A 42-year-old recreational runner has three months of pain at the midportion of the Achilles tendon, 4 cm above its insertion, with morning stiffness and thickening of the tendon on examination. There is no palpable gap and the Thompson test is negative. Along with activity modification and loading programmes, the specific exercise regimen with the best evidence for this condition is:

• A Complete immobilisation in a cast for six weeks
• B Passive stretching of the hamstring muscles only
• C Heavy-load eccentric calf muscle training (Alfredson protocol) ✓
• D Isometric quadriceps strengthening

Explanation

Midportion Achilles tendinopathy responds well to heavy-load eccentric training, classically three sets of fifteen repetitions of single-leg heel drops performed daily for twelve weeks, with the knee straight and then bent. This stimulates tendon remodelling and collagen organisation. Immobilisation is counterproductive in tendinopathy because unloading worsens tendon structure, and stretching alone does not provide the tensile load needed. Quadriceps work has no role since the calf generates the relevant load.

Reference: Campbell's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.