This protocol for achilles tendon repair work is developed to supply the rehab professional with a basic standard for patient care. Eccentric exercises for the calf muscles have been shown to be e. A proposed returntosport program for patients with. Achilles tendinopathy is a relatively common soft tissue injury that can affect both athletes and. In the achilles tendon, activity pain in the treatment group was reduced at 12 and 24 weeks compared with placebo, and it also improved outcomes at 6 months. Pdf eccentric loading for achilles tendinopathy strengthening or. Eccentric loading involves isolated, slow lengthening muscle contractions. Whilst doing your eccentric exercises you should expect your pain levels to be 34 out of 10. Avoid all passive motion into df for 1st 6 weeks postop 3. The goal is to improve your ankle and calf strength and to help the injured tissue heal properly. Midportion achilles tendinopathy at is a common overuse injury, usually requiring several months of rehabilitation. It attaches your two calf muscles gastrocnemius and soleus to the heel bone calcaneus and helps you go up onto tiptoes. The hakan alfredsons heel drop protocol involves twice daily exercises for 12 weeks.
Avoid creating pain discomfort is okay but pain should not occur and persist 3 days in a row. Department of physiotherapy department of sport and. Achilles tendonitis exercises hakan alfredsons heel. Pdf eccentric exercises for the calf muscles have been shown to be effective for chronic noninsertional achilles tendinopathy at. Achilles repair rehabilitation protocol key considerations. Phased achilles tendon loading program as per silbernagel et al. Twin cities orthopedics foot and ankle surgery preop.
Achilles tendonitis exercises hakan alfredsons heel drop. It is found at the back of the lower leg, just above the heel bone. Strazzulla 1 1 program in physical therapy, department of health, human function and rehabilitation sciences. Activities such as walking, running or jumping places stress on the tendon which can lead to over use, inflammation and small tears. No one has the cure for achilles tendon problems, but the nonsurgical approach with the best evidence is a 12week program of heel. Formerly referred to as achilles tendinitis, achilles tendinopathy is an overload condition leading to the development of heel pain.
It attaches the calf muscles soleus and gastrocnemius to the heel bone calcaneus. This guide demonstrates exactly how to perform certain eccentric calf strengthening exercises as part of your rehabilitation while managing your achilles tendinitis pain. Rom should be measure in both open and closedchain methods. As such, it should be stressed that this is only a protocol and should not be a substitute. G t allison,1,2 c purdam3 1 school of physiotherapy, curtin university, perth, australia. Achilles tendinopathy can be described as an insertional or midportion, the difference. Rehabilitation guidelines for achilles tendon repair the achilles tendon is the strongest and thickest tendon in the body. If both of these factors are important, one may question whether the generic eccentric programmes can be generalised to other tendons in other parts of the body. Unilateral toe raises, eccentric bilateral heel raises foot flat.
Alfredson versus silbernagel exercise therapy in chronic. Achilles tendinopathy is a common cause of pain on the backside of the heel, especially in athletes who frequently run and jump. Achilles heeldrop protocol for midsubstance achilles. Specific intervention should be based on the needs of the individual and should consider exam findings and clinical decision making. Effectiveness of the alfredson protocol compared with a lower. The optimal protocol using eccentric exercises for midportion achilles tendinopathy has to be established yet. Chronic achilles tendon pain treated with eccentric calmuscle training. Jul 15, 2019 the alfredson protocol is a specialized exercise program for people with achilles tendonitis or tendinopathy.
Pdf eccentric exercise protocols for chronic noninsertional. A 5year followup study of alfredsons heeldrop exercise. Exercise as treatment the use of exercise as a treatment for achilles tendinopathy involves 2 important clinical questions. Alfredsons isolated eccentric and silbernagels combined concentriceccentric exercise programs have both shown beneficial results, but it is unknown whether any of these programs is superior for use. Effects of lowlevel laser therapy and eccentric exercises. Achilles tendon rupture conservative treatment protocol. Achilles tendon rupture repair return to sport protocol keys for achilles tendon rehabilitation. Shock wave therapy associated with eccentric strengthening versus isolated eccentric strengthening for achilles insertional tendinopathy treatment. Standing with back of foot over a ledge, begin with all weight up on forefoot and calf muscles flexed standing up on toes. As such, it must be stressed that this is just a protocol and needs to not be a substitute for expert clinical decisionmaking regarding a patients development. Alfredson protocol for achilles tendionopathy youtube. Eccentric exercises for the calf muscles have been shown to be effective for chronic noninsertional achilles tendinopathy at. Achilles tendon is the biggest and strongest tendon in the body. Rehabilitation exercises for achilles tendinopathy michael.
