Refining Eccentric Exercise Protocols for Achilles Tendinopathy

Achilles tendinopathy, a chronic injury prevalent among diverse populations, particularly athletes, presents challenges in treatment due to repetitive stress on the Achilles tendon from activities. Conservative treatments, focusing on eccentric exercises, have garnered attention for their potential benefits, including collagen synthesis. The Alfredson program, a widely referenced intervention, involves patients performing maximal eccentric calf plantar flexion exercises, aiming for up to 180 repetitions daily over seven days. However, most studies employing this method have reported limited improvement in pain and functionality. Recent investigations have explored lower-intensity eccentric exercises with fewer repetitions, such as two variations of calf plantar flexion eccentric exercises in three sets of 15, performed twice weekly. Discontinuation of exercises due to pain, even with incomplete sets, and overall limited improvement in Achilles tendinopathy have been noted. Despite these studies, an effective protocol for Achilles tendinopathy remains elusive, crucial for facilitating a safe return to activity. Thus, this conceptual paper aims to review literature on eccentric exercise interventions for Achilles tendinopathy and to propose a comprehensive protocol for improving Achilles tendinopathy. A systematic literature search encompassing eight electronic databases was conducted. The findings of this paper suggest an effective protocol for an eccentric exercise program for improving Achilles tendinopathy. This protocol involves plantar flexion calf contraction with knee flexion and extension, comprising 90 repetitions per day and three sets of 15 repetitions, performed twice daily, five days a week, over a duration of 24 weeks.