lifestyle · for tendinitis & tendon repair
Eccentric Loading Exercise (Alfredson Protocol)
Reviewed by the Nimbera editorial team · Last updated May 2026
How to use
For Achilles: do heel-drop exercises off a step - 3 sets of 15 reps, twice daily, with knee straight and knee bent, lowering slowly (2-3 seconds) and using the good leg to return up. Progress by adding load in a backpack as pain allows. Continue for at least 12 weeks; mild-to-moderate pain during exercise is acceptable and expected. For tennis elbow or patellar tendon, use the equivalent slow eccentric wrist or squat versions.
How it works
Slow, controlled lengthening (eccentric) contractions apply mechanical tension that stimulates tendon cells (tenocytes) to lay down new, properly aligned collagen and remodel the degenerated tissue. The load also normalizes tendon structure and reduces abnormal neovascularization and nerve ingrowth that drive pain.
Where to buy
No purchase required - bodyweight and a step. Optional loading via a weighted backpack, dumbbells, or resistance bands (any brand such as TheraBand, Rogue, or Bodylastics). A physiotherapist can tailor the progression.
Typical cost: $0-$30 one-time for bands or weights
Safety notes
Expect some discomfort during loading, but sharp or escalating pain that lingers over 24 hours means you are progressing too fast - reduce load. Not appropriate for a suspected complete tendon rupture. People with insertional (rather than midportion) Achilles tendinopathy may need a modified flat-ground version to avoid compression.
Drug & supplement interactions
- Always tell your doctor or pharmacist about any supplements you take.
- Interactions can occur with prescription medications, blood thinners, and immunosuppressants.
- Herbal remedies can affect how the body absorbs or metabolises drugs.
- Check drugs.com interactions checker before starting.
Clinical source
PubMed - Stevens and Tan 2014This information is compiled from primary clinical literature and is for informational purposes only. It is not a substitute for professional medical advice. Read our full disclaimer.