Nonoperative treatment of achilles tendon ruptures phase. The alfredson protocol eccentrically loading is an exercise program for people with midportion achilles tendinopathy at. Continued sports activity using a pain monitoring model during rehabilitation in patients with achilles tendinopathy. This particular type of controlled exercise helps your swollen achilles tendon return to normal and forms the main component of the rehabilitation programme see. Effectiveness of the alfredson protocol compared with a.
Rehabilitation protocol for achilles tendon repair this protocol is intended to guide clinicians and patients through the postoperative course for an achilles tendon repair. It uses the concept of eccentric loading of your achilles tendon to improve the tendons ability to withstand forces and stressors. Jul 11, 2017 midportion achilles tendinopathy at is a common overuse injury, usually requiring several months of rehabilitation. Nov 08, 2019 achilles tendonitis heel drop exercises have proven to be very successful for chronic achilles tendon pain. Achilles tendinopathy is a disease process characterized by pain in the posterior part of the. If it does, rest the patient until pain level is clearly decreasing. Achilles and patellar tendinopathy loading programmes. It has been widely adopted in research and clinical practice. Eccentric heel raises standing on the floor 3 sets of 10. Mar 15, 2016 this protocol for achilles tendon repair work is developed to supply the rehab professional with a basic standard for patient care.
Rehabilitation guidelines for achilles tendon repair. A treatment algorithm for managing achilles tendinopathy. Eccentric interventions for achilles tendinopathy lower. Eccentric exercises have long been the standard treatment approach for tendinopathy. Eccentric interventions for achilles tendinopathy multiple descriptive studies have demonstrated the clinical benefits of eccentric exercise interventions in patients with achilles tendinopathy, but researchers have not yet identified the causeandeffect mechanisms leading to decreased pain or increased function. Eccentric musculotendinous loading has become the dominant conservative intervention strategy for achilles and patellar tendinopathy over the last two decades. It comprises bentleg and straightleg heel drops while the athlete is at one edge of a step. Open access protocol shock wave therapy associated with. This comprised any type of muscletendon unit loading, including eccentric, concentric, combined eccentric concentric, isometric and stretchshortening cycle ssc, loading involving a fast muscle tendon unit eccentricconcentric turnaround e. The evidence suggests that the eccentric loading profiles are clinically more efficacious at the ankle joint than at other. The alfredson protocol calls for performing this exercise for 3 sets of 15 repetitions. Eccentric loading for achilles tendinopathy strengthening. Department of physiotherapy department of sport and exercise. Massage the tendon with your figers achilles tendonitis.
A total of 60 patients with at were randomized into 3 groups. Dec 29, 2019 achilles tendon is the biggest and strongest tendon in the body. The ideal is to achieve full symmetry in all 3 areas. Achilles eccentric heavy load protocol nj sports medicine. Background eccentric exercises have the most evidence in conservative treatment of midportion achilles tendinopathy. Eccentric training for the treatment of tendinopathies. This video contains the two exercises that are part of the alfredson protocol for achilles tendinopahty.
The achilles tendon is the thick tendon above the heel that attaches the calf muscles to the heel bone. Achilles tendonitis heel drop exercises have proven to be very successful for chronic achilles tendon pain. Alfredson achilles tendinopathy rehab protocol youtube. Insertional and midsubstance achilles tendinopathies. Eccentric loading for achilles tendinopathy strengthening or stretching. When performing the exercise with your knees straight, a specific muscle that makes up the achilles tendon called the gastrocnemius is loaded and challenged. Heavyload eccentric calf muscle training for the treatment of chronic achilles tendinosis. The tendon transmits force from the contracting calf muscles to the calcaneus to cause the foot action of plantar. Clinical improvement after 6 weeks of eccentric exercise in patients with midportion achilles tendinopathy a randomized trial with 1 year follow up.
