Is stretching a good idea with an Achilles tendinopathy?

Achilles tendinopathy exercise series:

• Progressive treatment exercises for Achilles tendonitis/tendinopathy: What, when, and how much?

• Is stretching a good idea with an Achilles tendinopathy? (this article)

• What type of exercise works for Achilles tendinopathy and why? - Isometric exercises

• What type of exercise works for treating Achilles tendinopathy and why? - Isotonic exercises

• What type of exercise works for treating Achilles tendinopathy and why? - Eccentric exercises

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In this article, we take a look at the role stretching plays when you have an Achilles tendinopathy/tendinitis and why this might be best avoided in the first instance. Check out the other articles in our Exercise Series to understand when and how to use different types of exercise for treating Achilles tendinopathy.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in most of our articles.

In this article:

1. What does stretching the Achilles do?

2. When is stretching a good idea?

3. When can I stretch?

4. How we can help

Or, if you prefer to watch the video:

What does stretching the Achilles do?

You stretch your Achilles and calf muscles by taking your foot and ankle into dorsiflexion – a position where your toes and foot are being moved back towards your body. During this stretch, you naturally move the Achilles tendon towards the bone at the back of the heel. The stretch is felt in the calf muscles as the distance between where the calf muscles start (near the back of the knee) and where they insert (into the back of the heel) is being made longer.

When is stretching a good idea?

There is very little evidence that stretching for the sake of it can prevent injury.

As I mentioned above, when you stretch an Achilles and calf, the Achilles tendon is moved towards the bone at the back of the heel. In people without an Achilles problem this is a normal and natural movement. However, if you have an Achilles problem, this can compress the tendon and therefore irritate your symptoms. Think of it as having a bruise and pressing on it.

Stretching the calf and Achilles used to be a very popular exercise to prescribe for people with Achilles tendinopathy and tendinitis. Some recent research has indicated that stretching might not be such a good idea in the first instance. This is not to say that it can’t be reintroduced once the Achilles symptoms have improved.

When can I stretch?

One of the most important treatments for an Achilles tendinopathy/tendinitis is load management or relative rest.

Load is placed on an Achilles tendon when we run and use the tendon, but also when it is in a compressed position – for the Achilles this is when the foot is pulled back towards you (dorsiflexion). Therefore, when treating an Achilles tendinopathy/tendinitis we need to look at this compression component as well as how much running/sport/activity you do. All of this load/activity should be modified whilst your symptoms settle and the strengthening exercises make the Achilles, calf and rest of your leg/trunk more robust.

Once your symptoms have settled, all these activities (running, walking, stretching) can be slowly reintroduced. It is important that this is done on an individual basis, as we all have different starting points and end goals. Therefore, gaining advice on this is very important.

Warming up and cooling down are good times to consider stretching the other parts of your body. I explore this in more detail in my article titled Stretching for Warm up / Cool Downs.

How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author:

Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn, Facebook, Instagram, and Twitter.

References:

1. Cook, Jillianne Leigh, and Craig Purdam. "Is compressive load a factor in the development of tendinopathy?." Br J Sports Med 46.3 (2012): 163-168.

2. Docking S, Samiric T, Scase E, Purdam C, Cook J. Relationship between compressive loading and ECM changes in tendons. Muscles Ligaments Tendons J. 2013;3(1):7–11. Published 2013 May 21. doi:10.11138/mltj/2013.3.1.007