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Alfredson's "prescription" for achilles tendinopathy

Discussion in 'Biomechanics, Sports and Foot orthoses' started by emoclew, Mar 30, 2006.

  1. emoclew

    emoclew Member


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    Can anybody please fill me in on the Anderson set of exercise for achilles tedinopthay? I really like the idea of use a set prescription as a starting point.

    Thanking you
    Lisa
     
  2. Atlas

    Atlas Well-Known Member


    Do you mean the old stanish & curwin program?
     
  3. GarethNZ

    GarethNZ Active Member

    I think that you might be meaning the Alfredson techinque. Single leg eccentric drop downs off a step...3x15 reps...

    have to fly so will explain later when I have some time

    G
     
  4. Admin2

    Admin2 Administrator Staff Member

    Alfredson’s Achilles workout
    From:
    http://www.sportsinjurybulletin.com/archive/achilles-tendonitis-1.html
     
  5. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Anderson "prescription" for achilles tendinopathy

    Eccentric exercise in treatment of Achilles tendinopathy
    Scandinavian Journal of Medicine & Science in Sports
    Volume 17 Issue 2 Page 133 - April 2007

     
  6. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    Eccentric training in Achilles tendinopathy: is it harmful to tendon microcirculation?
    Karsten Knobloch
    British Journal of Sports Medicine 2007;41:e2
     
  7. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review
    J J Kingma, R de Knikker, H M Wittink and T Takken
    British Journal of Sports Medicine 2007;41:e3
     
  8. Admin2

    Admin2 Administrator Staff Member

  9. Asher

    Asher Well-Known Member

    Re: Alfredson’s "prescription" for achilles tendinopathy

    Can anyone tell me where I can find pictures of the Alfredson's exercises that I can give to patients.

    Rebecca
     
  10. admin

    admin Administrator Staff Member

    Re: Alfredson’s "prescription" for achilles tendinopathy

    Try this Google images search.
     
  11. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    Chronic Achilles Tendinopathy: Prospective Randomized Study Comparing the Therapeutic Effect of Eccentric Training, the AirHeel Brace, and a Combination of Both
    Wolf Petersen, Robert Welp, and Dieter Rosenbaum,
    The American Journal of Sports Medicine 35:1659-1667 (2007)
     
  12. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    Eccentric calf muscle training in athletic patients with Achilles tendinopathy.
    Maffulli N, Walley G, Sayana MK, Longo UG, Denaro V.
    Disabil Rehabil. 2008 May 10:1-8. [Epub ahead of print]
     
  13. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study
    P Jonsson, H Alfredson, K Sunding, M Fahlström, J Cook
    British Journal of Sports Medicine 2008;42:746-749
     
  14. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    Eccentric calf muscle exercise produces a greater acute reduction in Achilles tendon thickness than concentric exercise
    Nicole L Grigg, Scott C Wearing, and James E Smeathers
    BJSM Published Online First: 19 November 2008
     
  15. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    Eccentric exercises for the management of tendinopathy of the main body of the Achilles tendon with or without the AirHeel Brace. A randomized controlled trial. A: effects on pain and microcirculation.Knobloch K, Schreibmueller L, Longo UG, Vogt PM.
    Disabil Rehabil. 2008;30(20-22):1685-91.
    Eccentric exercises for the management of tendinopathy of the main body of the Achilles tendon with or without an AirHeel Brace. A randomized controlled trial. B: Effects of compliance.Knobloch K, Schreibmueller L, Longo UG, Vogt PM.
    Disabil Rehabil. 2008;30(20-22):1692-6
     
  16. Wendy

    Wendy Active Member

    Re: Alfredson’s "prescription" for achilles tendinopathy

    I started to thank each posting but found it would be easier to just type thanks to Admin, Admin2 and Newsbot for all the info and to emoclew for starting the thread - very easy to incorporate into clinical practice.
    Wendy
     
  17. Foot Doc

    Foot Doc Active Member

    ALFREDSON ACHILLIES PROGRAMME

    {ADMIN NOTE: Threads merged}

    Hi all,

    How do we increase the weights in the alfredson programme? Is there a specific incrimental weight increase? or is it just a matter of increasing enough so that the exercises cause pain and when its no longer painful with that weight......increase the weight until it causes pain again? Is there no systematic way of increasing the weight is my question?????

