Alfredson protocol for treatment of Achilles tendinosis

Eccentric exercises in Achilles Tendinopathy:

Eccentric stretching exercises should be an integral component of physiotherapy and can achieve a 40% reduction in pain. Moderate-level evidence favours eccentric exercise over concentric exercise for reducing pain. (1)

Eccentric exercises for chronic insertional Achilles tendinopathy are less effective in patients with metabolic syndrome but most effective when combined with extracorporeal shockwave therapy

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

• 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 pragmatic description of Eccentric Exercises for Achilles tendinopathy is provided below:

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Reference:

1. Wilson F, Walshe M, O'Dwyer T, Bennett K, Mockler D, Bleakley C. Exercise, orthoses and splinting for treating Achilles tendinopathy: a systematic review with meta-analysis. Br J Sports Med. 2018 Dec;52(24):1564-1574