The Alfredson Protocol is the one training exercise I need the most (apart from Fem’s floor sitting exercises). The one exercise that keeps me running, given how little training I currently do. The one exercise that, if I miss out performing at least the day before my long run, usually results in Achilles Tendonopathy and Plantar Fasciitis after the run.
Plantar Fasciitis is a disorder that results in pain or tenderness in the heel or sole of the foot.
Achilles Tendonopathy is a condition that results in pain, swelling or stiffness of the Achilles Tendon, the tendon that joins the calf to the heel.
Both conditions are usually a result of over use or a sudden increase in training load without time for body adaptation.
Have a look at the Youtube videos that demonstrate the 2 variations of the Alfredson Protocol.
Three sets of 15 heel drops over a stair with a straight leg.
Three sets of 15 heel drops over a stair with a bent leg.
Twice a day; for 12 weeks.
With additional weights if the going is too easy.
You should still proceed with the exercises even if there is a little bit of pain involved.
As mentioned before, I basically use it as a maintenance procedure.
Understanding Achilles Tendonopathy
I have never quite understood how and why Alfredsons work until now.
Even our understanding of what is Achilles Tendonopathy has changed relatively recently.
Fifteen years ago I was told my Achilles Tendon was inflamed and that I needed to strengthen my calf muscles with the Alfredson Protocol.
But tendon tissue biopsies from Tendonopathy sufferers have shown little or no inflammation.
Now we know Achilles Tendonopathy is a result of cellular degeneration of the tendon.
How does the Alfredson Protocol work?
I couldn’t understand how all of a sudden my calf muscles were weak and needed strengthen when the weeks before I was running hills without problems.
I couldn’t understand how “calf raises” could possibly remedy the condition when I was roughly conducting 7000 calf raises for every 10 kilometres ran.
But the reason Alfredsons work is not from the ‘calf raise’ but the heel drop. Which leads us into the eccentricities of Alfredsons…
Eccentricity #1 – Eccentric Training
A concentric contraction is when the active muscle is shortens under load. This is the calf raise. This is the bicep curl.
An eccentric contraction is when the active muscle lengthens under load. This is the heel drop. This is the extension of the arm after a bicep curl.
Eccentric training is the repetitive use of eccentric contractions.
Unless you are running backwards downhill, you are not doing eccentric training while running.
Eccentricity #2 -Eccentric Training as Mechanotherapy
Mechanotherapy is movement therapy that induces stress on the cells to stimulate a chemical response
which promotes a structural change (tissue repair and remodelling).
Eccentric training is Mechanotherapy.
This is why Alfredsons work.
The Alfredson Protocol is eccentric training, not a calf strengthening exercise.
Eccentric training promotes tendon tissue repair.
Something else to note. If Alfredsons are not calf strengthening exercises, there is no need to perform both the straight leg and bend leg variations, one will suffice. I am assuming these were to target the gastrocnemius and the soleus muscles respectively. I think the more important thing is the number of repetitions to keep form will doing them.
Plantar Fasciitis results in micro tears in the fascia of the foot. And this is why the Alfredson Protocol also works in the recovery from Plantar Fasciitis.