rehab · beginner

Eccentric Heel Drops (Alfredson Protocol)

The gold-standard eccentric loading protocol for Achilles tendinopathy rehabilitation. Developed by Dr. Hakan Alfredson, this exercise involves controlled lowering of the heel below step level to stimulate tendon remodelling.

  1. 01Stand on the edge of a step with the balls of your feet on the step and heels hanging off.
  2. 02Rise up on both feet to full plantar flexion (calf raise position).
  3. 03Shift your full body weight to the affected leg.
  4. 04Slowly lower the heel below the step level over 3 full seconds — this eccentric phase is the treatment.
  5. 05Use the unaffected leg to push back up to the starting position — do not concentrically load the affected side.
  6. 06Perform the protocol with the knee straight (gastrocnemius bias), then repeat with the knee slightly bent at 20-30 degrees (soleus bias).
  7. 07Mild discomfort (3-5/10 pain) during the exercise is expected and acceptable. Stop if pain exceeds 5/10.
Why it matters

The Alfredson eccentric heel drop protocol is the gold standard for Achilles tendinopathy rehabilitation. Eccentric loading stimulates collagen remodelling in the tendon, reversing the degenerative process that causes mid-portion Achilles pain. For runners, this is the single most evidence-supported exercise for returning to pain-free running after Achilles injury.