Alfredson's model of eccentric training involves no concentric loading and emphasises the need for patients to complete the exercise protocol despite pain in the tendon. If patients experience no tendon pain doing this programme, the load should be increased until the exercises provoke pain. Good short‐term and long‐term clinical results have been reported.
35,
36,
37 This 12‐week programme is effective when the other conventional treatments (rest, NSAIDs, change of shoes, orthoses, physical therapy and ordinary training programmes) have failed and is successful in approximately 90% of those with mid‐tendon pain and pathology. Insertional Achilles tendon pain is not as responsive, and good clinical results are achieved in approximately 30% of tendons.
38
A follow‐up study (mean 3.8 years later) of patients treated with eccentric training indicated the majority of the patients were satisfied and back to previous tendon‐loading activity level. Interestingly, the tendon thickness had decreased significantly, and ultrasonographically the tendon structure looked more normal.
39The same 12‐week programme resulted in a decrease in tendon volume assessed with MRI, as well as a decrease in tendon signal intensity by 23%.
40