Achilles tendinopathy exercises — Alfredson protocol explained

Alfredson published the protocol in 1998 and twenty-five years of follow-up RCTs haven't beaten it. The mechanism: eccentric loading (lengthening under tension) stimulates collagen remodelling in the tendon matrix — concentric loading (shortening under tension) doesn't have the same effect. The protocol: stand on a step with the ball of your foot on the edge, heels hanging. Rise to tip-toes with both feet, shift weight to the affected side, slowly (3 seconds) lower below step level. Come back up with the OTHER foot. 3 sets of 15, twice a day, 12 weeks. Do half straight-knee (gastrocnemius bias) and half bent-knee (soleus bias) — the bent-knee variant uses a soleus raise. Tendons are slow to remodel; the protocol expects 4-6 weeks before meaningful change.

Two critical safety distinctions. First: this is for tendinopathy (degenerative), NOT for partial or full rupture. If you can't rise to a single-leg calf raise without sharp pain, see a clinician first to rule out a tear. Second: heavy slow resistance variants exist (Couppé et al.) but the original Alfredson protocol works for the vast majority — start there, escalate only if 12 weeks of strict adherence don't budge the symptoms. Volya catalogues eccentric-heel-drop and soleus-raise as separate entries with the protocol math baked into the form cues. For acute insertional cases (pain WHERE the tendon meets the heel bone, not 2-6 cm above it) modified protocols apply — see an orthopedic clinician.