Alfredson protocol for treatment of Achilles tendinosis

Eccentric exercises in Achilles Tendinopathy:

The Alfredson protocol is a program of eccentric heel-drop exercises for treating Achilles tendinopathies - the eccentric movement is the heel drop and so this is the movement when the exercise is benefitting the Achilles tendinopathy (and so performed slowly - see below)

• the protocol recommends completion of 180 eccentric repetitions a day (1)
  • currently, there is no strong rationale for this repetition volume
  • the Alfredson protocol requires patients to continue with the exercise even if pain is experienced
    • however, the patient is advised to stop if the pain becomes disabling
  • raises significant practical issues related to exercise adherence and treatment satisfaction, which may impact the overall treatment efficacy of the protocol
• a small study showed that performing a 6-week do-as-tolerated program of eccentric heel-drop exercises, compared to the recommended 180 repetitions per day, did not lead to lesser improvement for individuals with midportion Achilles tendinopathy(1)

A pragmatic description of Eccentric Exercises for Achilles tendinopathy is provided below (2,3):

Open Image in Modal

Open Image in Modal

Open Image in Modal

Reference:

• Stevens M, Tan CW. Effectiveness of the Alfredson protocol compared with a lower repetition-volume protocol for midportion Achilles tendinopathy: a randomized controlled. trial. J Orthop Sports Phys Ther. 2014 Feb;44(2):59-67
• Sheffield Primary Care Trust. Eccentric training for treatment of Achilles Tendinopathy (Accessed 3/3/2020)
• Somerset Partnership NHS Foundation Trust. Eccentric Heel Drop Exercise Protocol for mid tendon Achilles tendinopathy (Accessed 3/3/2020)