A Comparative Study of Alfredson Protocol Versus Silbernagel Protocol on Achilles Tendinopathy

Background: Achilles tendinopathy (AT), an overuse injury affecting the largest and strongest tendon in the body, accounts for 20% of all tendon injuries and has an annual incidence of 1.85–2.35 per 1,000 individuals. Prevalence rises to 50% among high-intensity runners and 6% in the general population. Symptoms include pain, swelling, and reduced function, with nodular swelling and compromised plantar flexor function in chronic cases. Diagnosis involves clinical examination (e.g., Royal London Hospital test) and imaging with ultrasound or MRI. Treatment includes stretching exercises, various contraction therapies and passive modalities like orthotics, cryotherapy and acupuncture. Methods: A quasi-experimental study was conducted on 30 patients aged 18 to 45 years diagnosed with Achilles tendinopathy (AT). Participants were randomly assigned to two equal groups: Group A received the Alfredson protocol while Group B received the Silbernagel protocol. Treatment was administered over 12 weeks, six days per week. Outcomes were evaluated using the Visual Analogue Scale (VAS) and the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire at baseline, the 6th week and the 12th week. Conclusion: The study concluded that both the Alfredson and Silbernagel protocols effectively reduced pain and disability in AT with the Silbernagel protocol showing significantly greater improvements by week 12. Key words: Achilles tendinopathy, Alfredson, concentric exercise, eccentric exercise and Silbernagel