    CHEERS TO ALL IN ADVANCE,


    FD
     
    Last edited by a moderator: May 29, 2009
  18. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    This clinical trial has just been registered:
    Resistance Training as Treatment of Achilles Tendinopathy
     
  19. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    Gender and eccentric training in Achilles mid-portion tendinopathy.
    Knobloch K, Schreibmueller L, Kraemer R, Jagodzinski M, Vogt PM, Redeker J.
    Knee Surg Sports Traumatol Arthrosc. 2009 Dec 9. [Epub ahead of print]
     
  20. LER

    LER Active Member

    Re: Alfredson’s "prescription" for achilles tendinopathy

    Check out the article in the November issue of Lower Extremity Review on a four part approach to treating achilles tendinopathy. This clinical strategy for Achilles tendinopathy includes massage techniques that apply pressure along injured soft tissues to promote healing, as well as Mulligan taping for the control of pronation and management of symptoms.
    http://lowerextremityreview.com/article/achilles-tendinopathy-a-four-part-approach
     
  21. jesspt

    jesspt Member

    Re: ALFREDSON ACHILLIES PROGRAMME

    I am not aware of any research that looked at a sytematic increase in resistance for the eccentric training program. Most physical therapists will use a back pack loaded with weights until pain is reproduced with th eccentric portion of the exercise.
     
  22. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    One-year follow-up of a randomised controlled trial on added splinting to eccentric exercises in chronic midportion Achilles tendinopathy
    S de Jonge, R J de Vos, H T M Van Schie, J A N Verhaar, A Weir, J L Tol
    Br J Sports Med doi:10.1136/bjsm.2008.052142
     
  23. newuser

    newuser Welcome New Poster

    Re: Alfredson’s "prescription" for achilles tendinopathy

    Hi, I had a query regarding the number of sets and repetitions of the Alfreson prescription.

    With weight lifting fewer reps at heavier weight are generally considered best for building muscle strength. It's also beneficial to train on alternate days for maximum strength gain.

    I was wondering why the Alfredson recommends exercising every day instead of alternate days?
    Is it because of differences in building muscle strength or tendon strength where tendons benefit from more regular training?

    Thanks
     
  24. Tipsytoes

    Tipsytoes Member

    Re: Alfredson’s "prescription" for achilles tendinopathy

    The point of the Alfredson program is not to strengthen the muscle, but more to stress the tendon so the body jumps in to beef it up. (jump-starting the repair process) That's why it doesn't follow the classic strengthening protocol.

    If you want the patient's body to get to work you need to convince them that they are nagging their tissues like a parent nagging a child to clean their room. Telling the kid every other day to clean the room is less effective than nagging them every two hours...

    Some patients like hearing the story of how Dr. Alfredson "discovered" the program named after him. They laugh, but it does seem to help them remember the purpose of the exercise protocol. (He was sharing a rural surgical coverage in Sweden. The other doctor didn't want to work on Dr. Alfredson's achilles because then he'd have to cover Dr. Alfredson's practice during the healing process, so Dr. Alfredson tried to stress his tendon enough to rupture it to force the other doctor to attend to him. Instead the increased stress convinced his body to repair it.)

    You can find some good pictures in "Treat your own strains, sprains, and bruises" by Lindsay, Watson, Hickmott, Broadfoot, and Bruynel. Some patients like to borrow the book, so it's nice to have an extra copy or two around.
     
  25. newuser

    newuser Welcome New Poster

    Re: Alfredson’s "prescription" for achilles tendinopathy

    Thanks for the reply and a great story!

    I guess it's not overusing the tendon as it's done in a way that doesn't cause micro tears, eg in the way playing a strenuous sport every single day would?

    In other words it's gradual stress rather than sudden trauma.
     
  26. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy
    A van der Plas et al
    Br J Sports Med doi:10.1136/bjsports-2011-090035
     
  27. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    Chronic Achilles tendinopathy treated with eccentric stretching program.
    Verrall G, Schofield S, Brustad T.
    Foot Ankle Int. 2011 Sep;32(9):843-9.
     
