Achilles tendinopathy (AT) is a common condition both in athletes and the general population. The purpose of this study is to highlight the most effective form of exercise in managing pain-related symptoms and functional capacity as well as in a return to life activities, ensuring the quality of life of patients with AT, and creating a protocol to be used in rehabilitation. We conducted a systematic review of the published literature in Pubmed, Scopus, Science Direct, and PEDro for Randomised Controlled Trials concerning interventions that were based exclusively on exercise and delivered in patients 18–65 years old, athletes and non-athletes. An amount of 5235 research articles generated from our search. Five met our inclusion criteria and were included in the review. Research evidence supports the effectiveness of a progressive loading eccentric exercise program based on Alfredson’s protocol, which could be modified in intensity and pace to fit the needs of each patient with AT. Future research may focus on the optimal dosage and load of exercise in eccentric training and confirm the effectiveness of other type of exercise, such as a combination of eccentric–concentric training or heavy slow resistance exercise. Pilates could be applied as an alternative, useful, and friendly tool in the rehabilitation of AT.

Achilles tendinopathy (AT) is one of the most common tendon pathologies caused by excessive and repetitive loading [1], affecting both high and medium-level athletes as well as the general population [2,3]. It is a degenerative disorder resulting from a failed tendon healing response [4]. The exact pathophysiology remains unknown and is considered a disorder of a multifactorial aetiology [5] involving both endogenous and exogenous factors [2,6,7]. Clinical symptoms include pain, swelling and decreased function [3,7,8,9]. AT has a considerable negative impact on quality of life, work productivity, and participation in sports. These factors, along with increasing healthcare expenses, highlight the requirement for optimizing the therapeutic strategy.