Achilles Tendonitis

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This is pain and swelling of the Achilles tendon, which connects your heel to your calf muscles.


The main symptom is pain and stiffness at the back of your ankle. The pain is usually worse first thing in the morning, or after you have been inactive. Initially you might have pain at the start and finish of your exercise, but this pain goes away when exercising. Without treatment you may get constant pain while exercising. You may also have some swelling and tenderness. If you have sudden pain in your heel or calf, and it becomes swollen, bruised and very painful, you may have completely torn your Achilles tendon. If this happens, seek urgent medical attention.


It is an overuse injury which can be caused by rapid mileage increase, improper footwear and/or tight calf muscles.


Gentle stretching and progressive eccentric loading of the Achilles’ tendon is necessary.  

The Alfredson Protocol 

The method used to progressively eccentrically load your injured Achilles’ tendon. Eccentric loading of a tendon occurs when your muscle and tendon are contracting as you are lengthening the muscle.

Exercises:There are two separate exercises.


  • Stand on a step, the balls of your feet on the edge. Your heels hanging over the edge.
  • Lightly hold onto something stable for balance (try to get to the stage of not needing to hold anything).
  • Keep both knees straight.
  • Using both feet, rise up onto the balls of your feet.
  • Keep your foot with the injured tendon on the step, and lift your non-injured foot off the step.
  • Slowly lower yourself down using your injured ankle. Your heel should move towards the floor, then below the edge of the step, the ball of your foot stays in contact with the edge of the step.
  • Return your non-injured foot to the step and with both feet on the edge of the step, repeat.

Complete 3 sets of 15 repetitions.  This exercise loads your gastrocnemius calf muscle.


Repeat with your knees bent.  This loads the soleus muscle.  Again, perform 3 sets of 15 repetitions.

Both exercises need to be performed twice daily.  So you must complete 3 sets of 15 repetitions of the straight knee and bent knee heel lowering exercises, morning and in the evening.  A total of 180 reps.

As with Jumper’s Knee you need to progressively eccentrically load your injured tendon to treat it. You need to continue doing the exercises even when it causes moderate pain (stop if the pain becomes extreme), and once the exercise is painless you need to progressively add weight (such as dumbbells or weights in a backpack) once you can complete the basic 3×15 exercise twice per day without pain. The Alfredson Protocol states that you continue with the exercises unless any pain it causes becomes disabling.  If this occurs, consult your doctor.

The Alfredson Protocol must be continued for 12 weeks for best results.