Effectiveness of the Alfredson’s Protocol Compared With a Lower Repetition Volume Protocol for Mid-portion Achilles Tendinopathy

The aim of this study was to compare the effectiveness of the Alfredson’s eccentric heel drop protocol with a “do-as-tolerated” protocol for non-athletic individuals with mid-portion Achilles tendinopathy. Background The Alfredson’s protocol recommends the completion of 180 eccentric heel drops a day. However, completing this large number of repetitions is time-consuming and possibly uncomfortable. There is a need to examine varying exercise dosages that minimize the discomfort yet retain the clinical benefits. Twenty-eight persons from outpatient physiotherapy departments were assigned at random to either the standard (n=15) or the “do-as-tolerated” (n=13) 6 week intervention protocol. Other than from repetition volume all other aspects of management were standardized between groups. Tendinopathy clinical severity was assessed with the Victoria Institute of Sports Assessment – Achilles (VISA-A) questionnaire. Pain intensity was assessed using a visual analogue scale (VAS). Both were assessed at weeks 0, 3, and 6. Treatment satisfaction was assessed at week 6. Adverse effects were also monitored. There was a statistically significant within-group improvement in VISA-A score for both groups (standard: P=.03; “do-as-tolerated”: P<.001) and VAS pain for the “do-as-tolerated” (P=.001) at week 6 based on the intention-to-treat analysis. There was a statistically significant between-group variation in VISA-A scores at week 3 based on both the intention-to-treat (P=.004) and per protocol analyses (P=.007), partly due to a within-group deterioration at week 3 for the standard group. There was no statistically significant between-group difference for VISA-A and VAS pain scores at week 6, completion of the intervention. There was no significant connection between satisfaction and treatment groups at week 6. No adverse effects were reported.

The study found that performing a 6-week “do-as-tolerated” program of eccentric heel drop exercises, compared to the recommended 180 repetitions per day, did not result in reduced improvement for individuals with mid-portion Achilles tendinopathy based on the VISA-A and VAS scores.