What are the symptoms?
Achilles tendinopathy symptoms generally develop gradually and include pain around the Achilles tendon and back of the heel. This pain is worse in the morning and decreases once you get walking and moving. The discomfort usually goes away during an activity and re-appears an hour or two after.
Why Does It Happen
Achilles injuries occur when the load placed on the tendon exceeds the tendons ability to withstand that load. Some factors that predispose to Achilles tendinopathy include:
- A sudden increase in activity
- Decreased recovery time between training sessions
- Change in footwear
- Excessive arch collapse
- Calf weakness/ tightness
- Decreased ankle range of motion
What is the treatment?
Not Just Rest & Ice!
Treatment involves addressing the factors mentioned above as well as increasing the tendon’s ability to withstand load. The common advice of resting and icing often won’t fix Achilles symptoms. Although a short period of rest and ice may be beneficial after an acute Achilles injury, it is not effective at getting rid of the injury long term. The pain will mostly go away with rest but as soon as you return to activity it will come right back unless we improve the tendon’s capacity for loading. So how can we increase the strength of the tendon? One of the most well-known and researched ways is by performing heel drops.
Dr. Alfredson accidently discovered that heel drops were beneficial in the 1990’s. His boss wouldn’t allow him to go for Achilles surgery because the clinic couldn’t afford to give him the time off and his condition wasn’t serious enough yet. In order to worsen his injury and get the surgery he attempted to aggravate his Achilles symptoms using heel drops. Instead of making his heel pain worse his symptoms disappeared, and he discovered a new treatment approach. His protocol involves performing 180 heel drops per day!
To perform the exercises:
Start on your toes on the edge of a step (A)
Slowly lower the heel on the injured leg (B), (C)
To return to the starting position use the uninjured leg or your arms for support. You should only be performing the lowering part of the exercise with the injured leg. This protocol was tested in a 12-week study where participants performed 3 x 15 repetitions twice per day with the knee extended, and another 3 x 15 repetitions twice per day with the knee flexed. Both exercises were performed 7 days per week. Be warned that it is common to have some pain and discomfort when performing the heel drops especially during the first couple weeks of performing this exercise. Although the exercises may be painful, they are very effective at strengthening the Achilles tendon and relieving symptoms long term.
The results of Dr. Alfredson’s study showed that:
“82% of patients who performed the heel drops went back to their previous level of activity where as only 36% of those doing regular heel raises were able to do the same.”
If you are dealing with chronic Achilles Tendonopathy that doesn’t seem to go away… you’ve tried resting, icing and anti-inflammatories… and every time you return to activity the heel pain returns, it may be time to try a different approach. The Alfredson protocol is an effective way to load the Achilles tendon, improving its strength and resiliency for long-term health and recovery.
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Thanks for reading!
Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy‐load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26(3):360‐66.
Brukner, P. (2012). Brukner & Khan's clinical sports medicine. North Ryde: McGraw-Hill.