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©2013 UpToDate ® Print Email Alfredson's intensive rehabilitation of Achilles tendinopathy 1. Eccentric heel drop description a. Stand with the heel of the affected foot beyond the edge of the step or platform with the foot plantar flexed. Slowly lower the heel, bringing the foot into dorsiflexion. b. Perform the exercise both with the knee straight (gastrocnemius) and with the knee bent 45 degrees (soleus). c. Avoid concentric exercise by raising the foot back to the plantar flexed starting position using the unaffected foot, and hands if a railing is available. 2. Number of exercises a. Perform 3 sets of 15 repetitions with straight knees, then 3 sets of 15 repetitions with bent knees. b. Perform this cycle twice daily (180 drops/day). c. Continue the program 7 days per week for 12 to 24 weeks. 3. Exercise progression a. The exercises must be uncomfortable; when heel drops are no longer painful add weight by using a backpack, dumbbells, or a weight machine. Alfredson, H, et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 1998; 26:360.