Amazing Swedish Eccentric Training for Persistent Achilles Tendonitis

Reference:Alfredson H, et al Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998 May-Jun;26(3):360-6.

This Swedish study looked at the effect of heavy-load eccentric calf muscle training in recreational athletes who had the diagnosis of chronic Achilles tendinosis not responsive to past conservative treatments (i.e. rest, NSAIDs, changes of shoes or orthoses, physical therapy). All patients had Achilles tendon pain not allowing them to run, and all had significantly lower eccentric and concentric calf muscle strength on the injured compared with the non-injured side.

After 12-weeks of heavy eccentric training, all the patients were back at their pre-injury levels with full running activity.Their calf muscle strength on the injured side had increased significantly and no longer differed from that of the non-injured side. Meanwhile, none of the patients in the control group improved within the same time period.

So what exactly was the Exercise Program?

Two eccentric workouts were performed per day, seven days a week, for 12 weeks. Normal running training was advised only if it produced no significant pain or only mild discomfort.

Exercise #1: Stand on the edge of a step with both forefeet, and with primarily the help of the non-injured leg rise up onto the forefeet. Then raise the non-injured foot. Slowly and eccentrically come down using the single leg until the heel of the hurt leg is below the edge of the step. Perform 3 sets of 15 repetitions.

Exercise #2: Exactly as before, except this time bend the knee slightly to bias the soleus muscle. Perform another 3 sets of 15 repetitions.

Progression: When the eccentric exercises can be performed easily without any discomfort, increase the load by adding weight placed in a backpack.

In summary: Amazingly, Achilles tendon pain is mostly felt during the concentric phase, which can easily be fully controlled by assistance from the unaffected leg. Focus on maximal slow eccentric contraction.

Posted on: March 27, 2010

Categories: Foot & Ankle

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