Quick answer
Progressive tendon-loading exercise is a central treatment for chronic Achilles tendinopathy. Programs may use isometric, isotonic, eccentric, heavy-slow resistance and later energy-storage exercises depending on symptoms and goals.
Article
Beyond the Alfredson protocol
Eccentric heel drops have an important history in Achilles rehabilitation, but modern programs are not limited to one protocol. The key principle is progressive loading of the plantar-flexor complex.
Straight-knee and bent-knee work
Both gastrocnemius and soleus capacity matter. Straight- and bent-knee calf work can therefore be used, with load progressed from body weight to external resistance as appropriate.
Later-stage rehabilitation
A patient returning to running or court sport needs more than slow heel raises. Later stages may include faster loading, hopping, plyometric work and sport-specific exposure once strength and irritability permit.
Key points
- Loading at least several times per week is commonly used, but dose should be individualised.
- Insertional disease may initially require reduced dorsiflexion range.
- Calf strength and endurance deficits should be measured where possible.
Frequently Asked Questions
Are eccentric exercises still useful?
Yes, but they are one option within progressive loading rather than the only valid method.
How long should rehabilitation continue?
Often for several months, with progression based on symptoms, strength and functional goals.