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Achilles problems? Try the Alfredson protocol

This series of exercises will strengthen your Achilles tendon to get you back on the road after an injury

female runner injured

Achilles problems plague many runners, and injuries like Achilles tendonitis or Achilles tendinopathy can be frustratingly difficult to get rid of. The Alfredson protocol is commonly prescribed by physiotherapists to help heal and strengthen the injury-prone tendon, and should become a regular part of your strength training routine if you’re prone to Achilles problems.

Can you strengthen your Achilles?

The Achilles is a tendon, not a muscle, and has very little blood supply, which led many researchers in the past to believe that you couldn’t train them. This was distressing news to a lot of runners, especially those who suffer from frequent Achilles problems. After all, if you can’t train your Achilles, how can you heal it, or prevent it from becoming injured again in the future?

On top of that, your Achilles also impacts performance. If your tendon is longer and stiffer, it can store more energy, which is then released when you push off the ground with your toe. This makes you a more efficient and powerful runner. If you have a weak Achilles tendon but can’t train it, does this mean you’ll always be at a disadvantage?

The good news is, more recent research is showing that you can, in fact, train your Achilles tendon (take a look at this study in twins, which showed the Achilles tendon getting stronger after regular exercise). The bad news is that researchers and experts have not yet come to an agreement about how to train the Achilles effectively.

The Alfredson protocol

One thing that is widely supported by physiotherapists, however, is the Alfredson protocol. The Achilles is slow to adapt, so the program requires a minimum of 12 weeks to complete, and some runners may need to go even longer, depending on the condition of their Achilles when they started. Runners should do three sets of 15 repetitions for each exercise, twice daily, to achieve the best results. It’s important to note that if you have recently injured your Achilles, this protocol might be too intense right off the bat. Make sure you see a physiotherapist first, who can help you gradually build up your strength.

Follow these steps to perform the Alfredson protocol:

  1. Stand on the edge of a small step on the balls of your feet so that your heels are hanging over the edge, holding onto a railing or wall for balance.
  2. With your knees straight, lift your heels and rise up onto the balls of your feet.
  3. Leaving the foot of the injured/painful Achilles on the step, lift your other foot a couple of inches into the air.
  4. Slowly drop the heel of your injured Achilles toward the ground, keeping the ball of your foot planted firmly on the edge of the step.
  5. Return your non-injured foot to the step and repeat the process again.
  6. Once you’ve done three sets of 15 repetitions, repeat the entire process, with your knees slightly bent.

Some soreness or pain is acceptable when performing these exercises, but it shouldn’t be debilitating. Always listen to your body, and talk to your physiotherapist if you’re not sure if/when you should stop.