The Achilles Load Map: choose your starting point and know what to do next

Check whether this Map is the right starting point for you

This guide helps people with Achilles tendinopathy adjust their exercise plan. It assumes your problem has been identified: pain location alone doesn't establish a diagnosis. For an introduction to symptoms, read our Achilles pain guide.

If you've felt a sudden snap or pop, have new marked swelling or bruising, or suddenly cannot push off normally, seek prompt assessment rather than trying the exercises to see what happens. This isn't a programme for a suspected rupture or recovery after surgery.

Use the Map alongside your individual instructions. If they differ, check with your clinician before changing them.

Tendon Time is the free email course behind this approach. The Map helps you make exercise decisions between sessions. No signup is needed to read it.

Watch: Tim explains Achilles pain

Focus on the inputs and give the process time

In clinic, I often bring the conversation back to what we can influence: the exercise we're doing, the other loads we're asking the tendon to handle, and whether we're giving ourselves time to recover.

An exercise can become too easy to challenge you, or too demanding to recover from alongside the rest of your week. The dose needs to change as your capacity and activity change.

You don't need to improve after every session. Completing it with control, recovering and repeating it consistently are useful steps.

Keep your actual goal in sight: running with friends, walking to work comfortably or getting through the day without thinking about your heel. The exercises should help you work towards that life.

Learn when to progress, hold or downshift

The exercise dose is only good enough if you can recover from it.

During exercise, mild discomfort can be acceptable: a little sore, roughly 3 out of 10. Pay attention to your movement, the kind of discomfort and what happens afterwards.

Muscle effort, fatigue or a mild ache feels different from sharp pain, pinching at the heel or symptoms that keep escalating. If those sharper symptoms appear, stop the set. Don't use a number to talk yourself into continuing through them.

If the exercise is becoming more uncomfortable than mild, ease it. For a single-leg calf raise, the Map's downshift is to use both legs and share the load. Continue only if that makes the remaining repetitions comfortable and controlled. If it doesn't, finish the set there.

Then look beyond the session. How does your Achilles feel later that day? What are those first steps like the following morning compared with your usual pattern?

Holding steady is a useful decision. There's no prize for reaching the final waypoint first.

Adjust the plan for pain at the heel attachment

Insertional Achilles tendinopathy affects the heel attachment; midportion symptoms occur farther up the tendon. This changes the range used for calf raises.

For insertional pain, don't lower your heel below the level of the step or platform. The deficit option later in this Map is for midportion presentations. Follow any individual range instructions your clinician has given you.

In clinic, I'll often spend more time finding a comfortable range and using holds before adding more movement. You don't need to force a deep heel drop or rise as high as possible if the end position pinches.

Notice shoe contact: a collar pressing against a sore heel can make the day harder. If the source of pain is unclear, get it assessed before repeatedly changing exercises.

Find your starting waypoint and work through A–E

Start with a waypoint you can perform with control and recover from. You don't have to prove how much you can tolerate in one session.

In clinic, I often begin with a simple calf hold using both legs, then explore how the person tolerates more load or movement. The single-leg versions below are the Map's standard. Using both legs is a useful downshift when one leg is too demanding. If even the easier version is difficult to tolerate, get help choosing your starting dose.

Read each dose with its response and progression rules. Don't push through symptoms to finish a target.

The response rules apply at every waypoint. Progress one stage at a time without adding several new challenges together.

Keep the movement controlled

Use support for balance so you can concentrate on the calf exercise. Keep the heel movement steady rather than letting it roll in or out as you fatigue. Where one side is unaffected, the original Map starts that side first.

For holds, find a position you can maintain. For slow raises, keep the prescribed pace in both directions. For loaded raises, choose added resistance you can control. More weight is useful only when you can manage the exercise and recover from it.

Waypoint E introduces quicker calf loading. It isn't an automatic clearance for unrestricted running or jumping. Your activity demands and response still matter.

Account for running, walking, work and footwear

Imagine you've kept your exercises exactly the same, but yesterday involved a much longer day on your feet at work. This morning your Achilles is grumpier. The exercise programme hasn't changed, but the total job you've asked your tendon to do has.

Look back across the week. More walking? An extra run? A quicker run? Different shoes?

Where possible, change the thing that appears to be aggravating it. That might mean adjusting running distance or pace, finding a more comfortable shoe, or reducing an avoidable stretch of standing. Change something useful and see how you respond, rather than changing everything and losing track.

For a runner who's already tolerating some running, I may keep the exercises steady while we adjust their running. Someone introducing running after a period away needs a different starting point. Your goal matters, and so does what you're currently able to recover from.

Read more about Achilles pain when running or choosing running shoes for Achilles symptoms.

Use the 72-hour reset when symptoms flare

A flare is a reason to look at the dose and the week around it. Use the reset when morning symptoms are repeatedly worse or exercise discomfort lingers beyond your usual pattern. Sharp pain or a new loss of function needs assessment rather than simply waiting out a reset.

Resist the temptation to test the tendon repeatedly to see whether it's better yet.

For the next 72 hours:

• Don't add a challenge. No new exercises, extra load or progression.
• Return to a previously tolerated exercise level. Downshift to the level that was going well, rather than forcing the session that is now too much.
• Review loading outside the Map. Look for the extra workday, running change or footwear issue and avoid that aggravating factor where possible.

This doesn't mean you have to stop all movement. It means giving yourself a more manageable set of demands while things settle. Don't make up missed sessions afterwards.

When symptoms have settled, use the usual response rules to decide what comes next. Seventy-two hours isn't a deadline your tendon has to meet or permission to jump ahead. If things remain unsettled, are worsening, or you can't work out what's driving the flare, get individual help.

Get individual help when the Map cannot answer your question

An assessment lets us investigate what is sore, how you move, what you can tolerate and what the rest of your week asks of you.

That helps us choose which changes to exercise, footwear, running or other support matter for you.

If you're in Melbourne, you can read about an Achilles assessment at Pride Podiatry. If you'd like the explanations delivered a little at a time, Tendon Time is free. And if you simply want the Map beside you while you exercise, keep the printable version handy.

Focus on the inputs you can manage. Give yourself time. Use the response to decide what comes next.