How to Implement Eccentric Training for Achilles Tendon Health in Runners?

If you have ever experienced the sheer agony of an Achilles tendon injury, you know just how debilitating it can be. Whether you’re an Olympic athlete or a weekend jogger, Achilles tendon pain can significantly impact performance and life quality. But did you know that there is a technique that can help transform Achilles tendinopathy, and it’s called eccentric training?

This article will delve into the scientific basis of the eccentric training approach and how it can be effectively implemented in your routine to ensure Achilles tendon health and resilience. We will discuss the crucial role of load-bearing exercises, the ideal training regimen, and the promising research studies that illustrate the effectiveness of eccentric training.

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Understanding Achilles Tendinopathy

Achilles tendinopathy is a condition that causes pain, swelling, and limited movement in the Achilles tendon, which connects your calf muscles to your heel bone. This is a common issue among sports enthusiasts and runners, with a high incidence in these groups.

A wealth of studies published on Google Scholar and PubMed has shown the effectiveness of eccentric exercises in treating Achilles tendinopathy. For instance, a landmark study by Alfredson et al. demonstrated the benefits of eccentric training in a group of runners with chronic Achilles tendinopathy. This study found a statistically significant reduction in pain and improvements in function after 12 weeks of eccentric training.

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The Eccentric Training Protocol

Eccentric training involves lengthening the muscle-tendon unit during load-bearing exercises. Under eccentric load, the muscle contracts while it is lengthening, and this helps to strengthen tendons and muscles.

The Alfredson eccentric training protocol for Achilles tendinopathy is straightforward. It involves performing two specific exercises 15 times in two sets, twice daily, seven days a week for 12 weeks.

The first exercise is executed with the knee straight, and the second with the knee bent. These exercises are performed on a step or a similar elevated platform, allowing the heel to drop below the level of the step. It’s important to note that these exercises should be carried out despite the presence of pain, unless the pain becomes disabling.

The Scientific Evidence Supporting Eccentric Training

The Alfredson study, published on PubMed and widely cited on Google Scholar, showed a statistically significant improvement in patients’ pain levels and function after 12 weeks of eccentric training. The VISA (Victorian Institute of Sports Assessment) score, a validated measure of Achilles tendinopathy symptoms, improved from an average of 53 before treatment to 78 after treatment.

Since this initial study, numerous follow-up studies have confirmed these findings. A meta-analysis published in the British Journal of Sports Medicine showed that eccentric training was more effective than traditional physiotherapy or a wait-and-see policy in improving pain and function in patients with Achilles tendinopathy.

How to Integrate Eccentric Training into Your Routine?

Incorporating eccentric exercises into your training routine can not only help manage Achilles tendinopathy but also prevent its occurrence. But how do you integrate this training method into your regular routine?

Start by including the Alfredson protocol into your warm-up or cool-down routine. Ensure proper technique, slow and controlled movements. Do not rush through the exercises. You should feel a moderate to strong pull in your calf muscles, but it should not be painful. Over time, as your tendon gets stronger, gradually increase the load by wearing a backpack filled with weights during the exercises.

Remember, consistency is key. Stick to the regimen of doing these exercises twice daily for 12 weeks to garner the full benefits.

Monitoring Progress and Adjusting Load

During the 12 week period, it is essential to monitor your progress. The VISA score can be a valuable tool for tracking improvements in symptoms. Additionally, you can use a training diary to note down any changes in pain, function, and general well-being.

Adjusting the load is equally important. The Alfredson protocol suggests increasing the load if the patient can perform the exercises without discomfort. This can be done by adding weights in a backpack. If the exercises become too easy or too hard, the load should be adjusted accordingly.

In conclusion, Achilles tendon pain can be a significant barrier to enjoying sports and maintaining an active lifestyle. However, by incorporating eccentric training into your routine, you can improve your Achilles tendon health and keep running for many more miles.

The Impact of Lifestyle and Other Factors on Eccentric Training

It is crucial to appreciate that the environment and lifestyle choices can significantly impact the effectiveness of any training program, including the eccentric training protocol. Maintaining a healthy lifestyle by ensuring a balanced diet, getting adequate sleep, and managing stress levels can significantly enhance the body’s ability to recover from injuries.

Additionally, tobacco and excessive alcohol consumption can impair tissue repair and should be avoided. For instance, studies available on PubMed and Google Scholar have shown that smoking can reduce blood flow to the tendons, slowing down the healing process.

Moreover, appropriate footwear is vital when performing eccentric exercises. Consider investing in a good pair of training shoes that offer ample support and cushioning, particularly for the heel area.

Another essential factor to consider is the role of the body’s biomechanics. Alterations in foot alignment or running gait can overload the Achilles tendon, contributing to tendinopathy. Therefore, a thorough biomechanical assessment may be beneficial for some individuals.

Lastly, it’s worth mentioning that while the Alfredson protocol is the cornerstone of eccentric training for Achilles tendinopathy, it is not the only solution. Depending upon the individual’s response, the program can be modified to include other forms of eccentric exercises or alternative therapies, such as the use of an Airheel brace.

Why Eccentric Training is Not a Magic Bullet

Despite the promising results of eccentric training, it is not a magic bullet. Not everyone will respond well to this form of therapy. A control group in a placebo-controlled study on eccentric training for Achilles tendinopathy, available on PubMed and Google Scholar, showed that some individuals did not experience a statistically significant difference in their symptoms after 12 weeks of eccentric exercises.

These individuals might need other forms of treatment, like physiotherapy or even surgical interventions, in conjunction with eccentric training.

Also, remember that preventing injuries is always better than treating them. Incorporating eccentric training into your routine as a preventive measure can help strengthen the Achilles tendon and decrease the risk of developing tendinopathy. Regular eccentric calf raises can be particularly beneficial for runners and other athletes who extensively use their lower limbs.


In light of the scientific evidence, there is no doubt that eccentric training is a promising strategy for managing and preventing Achilles tendinopathy. However, it is important to remember that it is not a one-size-fits-all solution. Some individuals might need additional or alternative treatments, and lifestyle factors can significantly impact the outcome. Therefore, it is always recommended to consult with a healthcare professional or a trained physiotherapist before starting any new training program.

Remember, despite the benefits of eccentric training, prevention is always better than cure. Thus, incorporating eccentric loading exercises into your routine and maintaining a healthy lifestyle can help keep your Achilles tendon in top shape.

In closing, we hope this article can serve as a comprehensive guide for anyone keen on exploring the benefits of eccentric training for Achilles tendon health. By following the guidelines mentioned in this article, you can ensure a healthier running experience and keep Achilles tendinopathy at bay.