998;26(3):360-366. https://doi.org/10.1177/03635465980260030301
- Beyer R, Kongsgaard M, Hougs Kjaer B, Ohlenschlaeger T, Kjaer M, Magnusson SP. Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial. American Journal of Sports Medicine. 2015;43(7):1704-1711. https://doi.org/10.1177/0363546515584760
- Guy's and St Thomas' NHS Foundation Trust. Achilles tendinopathy. Patient information, resource number 4609/VER3. Last reviewed October 2024. https://www.guysandstthomas.nhs.uk/health-information/achilles-tendinopathy
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-16.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.