Recently a new published study in the BJSM from a group from the Netherlands (go Dutchies!) followed up with a group of achilles tendionpathy patients 5 years of they performed the excentric calf training, heel drop program. They found out that half of the patients (48,3%) had received one or more alternative treatments and 39,7% were completely pain-free (as measured on the VISA-A). Now thats not the cure it promised to be.
What makes this story interesting was that the original author of the protocol, doktor Alfredson actually suffered from achilles tendinopathy himself! Because he couldn't get sickleave he tried to make it worse by doing heavy eccentric heel drops at the gym... But he got better. When I applied the protocol to his patients 2/3 got better.
The theory behind it (proposed by Alfredson) is that the heel drops shears fatty tissue away from the tendon. Nerve ingrowth to the tendon, normally along with the new blood vessels stops at the sheath of the tendon en causes pain. By surgical or training away the fat you remove this.
The original Alfredson protocol, involves 2 different exercise: straight-leg and bent-leg heel drops. Start on your tiptoes, gradually lower your heel below the forefoot, then use the other leg (or your arms on a railing) to raise yourself back to the starting position. Do three sets of 15 reps of each exercise, twice a day for 12 weeks. When you feel no discomfort or next-day soreness from the program, add some weight in a backpack.
So what are your other options when suffering from achilles tendinopathy. A review from 2009 suggested that eccentric exercise have the most evidence of effectiveness in treatment of midportion Achilles tendinopathy. More investigation is needed into the utility of extracorporeal shockwave therapy, local corticosteroid treatments, injections of sclerosing agents or deproteinized hemodialysate, and topical glyceryl nitrate application. Thats not stuff you can do at home...
