Alfredson Protocol (Eccentric) for Achilles tendinopathy

The Alfredson Protocol (Eccentrically loading) is an exercise program for people with Mid-portion Achilles tendinopathy (AT). It comprises bent-leg and straight-leg heel drops while the athlete is at one edge of a step.

Dr. Håkan Alfredson talked about it in detail in this running shoes for Achilles tendinopathy. It uses the idea of progressive eccentric loading for the Achilles tendon to enhance the tendon’s ability to bear stressors and forces – hence treating the Achilles’ tendinopathy.

What’s the Efficacy of Alfredson Protocol?

A randomized study by Alfredson et al. reported that 82 percent of participants who undertook an eccentric exercise for Achilles tendinopathy had positive outcomes at 12 weeks. Further, another 6-week program of eccentric stretching showed positive efficacy.

In short: Eccentric tendon loading happens when the tendon and muscles contract as you’re lengthening the muscle.

Alfredson Protocol: 12-Week Eccentric Loading Program

The Alfredson protocol is composed of two distinct exercises for the treatment or Achilles’ tendinopathy.

  • Straight Knee – 3 x 15 repetitions twice every day
  • Bent knee – 3 x 15 repetitions twice every day

All you’ll require for the exercises is a small step – on which you’ll step while you’re exercising. However, you must consult with your physical therapist to determine if it’s safe for you to exercise and if we can do the exercises properly. Suitable running shoes for Achilles tendinopathy must be included is some of the modifiable risk factors for tendinopathy pain.

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Phase I:  Straight-legged heel drops

  1. Stand on the step but having your foot’s balls on the step’s edge. Therefore, in this position, you’ll have your heels hang over the edge of the exercise step.
  2. Ensure you hold onto a strong object to gain required stability and balance.
  3. Important for this first exercise phase it to keep both of your knees in a straight position.
  4. With both feet, lift the heels to rise to your feets’ balls.
  5. Maintain the foot with the Achilles’ tendinopathy soreness/ pain on the exercise step while lifting the uninjured foot off from the exercise step.
  6. Next, gradually lower your body using the injured ankle.  Ensure as the heel moves down towards the floor, you maintain your foot’s ball remains in contact with the edge of your exercise step.
  7. Finally, get back the uninjured foot to the exercise step and repeat – Perform 3 sets of 15 repetitions.

Phase I:  Eccentric loading with bent knees

  1. After completing the 3 sets of 15 repetitions when your knees are straight on the exercise step, now repeat the protocol but with the knees bent slightly. In this position, you’ll be loading the soleus muscle (calf muscle).
  2. Equally, repeat the exercise for 3 sets of 15 repetitions. Now total you’ll have completed 180 repetitions daily.
  3. Repeat the two Alfredson protocol exercises twice daily – morning and evening.

You might feel pain on your calf muscles or soreness at the back of your ankles next to the Achilles’ tendon. However, the pain will reduce as you continue exercising week after week – but discontinue if the pain if unmanageable – in which case you’ll need to see your doctor.

Conclusion

Continue with the exercise protocol for 12 weeks to best outcomes. Over the 12 weeks, you may consult a physical therapist to determine when you can go back to your regular workout and sports such as running.

For example, the physical therapist could recommend plyometric exercises or balance exercises so that you can both jump and run without re-injuring your Achilles tendon.