Alfredson and colleagues tested whether heavy‑load eccentric calf training could relieve activity pain, restore calf strength and return recreational athletes with chronic Achilles tendinosis to running after conventional nonsurgical care had failed.
Prospective study of 15 recreational athletes with a 12‑week training program in Umeå, Sweden, set against 15 similar athletes treated conventionally and then surgically.
Methods
Design
Prospective cohort
Comparison group treated conventionally, then surgically
Data source
Sports Medicine Unit, University Hospital of Northern Sweden, Umeå
Patients
15 recreational athletes in the training group
12 men and 3 women, mean age 44.3
Chronic Achilles tendinosis with long symptom duration
Failed conventional nonsurgical treatment
15 comparison athletes with the same diagnosis, mean age 39.6
Exposure
Heavy‑load eccentric calf training twice daily, 7 days a week, for 12 weeks (n = 15)
Comparison: rest, NSAIDs, shoe changes or orthoses, physical therapy and ordinary training, then surgery (n = 15)
Follow-up
12 weeks in the training group
24 weeks after surgery in the comparison group
Outcomes
Activity pain on VAS
Concentric and eccentric plantar flexion strength vs uninjured side
Return to preinjury running
Key Findings
All 15 trained athletes returned to full preinjury running by 12 weeks, while conventional care failed in all 15 comparison athletes, and every one of them went on to surgery.
Activity pain on VAS fell from 81.2 to 4.8 mm over 12 weeks of training (p < 0.001), and in the surgical group from 71.8 to 21.2 mm at 24 weeks after surgery (p < 0.01).
Injured‑side calf strength started 11% to 18% below the uninjured side, rose significantly with training and no longer differed between sides at 12 weeks.
Trained athletes regained preinjury activity at 3 months, vs around 6 months after surgery in the comparison group.
No patient dropped out of the twice‑daily training program.
Board pearl
The Alfredson protocol uses 2 eccentric calf exercises, one with the knee straight and one with it bent, 3 sets of 15 each, twice daily, 7 days a week for 12 weeks, with load added in a backpack.
Authors' conclusion
Our treatment model with heavy-load eccentric calf muscle training has a very good short-term effect on athletes in their early forties.
Alfredson and colleagues tested whether heavy‑load eccentric calf training could relieve activity pain, restore calf strength and return recreational athletes with chronic Achilles tendinosis to running after conventional nonsurgical care had failed.
Prospective study of 15 recreational athletes with a 12‑week training program in Umeå, Sweden, set against 15 similar athletes treated conventionally and then surgically.
Methods
Design
Prospective cohort
Comparison group treated conventionally, then surgically
Data source
Sports Medicine Unit, University Hospital of Northern Sweden, Umeå
Patients
15 recreational athletes in the training group
12 men and 3 women, mean age 44.3
Chronic Achilles tendinosis with long symptom duration
Failed conventional nonsurgical treatment
15 comparison athletes with the same diagnosis, mean age 39.6
Exposure
Heavy‑load eccentric calf training twice daily, 7 days a week, for 12 weeks (n = 15)
Comparison: rest, NSAIDs, shoe changes or orthoses, physical therapy and ordinary training, then surgery (n = 15)
Follow-up
12 weeks in the training group
24 weeks after surgery in the comparison group
Outcomes
Activity pain on VAS
Concentric and eccentric plantar flexion strength vs uninjured side
Return to preinjury running
Key Findings
All 15 trained athletes returned to full preinjury running by 12 weeks, while conventional care failed in all 15 comparison athletes, and every one of them went on to surgery.
Activity pain on VAS fell from 81.2 to 4.8 mm over 12 weeks of training (p < 0.001), and in the surgical group from 71.8 to 21.2 mm at 24 weeks after surgery (p < 0.01).
Injured‑side calf strength started 11% to 18% below the uninjured side, rose significantly with training and no longer differed between sides at 12 weeks.
Trained athletes regained preinjury activity at 3 months, vs around 6 months after surgery in the comparison group.
No patient dropped out of the twice‑daily training program.
Board pearl
The Alfredson protocol uses 2 eccentric calf exercises, one with the knee straight and one with it bent, 3 sets of 15 each, twice daily, 7 days a week for 12 weeks, with load added in a backpack.
Authors' conclusion
Our treatment model with heavy-load eccentric calf muscle training has a very good short-term effect on athletes in their early forties.