No difference in clinical effects when comparing Alfredson eccentric and Silbernagel combined concentric-eccentric loading in achilles tendinopathy: a randomized controlled trial

Review written by Tom Goom info

Key Points

  1. This RCT compared the effectiveness of the Alfredson and Silbernagel protocols for mid-portion Achilles tendinopathy using VISA-A at 1 year follow up as the primary outcome measure.
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Two key studies had a huge impact on how we manage Achilles tendinopathy (AT). Firstly, the work of Professor Håkan Alfredson and colleagues reported good results with an eccentric loading protocol (1). Then Dr Karin Silbernagel and her team found similar improvements using a combined loading approach alongside a pain monitoring model (2).

To date these two approaches have not been compared directly, so this randomized controlled trial set out to examine their effectiveness in athletes with AT.

Good results for Achilles tendinopathy have been reported with an eccentric loading protocol and similarly with a combined loading approach.
There are multiple loading options for mid-portion Achilles tendinopathy including eccentrics, a combined approach, and heavy slow resistance training.


Initially over 100 recreational athletes with chronic (3 months or more) mid-portion AT were enrolled in this study but only 40 met the inclusion criteria and were able to participate.

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