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

Achilles Tendinopathy Exercise Series:

Is stretching a good idea with an Achilles Tendinopathy / Tendonitis?

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 (this article)

There is no one-size-fits-all exercise regime when it comes to treating Achilles tendinopathy and the exercises we prescribe for patients are very rarely the same. In this blog series we explain what type of exercise does what and how that can help your tendon, according to the latest research. In this article we discuss eccentric exercises. Using eccentric exercises for Achilles Tendinopathies gained popularity with the research conducted by Alfredson in the late 1990’s and pioneered the way we treat and prescribe exercises today.

In this article:

  • What are eccentric contractions/exercises?

  • How do eccentric exercises help an Achilles tendinopathy?

  • When do I use eccentric exercises if I have an Achilles tendinopathy?

What are eccentric contractions/exercises?

As a quick recap – you get 3 types of muscle contractions:

  • Isometric: The muscle contracts, but it stays at the same length.

  • Concentric: The muscle shortens while it contracts

  • Eccentric: The muscle lengthens while it contracts

An eccentric contraction is where the muscle lengthens whilst under relatively constant tension. An example of an eccentric contraction for the calf muscle is the down phase of the classic calf raise exercise that’s so often associated with Achilles tendinopathy rehab – the calf muscles lengthen while lowering you down.

Alfredson used the method of slowly lifting yourself up on two feet and then lowering down on the painful foot only. This is an example of an eccentric dominant exercise, because the muscle works the hardest whilst it lengthens. You can also use eccentric contractions in combination with concentric contractions as part of isotonic exercises.

How do eccentric exercises help an Achilles Tendinopathy?

This is the million dollar question and is still unknown. Lots of theories exist and more research is needed to help prove or disprove them.

One theory is that it strengthens the tendon by laying down more healthy collagen fibres. Your Achilles is made of lots of collagen fibres organised in many bundles. Think of lots of bundles of dried spaghetti next to each other.

Another theory is that this type of strengthening improves the tendon’s response to the activity (strain) by increasing its stiffness.

Thirdly researchers are questioning whether eccentric training helps through improving the Achilles’ springiness, allowing us to jump / push off better when walking, running or jumping.

When do I use eccentric exercises if I have an Achilles tendinopathy?

There is no doubt that strengthening the calf and Achilles tendon using eccentric exercises is beneficial to help reduce symptoms and improve activity levels when you have Achilles tendinopathy. However, more research has been conducted since the original work done by Alfredson and this shows that other types of exercise are also important in tendon rehabilitation. More commonly now exercises working on both the lengthening (eccentric) and the shortening (concentric) phases are prescribed.

Therefore, as each individual is different and can tolerate different types of exercises, has varying fitness levels, goals, health issues and genetics, there is no recipe and you would need to be assessed by a medical professional to help establish what exercises are best for your individual case. The main take home message is that strength training is the most effective, evidence based treatment for Achilles tendinopathy that we have and that it needs to include the eccentric phase.

Let me know if you have any questions. Need more help with your Achilles injury? You’re welcome to consult us online via video call for an assessment of your injury and a tailored treatment plan.

Best wishes


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 or Twitter.


  1. Alfredson, Håkan, et al. "Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis." The American journal of sports medicine26.3 (1998): 360-366.

  2. Beyer, R., Kongsgaard, M., Hougs Kjær, B., Øhlenschlæger, T., Kjær, M. and Magnusson, S.P., 2015. Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. The American journal of sports medicine, 43(7), pp.1704-1711.

  3. O’Neill, Seth, Paul J. Watson, and Simon Barry. "Why are eccentric exercises effective for achilles tendinopathy?." International journal of sports physical therapy 10.4 (2015): 552.


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