What is the Alfredson Protocol

It's an injury update video. No, no injuries. We do this from time to time because injuries, unfortunately, seem to be an inevitability for the vast majority of us. Something like 70% of runners get injured at some point during their year.

It's an injury update video. No, no injuries. We do this from time to time because injuries, unfortunately, seem to be an inevitability for the vast majority of us. Something like 70% of runners get injured at some point during their year. So we each deal with different things. And today we're going to be talking about Achilles tendonitis or Achilles tendinopathy and in particular, what is the Alfredson protocol?

I'm Jesse Funk, the founder of Solpri.com and the host of this show Runner's High where we talk about everything running and endurance related. So if you got injured from running or something endurance-related or that's kind of your thing, stick around. Hit subscribe. Every episode comes out on every episode, Tuesdays and Thursdays or one new episodes come out. If I can talk, that's something you'll find. I just kind of shoot and then let things go.

So you know that you get it straight for me anyway. We want to talk about the Alfredson protocol. Why are we talking about this? Well, it is important for anybody dealing with Achilles tendonitis or Achilles tendinopathy. The difference between the two basically being tendinitis is a short - short-lived condition. Tendinopathy is something that happens for a period of time. So if you've been dealing with ankle issues for a while or Achilles issues in particular for a while, it's more likely classified as tendinopathy.

There are two types, and today the Alfredson protocol, as I understand it, deals more with insertional tendinopathy, which is what I'm dealing with. And that's kind of how some of these injury things go, I get an injury and it makes me think about it and I say, "Let's do a video."

So the Alfredson protocol has to do with eccentric loading of the Achilles tendon. I've talked about this in other running videos where we talk about injuries and what to do, but often we want to put some kind of eccentric load on your muscles, which is kind of the opposite of how we do most of our exercises.

So when we say like, because you can see my arms, like when I do a bicep curl, I'm doing this, I'm flexing my very small muscles here. This is not a gun show, unfortunately. This is the opposite of eccentric. So eccentric is what I would be going out. So I would be taking a weight or a resistance band or something and going out so that in the lengthened position of the muscle, you want to be strong there. It's the same idea with our Achilles tendon. The big difference it's especially important to pay attention to is that tendons, the Achilles tendon in particular, takes a longer time to adapt than muscles do.

This is something I spoke with Dr. Mark Gallagher about on the Smart Athlete Podcast. He is a podiatrist in the UK. I think I believe I'll link to my conversation if you're interested in more like foot ankle injury kind of stuff at the end of this video will be on the screen. So check out my conversation with Mark. We actually also talk about some other really great stuff as well.

But when we talked about the adaptation time of tendons versus muscles, it's often quoted that tendons will adapt within about 12 weeks. But in his experience and I think is becoming more common, it just basically varies. It can often be longer for some people can be shorter. It depends on the severity. Now, in this case, with Achilles tendinopathy insertional, an Achilles tendinopathy that is turned off, the inflammation where the Achilles inserts into your heel versus like along the length of it, it can take a considerable amount of time to heal depending on what you're doing about it.

So the Alfredson protocol basically tells us to put this eccentric loading like we've talked about on the Achilles tendon. That's where we're going to stand on a step and then slowly drop down. So I'm going to demo that here in a second. But first, I want to tell you that this is not the entirety of what some physical therapists recommend.

And mine in particular actually has a six step eccentric loading process that doesn't start with this step. It first starts with just doing this eccentric loading on the ground and then goes to adding weight. So I have a backpack I put on to do these. So you're on the ground, you do it flat or neutral, then you add 10lbs and 20lbs, then 30lbs. Then you go to the step, then you do another 10lbs, 20lbs, 30lbs. I guess that's seven steps, not six steps. And that's the entire protocol that he suggests is more standard nowadays.

So let's head to the kitchen where I can film with a step and kind of show you what this looks like and give you some guidelines for what you might do if you're dealing with this without a physical therapist.

So here we are on our step. This is you can see this is the one I've been dealing with. That first progression, again, is just on neutral. So you're just on the ground. You go up with both legs, go on to the affected leg, and then you're slowly lowering down. As you progress, do that with your weights. And then to the more classic Alfredson protocol, you're off the edge of the step and go up with both legs to the single leg, the one that's affected lower, slowly down until you're below the step. And then you go back up. Rinse and repeat.

Now I demo that stuff so that you can kind of see it, but you should always, if you have the opportunity to work with somebody, somebody qualified, that means not me, because I can demo what I've been through it, I'm doing it. I'm working with somebody who's qualified to suggest a particular protocol for me. But this is a pretty standard protocol for dealing with Achilles tendinopathy and Achilles tendonitis.

One of the things you want to pay attention to when you're doing it is that unlike typical muscle rehab, where you want to avoid pain, there is some slight discomfort when you're doing it and you shouldn't progress to the next step until that discomfort has subsided. What we're doing physically here is trying to make sure all of the repaired strands of your tendon are aligned in the same way.

So if you have inflammation or tearing or anything like that, your body is eventually going to repair it. Again, it takes longer for tendons and muscles, but what happens is that instead of being in a nice kind of parallel form, the repairs end up being all squiggly, which when you put load on it makes it more likely to tear again. So when you put eccentric load on it, you're trying to tell the tendon, basically, this is the direction that we need to go like this parallel direction. That's the direction that things needed to be loaded in and the things that need to be repaired and growing.

Whereas say we completely immobilize it and don't use it, then that kind of, like I said, squiggly, messy spaghetti-looking pattern of fibers is what would grow back and be more subject to injury again in the future. Another kind of good point about going through this progression again. You start with that neutral I showed when I was on the step, not off of it. Then you add 10lbs, 20lbs, 30lbs each part of the progression. As my physical therapist suggested to me, should last at minimum a week, even if it feels fine.

And that is because of the slow time it takes to adapt to load basically with any kind of tendon because they're slower to adapt and muscles are. So you want to give your body the chance to adapt before you go on to the next step and potentially overload it, which can set you back. Ask me how I know. Actually, I went and raced when I thought I was fine and it was too much of a load and it set me backwards. So that's the Alfredson protocol. That's kind of the gist of what protocol looks like and the extended form, the seven step version where you're doing it from no load on neutral ground all the way through off of the edge of the step with 30lbs.

I'm about halfway through right now. So if you follow all of these guidelines, the fastest you would possibly go through this progression is like 7 to 8 weeks, but it is often suggested that it can take, as mentioned previously, 12 weeks or more. It depends on the severity of your particular issues and again, if you have the opportunity to work with a qualified health provider. But I make this video because I also know, especially early on when I was young, trying to fix things yourself because you don't always have the means or opportunity to get in front of the right person that can help you.

So do you have any questions for me or do you have any rehab type questions? I do have an open invitation from my physical therapist to do other videos with him. He's volunteered himself for that so we can get him in to do some stuff. If you have particular questions about physical therapy, we can get a qualified expert to actually answer those things, so leave them in the comments below. Check out my conversation with Mark. That will coming up on the screen here shortly and I'll see you next time on the next episode of Runner's High.

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