Eccentric Heel DROPS for Insertional Achilles Tendonitis

By | August 6, 2013

If there is one thing you want to get out of this article it is this: notice the title of this post is “Eccentric Heel DROPS,” not “Eccentric Heel Raises.” Very important distinction.


If you’re like me, you’ve scoured the web looking for research and/or anecdotal evidence of a cure for insertional achilles tendonitis. And you may have discovered like I have that there is very little real science out there on this variant of achilles tendonitis. Unfortunately for me, it seems all the research money is into the typical tendonitis that afflicts runners.

Fortunately, in 2008 a group of researchers did do a limited study and documented it here. Unfortunately it is on PubMed, so no free access.

Fortunately, John David over at has a great summary of the article along with the protocol that the researchers recommend:

  • 3 sets of 15 straight-legged eccentric heel drops on flat ground, twice a day for twelve weeks
  • Starting with the heels raised and your weight on the injured leg, use the calf muscles to slowly lower your heel to the ground, keeping your knee straight.
  • Use your good leg to return to the starting position.
  • Exercise into mild or moderate pain, but stop if pain becomes excruciating
  • Once you can complete all three sets without pain, add weight using a backpack.
  • Once you have recovered, it is not a bad idea to keep doing these exercises for maintenance/prevention.

If you read the comments on the above article, there are lots of clarifications. Basically, in simple terms, people seem to have not understood that you have to avoid “pushing up” using the leg with the injured tendon.

So this is the protocol I’ll be following. Below is a video of me performing a single set. Note that I am performing three sets of what you see in the video, two times per day.

So that takes care of the strengthening re-building/aligning of the tendon fibers…which leaves the million-dollar question: stretching of the tendon. I’m still not sure what I’m going to do about stretching the tendon, if anything, at this point. Why? Because there is so much conflicting advice out there on the subject. John David mentions in the above link to avoid stretching for acute (i.e., still painful) insertional tendonitis.

My Sports Med doctor has been very contradictory, as are the physical therapists I’ve consulted. One on hand, they say, often in the same conversation, to:

  • Use heel lifts to alleviate stretching of the tendon
  • Minimize pain as much as possible during the healing process
  • Do not wear minimalist shoes (e.g., shoes with little or no heel to toe ‘drop’) as they put tension on the tendon

Then, they’ll say:

  • You’ve got to stretch the tendon, to alleviate the tightness/pressure
  • Massive amounts of strecthing/mobility
    • All of the physical therapists I’ve consulted with prescribed, to various degrees, a static stretching protocol; one in particular had me spending over 2 hours per day doing static stretches (after 5 weeks of that, it resulted in increased tendon pain and no healing, but damn was my mobility much better everywhere else in my body!)

So which is it? Do we need to shorten the tendon or lengthen it? It makes sense that we would want to lengthen the tendon to alleviate the tightness that caused the problem, but how does one do that without incurring pain and, more importantly, causing further damage to the tendon? If you figure it out, leave a comment and let me know!

In the meantime, I’m going to do the eccentric heel drop protocol as prescribed above, and also perform static stretching at least once per day. More on that in a separate post.