Physio webchat with Paul Hobrough

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Q. Achilles tendonitis. Came on after PTT, which went away no problem, but the achilles just won't get better. Tried rest, heel raises, short runs, ice... Any other options or tricks? - Martin Hook

A. Achillies tendon issues are very successfully fixed using the Alfredson protocol http://www.ncbi.nlm.nih.gov/pubmed/9617396. The heel drops must be eccentric, slow, with weight and every other day. The protocol takes 12 weeks to full completion and I require my clients to come bi monthly for the duration for treatments.  Running is ok as long as you do not run with a pain over 4/10 (0 being no pain 10 being the most pain you can imagine) and that the pain doesn't increase either during a run or over a weekly period.  If the pain does fall into these categories then rest will be required for a week and then try again. The way that I prescribe this protocol is as follows (there may be subtle differences) months 1 is 3 x 15 reps (alternate days for all of these - not every day!!)  as described, month two =  4 x 10 reps with a heavier weight and the final four weeks are 4 x 6 reps again with a heavier weight. 


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