Achilles tendinopathy achilles tendinopathy is an overuse injury characterized by a combination of pain, swelling diffuse or localized, and impaired performance. Efficacy of customised foot orthoses in the treatment of achilles tendinopathy. Feb 12, 2016 this video contains the two exercises that are part of the alfredson protocol for achilles tendinopahty. Achilles tendon rehabilitation protocol jeffrey seybold, m. Calf girth, plantar flexor strength and ankle rom are all keys to full recovery. The alfredson protocol for achilles tendonitis verywell health. Achilles tendinopathy achilles heeldrop protocol for mid.
Achilles heeldrop protocol for midsubstance achilles tendinitis. Alfredsons isolated eccentric and silbernagels combined concentriceccentric exercise programs have both shown beneficial results, but it is. Rehabilitation protocol general principles this protocol for achilles tendon repair is designed to provide the rehabilitation professional with a general guideline for patient care with the alterg antigravity treadmill. Eccentric calf strengthening for achilles tendinopathy. The primary hypothesis is that adjunctive shock wave therapy will mitigate pain and improve function as compared to placebo. Such exercises have some degree of clinical utility in comparison with concentric training and are often referred to as a strengthening programme. Week 2 postop splint is removed and removable boot is applied with heel lifts to maintain 20 plantarflexion weight bearing is initiated and progressed as tolerated typically advance 2550%. Oct 17, 2018 achilles tendinopathy is a common cause of pain on the backside of the heel, especially in athletes who frequently run and jump. Effects of lowlevel laser therapy and eccentric exercises in the treatment of recreational athletes with chronic achilles tendinopathy. Alfredson protocol eccentric for achilles tendinopathy. Aim to evaluate the 5year outcome of patients with chronic midportion achilles tendinopathy treated with the classical alfredsons heeldrop. Overuse injuries involving the achilles tendon are com mon, especially among. The alfredson protocol is a specialized exercise program for people with achilles tendonitis or tendinopathy. Alfredson versus silbernagel exercise therapy in chronic midportion achilles tendinopathy.
Achilles tendon rupture repair return to sport protocol. Eccentric exercise protocols for chronic noninsertional. Rehabilitation exercises for achilles tendinopathy. More recent studies have used patients with achilles tendon pathology and have attempted to examine changes occurring to the tendon and the gastrocnemiussoleus complex with eccentric biased strengthening programs. Alfredsons isolated eccentric and silbernagels combined concentriceccentric exercise programs have both shown beneficial. A total of 52 recreational athletes with chronic achilles. Feb 18, 2012 no one has the cure for achilles tendon problems, but the nonsurgical approach with the best evidence is a 12week program of heel drops that strengthen the calf eccentrically. Heavyload eccentric calf muscle training for the treatment of chronic achilles tendinosis article pdf available in the american journal of sports medicine 263. As such, it must be stressed that this is just a protocol and needs to not be a substitute for expert clinical decisionmaking regarding a. Strengthening program with progression to eccentric program and use of a step 6 resumption of sports or recreational activities. April 20, 2012 page 1 appendix a achilles tendinopathy. Alfredson created an achilles rehabilitation program based on eccentric exercises but made three innovations. Week 2 postop splint is removed and removable boot is applied with heel lifts to maintain.
Materials and methods fifteen consecutive recreational athletes 12 men and 3 women. Pdf heavyload eccentric calf muscle training for the. Some years later, alfredson in the first published study on a patient material created a successful protocol of eccentric training of calf muscles to treat chronic achilles tendinopathy. Medical and surgical interventions manual therapy carcia et al. Although shortterm studies show significant improvement, little is known of the longterm 3 years results. Alfredsons protocol consisted of a 12week program where the subjects performed solely eccentric strengthening exercises three sets of 15. Perform exercises every day and with heavier load 2.