Achilles’ Tendonitis? Time to work into the pain

Achilles tendonitis protocol

Achilles tendonitis can be an annoying thing to deal with. As a Chiropractor/ Athletic Therapist I have a number of athletes (Runners, Triathletes, Crossfit athletes etc) that come to me for Achilles’ tendonitis. A better term for it is Achilles’ tendonopathy because there doesn’t appear to be any inflammation that is occurring. Achilles’s tendonopathy often can be frustrating because you can stop activity and have the pain disappear but then it will come back when the activity is reintroduced.

I have seen success with using Active Release Techniques, acupuncture, stretching, assessing and treating for hypomobility and joint instability as well as movement mechanics when treating Achilles’ tendonitis. Not everything works for everyone. So what can I give my patients that they can do for themselves? The Alfredson protocol may be helpful, if you can handle working through the pain.

The Alfredson Achilles’ tendonitis protocol goes like this:

Type of exercise: 180 slow heel drops off a step/ledge performed daily (increase speed of drop or weight as pain diminishes)
Duration: 12 weeks (some people may need to continue beyond this)

Note: I recently (August 20, 2013) discovered more about the protocol.  The protocol involved using 3 sets of 15 repetitions with the knee fully extended and 3 sets of 15 repetitions with the knee partially flexed. This program was repeated twice daily, every day for 12 wk. Producing patients’ tendon pain during the exercises was expected, but patients were told that pain should not be progressive or disabling. Additional resistance was added (e.g., by wearing a back pack with weights) when the exercises became easier

The key to this protocol is that you will experience pain while performing this exercise. Now this seems to be backwards to what most therapists would say for treating Achilles’s tendonitis/tendonopathy but the research has shown that for those who have mid-tendon pain 90% of them will have success with the protocol. If you have pain at the insertion into the heel though the success rate is only 30?

After a 1 to 5 year follow up 39.7% of the patients were completely pain-free and 48.3% had received one or more alternative treatments. Also, the thickness of the tendon decreased and the structure of the tendon appeared normal.

Now this is all and good but 180 calf raises daily? How many people will be compliant? Can similar results be made performing less aggressive approaches? The research has found using 3 sets of 15 to have a tendency towards being beneficial but it has not been compared to 180 repetitions a day.
So for now this seems to be the most effective method.

I have been suffering with this problem on and off for years. I think it’s time for me to do the protocol.

Have you tried this method?

If you haven’t tried then talk to your healthcare provider about the method. If you do try it leave me a comment.

Dr Notley
Winnipeg’s only dual credentialed Chiropractor and Athletic Therapist

References
http://bjsportmed.com/content/46/3/214.abstract
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658946/
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.2009.00981.x/full
http://img2.tapuz.co.il/forums/1_115845356.pdf

2 thoughts on “Achilles’ Tendonitis? Time to work into the pain

    • I find my patients need to work themselves into the program. Some actually manage to do the 180 others might end up doing half or every other day

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