  28. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    Effect of Eccentric Strengthening on Pain, Muscle Strength, Endurance, and Functional Fitness Factors in Male Patients with Achilles Tendinopathy
    Yu, JaeHo PhD, PT; Park, DaeSung PhD, PT; Lee, GyuChang PhD, PT
    American Journal of Physical Medicine & Rehabilitation; 5 October 2012
     
  29. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    Effects of eccentric training on mechanical properties of the plantar flexor muscle-tendon complex
    Alexandre FOURÉ, Antoine NORDEZ, and Christophe CORNU
    Journal of Applied Physiology December 13, 2012
     
  30. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    Comparing two eccentric exercise programmes for the management of Achilles tendinopathy. A pilot trial
    Dimitrios Stasinopoulos, Pantelis Manias
    Journal of Bodywork and Movement Therapies Available online 12 December 2012
     
  31. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    COMPARING TWO ECCENTRIC EXERCISE PROGRAMMES FOR THE MANAGEMENT OF ACHILLES TENDINOPATHY. A PILOT TRIAL
    Dimitrios Stasinopoulos, Pantelis Manias
    Br J Sports Med 2013;47:e3
     
  32. wdd

    wdd Well-Known Member

    Re: Alfredson’s "prescription" for achilles tendinopathy

    I was wondering if any more consideration has been given to Alfredson's protocol for achilles tendonopathies?

    Is there any scientific or quasi scientific rationale for 3 sets and 15 repetitions with leg straight and 15 repetitions with leg bent?

    Did he give a suggested speed? Why did he select that speed?

    The only way in which the exercises seem to be progressive is in incre
     
  33. wdd

    wdd Well-Known Member

    Re: Alfredson’s "prescription" for achilles tendinopathy

    I was wondering if any more consideration has been given to Alfredson's protocol for achilles tendonopathies?

    Is there any scientific or quasi scientific rationale for 3 sets and 15 repetitions with leg straight and 15 repetitions with leg bent?

    Did he give a suggested speed? Why did he select that speed?

    The only way in which the exercises seem to be progressive is in increasing the weight over time.

    Has anyone modified them to make them more progressive over time, eg increasing velocity of heel drop, increasing the number of sets or repetitions or no. of times per day, progressively including a concentric component, etc?

    Bill
     
  34. Deka08

    Deka08 Active Member

    Re: Alfredson’s "prescription" for achilles tendinopathy

    Hi Bill,
    I found a slightly modified version which increases sets each week for 4 weeks. It also uses additional exercise (running) to load the tendon to a point of pain. I have good success with this (clinically - not conducting a high quality RCT) although I must say not always returning to 100%, patients are able to regain 90% of function, but struggle to shake the last 1 or 2 points on the VAPS.
    You are probably gonna ask me for the version I found. It's on the desktop of another work site, I won't be back there until Wednesday. I will try to remember to post it.
    I have no other help for your other questions but also find it interesting that there is no real increase in volume of reps/speed etc to allow for adaptation.

    As a side, eccentric exercises can be useful for similar patella tendon repair. Maybe nothing new there.

    As a second side, I recently came by some info regarding the use of vitamin C (not so new) and 1/2 a cup of jelly before exercises can assist in the rebuilding of tendon. If anyone has anything solid on this I would be keen for a read.

    Regards
    Derek Condon
     
  35. wdd

    wdd Well-Known Member

    Re: Alfredson’s "prescription" for achilles tendinopathy

    Hi Derek,

    If you do manage to get the modified Alfredson's it would be interesting to read it.

    Thanks,

    Bill
     
  36. Admin2

    Admin2 Administrator Staff Member

    Re: Alfredson’s "prescription" for achilles tendinopathy

    Effectiveness of the Alfredson's Protocol Compared With a Lower Repetition Volume Protocol for Mid-portion Achilles Tendinopathy: A Randomized Controlled Trial.
    Stevens M, Tan CW.
    J Orthop Sports Phys Ther. 2013 Nov 21.
     
  37. Blaise Dubois

    Blaise Dubois Active Member

  38. drsarbes

    drsarbes Well-Known Member

    Re: Alfredson’s "prescription" for achilles tendinopathy

    Just a side note re: Achilles tendinopathy, tendinitis, tendinosis....

    I have rarely, if ever, had a patient with a true Achilles Tendinopathy (tendinosis... pain and swelling at the watershed area) who was able to do even a single heel lift without considerable pain.
    Are we discussing a simple tendinitis or a true tendinopathy/tendinosis (these should be differentiated)



    Steve
     
    Last edited: Nov 26, 2013
  39. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    Eccentric exercise training in chronic mid-portion Achilles tendinopathy: A systematic review on different protocols
    B. Habets and R. E. H. van Cingel
    Scandinavian Journal of Medicine & Science in Sports; Early View
     
  40. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: Alfredson’s "prescription" for achilles tendinopathy

    THE EFFECTS OF CONVENTIONAL PHYSICAL THERAPY AND ECCENTRIC STRENGTHENING FOR INSERTIONAL ACHILLES TENDINOPATHY
    Margaret Kedia, et al
    Int J Sports Phys Ther. Aug 2014; 9(4): 488–497.
     
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