Alfredson Protocol for Achilles Tendinitis

The Alfredson Protocol is an exercise program for people with Achilles tendinitis (tendinopathy). These exercises stretch your Achilles tendon in a way that helps it better handle force and stress. This is called “eccentric loading”.

If you have Achilles tendonitis, walking and running can be painful. You may have to stop doing fun activities like exercise. Depending on your job, having this condition may even make it harder for you to work.

This article will introduce you to Alfredson’s protocol for treating Achilles tendinitis. You’ll learn about the situation and how practice can help.

What do tendons do?

Achilles tendinitis basics

Achilles tendonitis occurs when the Achilles tendon at the back of the ankle is injured. This is common among runners. Here are some signs and symptoms of the disease:

  • Pain in the back of the calf, just above the heel
  • Pain when running, jumping, or resisting resistance with your toes
  • A small lump on the Achilles tendon just above the heel

If you think you have injured your Achilles tendon, the only way to be sure is to see a doctor.

What causes Achilles tendon pain?

Tendonitis or tendinopathy?

In medical language, the term “tendinitis” means “inflammation of the tendon.” However, research suggests that people with this condition may not have inflammation in their tendons.

When a part of the body becomes inflamed, inflammatory cells appear in it. People often experience pain in inflamed body parts. If you have Achilles tendonitis, your Achilles tendon can be injured. However, this may not be due to inflammation of the tendon.

In 2014, researchers looked at tendon tissue from people with Achilles tendinitis under a microscope. They didn’t see any inflammatory cells in the tissue. This means that even if people feel pain in the tendon, it is not inflamed.

The word “disease” is at the end of a medical word and means “disease”. so, Achilles tendinopathy is a more accurate name for the condition, especially when someone has the condition for more than a few weeks (chronic). However, your doctor or physical therapist may still call it Achilles tendonitis.

If there are no inflammatory cells in the tendon, this could explain why people with Achilles tendinopathy often don’t get relief from anti-inflammatory treatments. This includes drugs like ibuprofen, which are non-steroidal anti-inflammatory drugs (NSAIDs).

READ ALSO:  Pectus excavatum physical therapy exercises

However, there are ways to relieve pain from Achilles tendonitis. Studies show that if you have this condition, gentle exercise and “eccentric loading” of the tendons can help more than other types of exercise. However, researchers aren’t sure why these exercises are so useful.

What is centrifugal exercise?

If your Achilles tendon is injured, a physical therapist can help you manage the injury. They can help you make your tendons stronger once you start to heal. You’ll start with easy exercises slowly and work your way up to harder ones.

First, your physical therapist will teach you “eccentric loading” exercises. They make you stretch (lengthen) your muscles. When you do this movement, the muscles and tendons shorten (contract).

For example: hold something in your hand with your elbows slightly bent. While you are still holding the item, slowly straighten your elbows. Your biceps will lengthen as you hold and slowly straighten your elbows.

What you are seeing is an eccentric contraction or eccentric loading of the biceps.


“Eccentric loading” exercises work your muscles and tendons to help them get stronger. The movements you do in the Alfredson program are eccentric loading exercises that target your Achilles tendon and the muscles that support it.

How Physical Therapy Works

Alfredson Protocol Exercise

You will need to consult your doctor or physical therapist before doing any exercise on the tendon. They can let you know if it’s safe to try them. If they say it’s ok, here’s how to implement the Alfredson protocol:

  1. First, you need a small step or curb that you can stand on.
  2. Stand on the steps with the balls of your feet on the edge. Your heels should hang over the edge of the step.
  3. Hold onto something stable for balance.
  4. Keep your knees straight. This loads a muscle that is part of the Achilles tendon, called the gastrocnemius.
  5. Use both feet to lift the heels and lift the balls of the feet.
  6. Keep the foot on the step with the sore Achilles tendon. Lift the uninjured foot off the step.
  7. Slowly lower yourself with the injured ankle. Your heels should move toward the floor. The balls of your feet should be in contact with the edge of the step.
  8. Return the uninjured foot to the step and repeat the exercise.

You’ll do three sets of 15 reps with your knees straight. You can then perform the Alfredson protocol again with a slight bend in the knee.This will work a muscle called the soleus, which connects to the gastrocnemius And get your Achilles tendon. Again, perform three sets of 15 repetitions.

You should perform both of these exercises according to the Alfredson protocol twice a day. You may want to do it in the morning and evening. Whenever you choose to do this, you will perform three sets of 15 reps with your knees straight and three sets of 15 reps with your knees bent. In total, you will perform 180 repetitions per day.

how would you feel

You may feel soreness or pain in the back of your ankle in your Achilles tendon after starting the exercise. Your calf muscles may also be injured. This pain will last for about a day. You will feel less pain as you progress over the next few weeks.

You should keep practicing unless the pain becomes too great to continue. If this happens, call your doctor or physical therapist.

While research shows that the Alfredson protocol works for many people, that doesn’t mean it’s easy to stick to. Some people find that 180 repetitions is too much.

That said, you don’t have to give up the practice entirely. Research shows that taking a “do as much as possible” approach can still help people. It might even help with 180 full repetitions a day.

How long does the Alfredson protocol take to execute

The Alfredson protocol is most beneficial if you stick to it for about 12 weeks. However, when you reach that point, don’t immediately jump back to your old routine.

Ask your physical therapist when you can start doing things like running. They can make sure you’re ready and won’t hurt your Achilles again when you go back to old habits.

For example, they might have you use a BAPS board for balance and plyometric exercises.


The Alfredson protocol consists of two exercises that you will perform daily for 12 weeks. You’ll be doing Achilles-strengthening exercises 180 times a day.

At first, you may feel pain. This discomfort will get better over time. However, if doing these exercises is really painful, stop the exercises and tell your doctor or physical therapist right away.

If you can’t do 180 repetitions a day, you can do simpler exercises instead.

How to use the BAPS board


The Alfredson protocol includes exercises that provide an eccentric load to your Achilles tendon. It is used to treat a painful condition called Achilles tendinopathy.

These exercises work your Achilles tendon and the muscles that support it. You don’t need any special equipment and you don’t need to go to the gym. You can do this exercise at home as long as you have a step or raised platform that you can safely step on.

You’ll need to do the exercise daily (including 180 repetitions) for about 12 weeks to see the full benefits. If this is too much, ask your physical therapist if modifications can be made.

VigorTip words

If your Achilles tendon is injured, make an appointment with your doctor. If they think you have Achilles tendonitis, the next step may be to work with a physical therapist.

A physical therapist can show you how to perform the Alfredson protocol, which research shows is helpful for people with this condition. They can also show you how to perform other types of exercises to strengthen the tendons and get you back to your favorite activities.

Do you need surgery if you tear your Achilles tendon?

Frequently Asked Questions

  • How do you treat Achilles tendonitis?

    The first line of treatment is rest and ice to the tendon. Anti-inflammatory medications can help reduce pain. Exercises that stretch nearby muscles also help gradually increase the amount of pressure the tendon can withstand, ultimately reducing inflammation and swelling.

    understand more:

    Types of overuse injuries

  • What is the Alfredson Agreement?

    The Alfredson protocol is a series of eccentric exercises in which slow movements focus on prolonging muscle contractions in specific muscles. These protocols include heel drop exercises to help relieve Achilles tendon pain.

    understand more:

    Causes of Achilles Tendon Pain

  • What type of physical therapy can help with Achilles tendon injuries?

    Stretching and flexibility exercises help the Achilles tendon heal. PT may also include strengthening exercises, ultrasonic heat therapy, and deep massage.

    understand more:

    Benefits of Physical Therapy Massage