One of the first steps taken in the treatment of Achilles tendinopathy is typically an exercise regimen that aims to eccentrically load the tendon. This typically consists of sets of straight leg and bent leg heel drops at the edge of a step. Dr. Håkan Alfredson pioneered this technique, and a few years ago I listened to a podcast interview on BMJ Talk Medicine in which he describes how he developed his version of the technique which emphasizes painful eccentric heel drops. It’s actually a great story about the lengths a runner (Dr. Alfredson himself in this case) will go to return to the sport, and I won’t give it away the details here (you can listen below). I’ve been meaning to share this podcast here for a long time, and was reminded to do so after recently chatting with a friend and former colleague whose running career was halted by a chronic Achilles injury.

In the podcast Dr. Alfredson also discusses specific eccentric loading protocols for mid-tendon vs. insertional pain, other treatment options for Achilles tendinopathy should conservative management attempts fail, the dangers of cortisone injections in managing pain from AT, and a particularly interesting observation on the possible role that the plantaris muscle might play in some cases of medial Achilles pain.

If you’re not familiar with the plantaris, it’s an interesting muscle because the muscle belly is small and the tendon is very long and its insertion is variable, typically attaching either into the Achilles tendon or onto the medial calcaneus. What’s more, the plantaris is actually absent in some humans (~7% lack it according to this study). In contrast, it is a fairly large muscle in the cats I used to dissect with my students in A&P lab. I found Alfredson’s discussion of the plantaris interesting because it’s another example that highlights human variability and how that might influence individual injury risk.

Anyway, enough of an intro. If you’re interested in this subject, I encourage you to listen to the podcast:

And for anyone interested in what these eccentric loading exercises look like, here are a few videos (if you currently suffer from an Achilles injury, please see your doctor or therapist for proper diagnosis before attempting this as treatments differ for different types of Achilles injuries):

Straight legged heel drops:

Bent-knee heel drops: