Eccentric exercises (calf raises) for Achilles tendonitis – How they work and when to use them
- Alison Gould
- Dec 6, 2025
- 7 min read
Updated: Dec 8, 2025
Eccentric exercises are one of the most talked-about treatment options for Achilles tendonitis (or tendinopathy), but not everyone responds equally well to all versions of eccentrics. In this article, we break down the different types of eccentric calf raise, how they help your tendon to recover, when they’re useful, and when other exercises might be a better fit for your rehab.
Remember, if you need help with an Achilles injury, you're welcome to consult one of our team via video call.
The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.
In this article:
We also discuss and demonstrate eccentric exercises for Achilles tendonitis in this video:
What are eccentric Achilles exercises?
Our Achilles tendon attaches our calf muscles to our heel bone. When we contract our calf muscles, the tendon pulls on the heel bone.
You can contract a muscle (including your calf muscles) in three ways:
A concentric movement is when you contract the calf muscles to make them shorter, e.g. when you go up on your tiptoes.
An isometric contraction is when you keep the muscles and the tendon in the same position, e.g. standing on your tiptoes without moving.
An eccentric movement is when you contract the calf muscles while they are lengthening, e.g. slowly lowering your heels from a tiptoe position, preventing gravity from just letting you plonk down.
Tiptoes (or calf raises, if you think in exercise terms) is just an example – these various types of calf muscle contraction happen all the time when we do things like walk, run, and jump.
The classic calf raise exercise for Achilles tendonitis consists of both a concentric (calf muscles shorten) and eccentric (calf muscles lengthen) phase.
Maryke demonstrates the different muscle contraction types in this video clip:
The two types of eccentric exercise for Achilles tendonitis rehab
1. Eccentric-only exercises (eccentric heel drops)
With this version, you focus on working the calf muscles and Achilles only in the eccentric phase of the calf raise. You typically lift yourself up onto the balls of your feet using both legs (so it’s easy and doesn’t really count as exercise) and then lift one leg off the floor to lower yourself down using only one leg.
This is the type of eccentric exercise used in the classic Alfredson protocol, which was traditionally viewed as the gold standard for Achilles rehab. However, we rarely use this now – I’ll explain why in a minute.
In this video clip, Maryke shows how to do the eccentric-only Achilles exercise:
2. Eccentric-biased or accentuated exercises (eccentric calf raises)
With this version, you work your calf muscles and Achilles tendon equally hard on the up (concentric) and down (eccentric) phase, but you slow down the eccentric phase – typically taking about 3 seconds to fully lower yourself.
This version can actually also be classed as a type of isotonic calf raise, and it’s the one we favour and tend to see the best results with – more on this in the next sections.
And here Maryke demonstrates how to do different versions of eccentric-biased calf raises:
How do eccentric exercises help your injured Achilles tendon?
Both eccentric-only and eccentric-accentuated exercises can improve pain, strength, and function in people with Achilles tendonitis. Research shows they may help by:
Improving the injured area’s structure: A 12-week eccentric programme can help restore the injured part of the tendon’s structure so it looks more normal on scans.
Strengthening the rest of the tendon: It also builds healthier collagen in the rest of the tendon, so even if the injured area doesn’t fully return to normal, the rest becomes strong enough to cope with your activities.
Increasing tendon stiffness: A healthy tendon is usually stiffer and responds better to load. Researchers measure tendon stiffness with a special type of ultrasound machine – it’s not the same as a tight or short tendon.
Boosting its springiness: Eccentric work may improve how efficiently the Achilles stores and releases energy during walking and running.
Improving control: Slowing the lowering phase helps retrain the brain–tendon connection, improving motor control (how well your brain can control that part of your body).
Why we rarely prescribe eccentric-only calf raises for Achilles tendonitis
For a long time, eccentric-only calf raise protocols were seen as the gold standard for Achilles tendonitis rehab. This was mainly thanks to the seminal research by Dr. Håkan Alfredson and his colleagues – they conducted the first study showing that exercise-based treatment plans were effective for Achilles tendonitis.
They used a super-high dose of heavily-loaded eccentric exercises (3×15 reps twice a day with no recovery days).
We rarely use this type of eccentric-only programmes because:
They are more likely to flare your pain up – very few people can handle the volume of exercise prescribed in the original Alfredson protocol.
Achilles tendonitis is an overuse injury – if you don’t include recovery days, you often just overwork it even more.
When we move, we use both the lifting and lowering phases of a calf raise, so you should restore both and keep them balanced. We’ve seen patients in our online clinic who have focused only on the eccentric action and can handle heavy lowering loads but then lack strength in the lifting action.
👉 We’ve discussed in more detail why eccentric heel drops might not work for you here.
When might eccentric-only Achilles exercises be useful?
Every person is different, and sometimes eccentric-only calf raises can be very useful. This is why we don’t believe in a never-or-always approach to prescribing rehab exercises – instead, we look at what is needed for each specific case.
For example, when a patient’s calf muscles aren’t currently strong enough to lift them all the way onto their tiptoes, eccentric-only exercises can be a great way to help restore that initial strength.
Achilles rehab can sometimes reach a plateau, where a patient seems stuck and unable to progress. In cases like these, it can often help to mix the exercises up and try a different approach. Depending on what you've been doing, it might be useful to trial heavy eccentric heel drops to see if it brings about the changes required.
👉 But, when we use these exercises, we tend to use them in combination with others and always tailor the recovery days and volume to what that specific patient needs.
Research update on what exercises work best
Fortunately, Dr Alfredson and many other research teams have continued their work, and it shows that other types of exercise are also important in tendon rehabilitation and might actually be easier to tolerate.
Thanks to the newer research, we now understand that it’s not about which exercise is “the best” in general, but rather:
Choosing exercises that match your tendon’s current strength and sensitivity, and
then progressing them over time to help restore the strength, endurance, and movement types required by your sport or activities.
👉 Or in other words, tailoring the exercise plan to the individual.
More commonly now, isotonic exercises, which work both the lengthening (eccentric) and shortening (concentric) phases, are prescribed.
And if you take part in sports that require explosive calf contractions, plyometric exercises are also recommended to ensure that your tendon is fully prepared.
Isometric exercises, where you contract the muscles without moving, can also be useful in some cases – especially if your tendon is very painful or you lack quite a bit of strength.
👉 You can find a detailed discussion about exercise-based treatment plans for Achilles tendonitis here.
Other articles in the 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/tendonitis?
Isometric exercises for Achilles tendinopathy - How they work and when to use them
Isotonic exercises - What they are and how to use them for treating Achilles tendonitis
Eccentric exercises for Achilles tendonitis - How they work and when to use them (this article)
How we can help
Do you need help with an 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. Your physio will listen to how your injury came about and get you to do some movements to assess the current strength and pain levels of your injured tendon.
This will inform what the type and difficulty level of exercises (which will likely include a version of the calf raises discussed above) they will then prescribe you.
They will also take into account what activities you have in mind for when your tendon has recovered – exercises for a long jumper will obviously be very different from those for someone who just wants to walk their dog!
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.