On Track Physiotherapy


Alfredson Protocol for Achilles Tendinopathy

April 26, 2018

If you have ever experienced an achilles injury or dealt with chronic achilles re-injuries or tendinopathy chances are your physician may have recommended something called the Alfredson Protocol.

This is an aggressive loading program with the intent of building back the strength and capacity back up in the tendon so that it can withstand normal daily movement as well as the activity levels your more than likely looking to regain.

The Alfredson Protocol consists of 2 exercises performed for 3 sets of 15 reps that would be repeated 2x per day (which is a total of 180 reps every day).

This is one of the exercises below. There are ways to make this activity easier or more challenging depending on the clients symptoms, strength, and skill level.

Now I know what you are thinking….thats a lot of reps, and that is probably going to hurt!

The reality is that this is a protocol which is standardized for research purposes. Many people do not do well with this aggressive approach. This approach is modified or altered depending on location of achilles pain as well. The exercises for mid achilles tendon pain are different than insertion (or at base of heel).

Having seen numerous achilles tendon cases before, we at On Track Physio have found that while this strengthening approach certainly works, we also need a menu of exercises to choose from which allows the client to perform the activity comfortably.

Depending on your case and presentation we may also recommend less repetition or utilizing a heavier weight. This very much depends on the person.

Likewise, to make things even more comfortable, we have found that utilizing soft tissue techniques in conjunction with this will allow you to perform the exercise more comfortably. Below is a picture of cupping, which applies a distraction force to the tissue. This sensation seems to work better than compressive massage techniques possibly because achilles tendinopathy tend to be a repetitive compression based injury. In some instances we will perform dry needling, but not always.

The more comfortable you are able to perform the exercises, the more likely we can continue to progress the exercises and perform them on a daily basis. On a daily basis is a very important part of this process, which is why once we determine the correct exercise for you, it’s just a matter of doing it. We do not need to see you very often, we just need YOU to do the exercise daily and remove or modify the aggravating factors (something we will also help you do). Our goal is never to stop you from being active, however we may need to modify things slightly so that it gives the tendon a chance to recover.

To learn more about how we can help you with this process, apply for a free discovery session.

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

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