You're now in the longest and arguably most important phase of your recovery. The boot is behind you, physiotherapy is underway, and your focus shifts to rebuilding the strength and function you've lost. Weeks 13-25 are about progressive strengthening, building endurance, and gradually returning to normal life. This phase requires patience, consistency, and a long-term perspective.
Understanding This Critical Phase
What's Happening to Your Tendon (Late Remodelling)
Your tendon is well into the remodelling phase - the longest stage of healing that continues for 12-18 months or longer.
- Type III collagen continues to be replaced by stronger Type I collagen
- Collagen fibres are aligning along lines of stress and force
- The tendon is becoming progressively stiffer and stronger
- Cross-linking between collagen fibres is increasing
- The tendon is adapting to the loads you place on it
- Tendons respond to stress by getting stronger (within limits)
- Too little loading = weak tendon
- Appropriate loading = progressive strengthening
- Too much loading = risk of damage
The Goldilocks principle: Your rehabilitation needs to find the "just right" balance - challenging enough to stimulate adaptation, but not so much that you overwhelm the healing tissue.
Why This Phase Takes So Long
Many patients are frustrated by how long recovery takes. Understanding the biology helps.
Tendon healing is slow because:
- Tendons have limited blood supply compared to muscles
- Collagen remodelling is inherently slow
- The tendon needs time to adapt to progressively higher loads
- Rushing causes problems (elongation, re-rupture)
| Tissue | Healing Time |
|---|---|
| Skin | Days to weeks |
| Bone | 6-12 weeks primary healing |
| Tendon | 12-18+ months full remodelling |
The reality: Full recovery from Achilles rupture typically takes 6-12 months. Some patients take longer. Rushing leads to setbacks; patience leads to better outcomes.
Setting Realistic Milestones
Having clear milestones helps maintain motivation and track progress.
| Period | Key Goals |
|---|---|
| Weeks 13-16 | Walk 20-30 min comfortably, 20+ double-leg heel raises, good balance, minimal swelling |
| Weeks 17-20 | Single-leg raises beginning (with support), 30+ min walking, light stationary cycling, stairs normally |
| Weeks 21-25 | 10+ single-leg raises, consideration of light jogging (if criteria met), near-normal activities |
Progressive Strengthening Exercises
Single-Leg Heel Raises - The Gold Standard
The single-leg heel raise is THE benchmark exercise for Achilles rehabilitation.
Why it matters:
- Tests and builds calf and Achilles strength
- Directly relates to functional activities
- A key return-to-sport criterion (25+ repetitions)
- Measures progress objectively
- Both feet on floor, rise onto toes together
- 2-3 sets of 15-25 reps
- Target: Build foundation for single-leg work
- Single-leg seated isotonic and isometric calf raises
- Target: 1.4x body weight MVIC (seated, plantarflexion)
- Target: 1.2x body weight seated isotonic
- Double to single leg standing progressions
- Goal: 15 body weight single-leg calf raises on flat ground
- Single-leg standing and seated isotonic (progressing load)
- Target: 2x body weight plantarflexion isometric MVIC (seated)
- Progressively introduce dorsiflexion using plates (1", 1.5", 2")
- Sled work as approaching targets
- No support, full range of motion
- Goal: 25+ repetitions (key return-to-sport criterion)
- Rise straight up, push through big toe and ball of foot
- Full squeeze at top, slow controlled descent (3 seconds)
Progressive Dorsiflexion Introduction (Stage 3)
Important Approach
How it works:
- Use plates under your toes to create gradual dorsiflexion
- Start with 10kg plate (~1 inch)
- Progress to 1.5 inch plate, then 2 inch plate
- Do this in both knee bent and knee straight positions
- This replaces flexibility work - flexibility comes naturally with loaded dorsiflexion
Eccentric Calf Drops (When Safe)
Eccentric exercises (muscle lengthening under load) are particularly beneficial for tendon health.
When to start: Usually week 20-24+, with physiotherapist approval, after you've built good strength.
- Stand on a step with heels hanging off
- Rise onto toes using BOTH legs
- Shift weight to injured leg
- Lower slowly (3-5 seconds) on injured leg only
- Rise again using both legs
- Repeat 10-15 times, 2 sets
Balance and Proprioception Work
Proprioception (body awareness) is often impaired after injury and immobilisation.
| Level | Exercise | Duration |
|---|---|---|
| 1 | Single-leg stance, eyes open | 30-60 seconds |
| 2 | Single-leg stance, eyes closed | 30 seconds |
| 3 | Balance on pillow/wobble cushion | 30 seconds |
| 4 | Single-leg stance with arm movements or catching ball | 30 seconds |
Why this matters: Reduces risk of future ankle injuries, improves confidence in movement, essential for sport return, helps prevent re-injury.
Building Cardio Without Risk
Swimming and Pool Exercises
Swimming is excellent cardiovascular exercise with minimal tendon loading.
When to start: Once any surgical wounds are fully healed and with specialist approval.
Benefits: Zero impact, excellent cardiovascular workout, resistance for strengthening, good for mental health.
Pool exercises: Walking in the pool, swimming (freestyle, backstroke), pool running with flotation belt, water-based calf raises.
Precautions: Avoid push-off from wall initially, breaststroke may strain ankle, avoid flip turns initially.
Stationary Bike Protocol
Cycling is a great low-impact option for cardio and early calf engagement.
When to start: Usually week 12-14.
- Low resistance, moderate cadence (60-80 rpm)
- Start with 10-15 minutes
- Ball of foot on pedal (not heel)
- Increase duration before intensity
- Work up to 30+ minutes
Elliptical Training
When to start: Usually week 16-20.
- Low resistance, moderate pace
- Forward motion only (not backward initially)
- Start with 10-15 minutes
- Can be a stepping stone to running
Returning to Normal Life
Daily Activities
By weeks 13-25, most daily activities should be possible:
- Walking without limp
- Stairs with normal pattern
- Standing for extended periods
- Light household chores
- Returning to most office/desk work
- Driving (usually cleared by week 12)
Activities to Approach Carefully
- Ladders and climbing (balance, strength)
- Carrying heavy loads
- Uneven terrain walking
- Activities requiring quick movements
- Any impact sports (wait for clearance)
FAQs for Weeks 13-25
Summary: Your Weeks 13-25 Checklist
- Progress heel raises from double to single leg
- Build up to 15+ single-leg heel raises
- Introduce progressive dorsiflexion with plates
- Build walking duration to 30+ minutes
- Add cardio: cycling, swimming, elliptical
- Work on balance and proprioception
- Attend regular physiotherapy sessions
- Consider eccentric exercises (with physio approval)
- Monitor for setbacks and warning signs
- Stay patient and consistent
