Hi folks! We are here to help you get relief with your tendon pain! Athletes, people who spend extended periods of time on their feet, in fact almost everyone has experienced tendon pain. It’s that dull ache that you get at the very end of a musle near a bone, often accompanied by swelling. There is plenty of ways that we can talk about this abstractly, but digging into a specific example will serve us better.
Too Long Did Not Read
The purpose of the Alfredson protocol is to help you develop a relationship with discomfort while increasing your strength through an offending range of motion:
1. Do an exercise that targets your offending tendon
2. Optionally add weight to this exercise
3. Do 6-10 repetitions of that exercise
4. Aim to trigger a mild form of the discomfort
Let’s talk about your Achilles tendon. It’s the strongest tendon in your body, connecting your calf muscles to your heel bone. It plays a crucial role in walking, running, and jumping.
Achilles tendinopathy isn’t usually caused by a sudden injury. Instead, it often develops gradually due to overuse, repetitive strain, or sudden increases in activity without proper conditioning. Think of it like a rope that gets frayed over time with too much stress. This can lead to pain, stiffness, and sometimes swelling in and around the tendon.
Enter the Alfredson Protocol: Strength is Your Friend
The Alfredson Protocol, developed by Swedish orthopedic surgeon Håkan Alfredson, is a specific exercise program that focuses on eccentric strengthening of the calf muscles. Now, what exactly does “eccentric” mean?
Imagine doing a calf raise:
Concentric contraction: This is the action of your calf muscles shortening as you rise up onto your toes.
Eccentric contraction: This is the controlled lowering of your heel back down to the ground. Your calf muscles are lengthening while still under tension.
The Alfredson Protocol emphasizes this controlled lowering phase. Why? Because research has shown that eccentric exercises can stimulate tendon healing and help to reduce pain in tendinopathy. It’s thought that these exercises encourage the remodeling of the damaged tendon fibers, making them stronger and more resilient.
The Basic Principles of the Alfredson Protocol
Here’s the core of the Alfredson Protocol:
The Exercise: It involves performing calf raises with a straight knee, focusing specifically on the lowering (eccentric) phase.
Double Leg Raise, Single Leg Lower: You’ll typically start by rising up onto your toes using both legs (the healthy and the affected one). Then, you’ll slowly lower down only on the leg with the Achilles tendinopathy.
Progressive Overload: As your tendon gets stronger and your pain decreases, you’ll gradually increase the load. This can be done by adding weight (like a backpack with books) or by increasing the number of repetitions.
Frequency and Consistency: The protocol usually involves performing these exercises twice a day, 7 days a week, for a period of several months. Consistency is key!
Pain Monitoring: It’s normal to experience some pain during the exercises, but it shouldn’t be debilitating. Your physiotherapist will guide you on what level of pain is acceptable (often described as a tolerable pain level, around a 3-4 out of 10). The goal is to work through the pain to a certain extent, not to aggravate it significantly.
How Your Physiotherapist Will Apply the Protocol
Your physiotherapist plays a vital role in guiding you through the Alfredson Protocol. They will:
Assess your condition: They’ll properly diagnose your Achilles tendinopathy and rule out any other issues.
Teach you the correct technique: Proper form is crucial to get the most out of the exercises and avoid further irritation. They’ll show you exactly how to perform the calf raises and the controlled lowering.
Tailor the program to you: They’ll consider your pain levels, activity level, and overall fitness to design a program that’s right for you. This includes determining the initial number of sets and repetitions and how to gradually progress.
Monitor your progress: Regular check-ups will help them track your improvement and adjust the program as needed.
Address other contributing factors: Your physio might also work on other factors that could be contributing to your tendinopathy, such as calf muscle tightness, ankle mobility issues, or footwear.
Guide your return to activity: Once your pain has reduced and your tendon strength has improved, they’ll help you gradually and safely return to your usual activities.
Important Considerations
It takes time: The Alfredson Protocol is a long-term commitment. You likely won’t see immediate results, so patience and persistence are essential.
Listen to your body: While working through some pain is often part of the process, don’t push yourself too hard. If your pain becomes severe or persists for a long time after exercise, consult your physiotherapist.
This is not a one-size-fits-all approach: While the Alfredson Protocol is effective for many, your physiotherapist might incorporate other treatments like manual therapy, stretching, or load management strategies alongside it.
In Conclusion
The Alfredson Protocol offers a structured and evidence-based approach to managing Achilles tendinopathy. By consistently performing these specific eccentric exercises, you can work towards reducing your pain, strengthening your tendon, and getting back to the activities you love. Remember, it’s a journey, not a sprint, so stay patient and trust the process!