Why do eccentric heel drops help with achilles tendinosis?

Coming from a certified athletic trainer:

A achilles teninosis is a degeneration of the achiles tendon. When this injury occurs is inflammation within the tendon. Now eccentric exercises help strengthen the tendon while it lengthens. These contractile units are overloading and weakned when you have an overuse injury thereby cauing them to get stronger.

Go to pubmed and do a search you will find out who,what, when where and why.

You will also find a personal account of the MD whom has done alot of research on ecentrics and the achilles that you should find interesting.

Good info.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3105370/

really?????? wrote:

Good info.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3105370/

This looks neat, but can someone give me a summary? Talk to me like I'm five years old. My background is in mathematics and computer science. Everything that I know about this sort of thing I know through the sport, so I don't really understand the significance of anything in the "physiology of eccentric exercise" section.

Thanks for all of the responses.

i am coming back from double heel surgery and keep hearing about the benefits of eccentric heel drops. how exactly do you "perform" these? how are they different from "regular" heel drops? i keep thinking i am not being aggressive enough with my heel drops but i am VERY paranoid about a reinjury...

thanks in advance!

It maximizes a muscles force, causing microtrauma to muscle fibers (resulting in increased delayed onset muscle soreness), and it increases collagen deposition to strengthen the tendon. The forces and stretch during the movement cause good scar tissue remodeling in the process.

Much of the function of the Achilles in good running form is deceleration of the heal moving to the ground. Eccentric drops are nearly purely functional in this mechanism.

Part of it is that eccentric exercises, like heel drops, help break up scar tissue in muscles. This will help to restore elasticity in the soleus, which means there will be less tension on the achilles tendon.

I tell patients to do heel raises on both feet on stairs on a count of 3, then slowly lower the heals or bad side only so they drop lower than the stair you are standing on in a count of 10 and repeat 15 up to 25 times. Other people may tell you differently, but the basic idea is to lengthen the posterior calf muscles slowly. I also have people do them with straight legs and with bent knees (to about 15 degrees) to better involve all the calf muscles.

There are a bunch of videos on youtube. Just type in eccentric heel drop.

Thanks, this is all helpful. Here is a follow-up:

I do strength training twice a week right now. Is it a good idea to include eccentric heel drops in my normal strength routine once I am healthy? If so, should I do both legs, and how many?

My opinion is that because the calf muscles are made for endurance, higher reps (25 or so) are good. Perform the concentric and eccentric phases on both calves. You can do this with a seated or standing calf raise machine at the gym with added resistance too, 2-3 x a week, but many people get along fine without doing them once rehab is done. Remember just because the pain is gone doesn't necessarily mean its fully healed so do the exercises for a month or so after pain is gone and slowly taper off to nothing or to what you want your normal routine to be. Its not an exact science.

I did a lot of research on this topic a few years ago. A lot of people are going to send you a single study here or there that show it works while missing the systematic reviews that make comparisons of these smaller studies.

Studies have demonstrated that eccentric heel drops can reduce pain. However, when eccentric heel drops were compared to other methods (ie stretching, concentrics, etc) there was no significant difference in improvement. So there is benefit to doing them...but is it superior to other methods? That is questionable.

In other words (from that pub med article linked earlier):

" These reviews revealed that eccentric exercise may reduce pain and improve strength in patients with lower extremity tendinopathies, but whether it is better than other forms of rehabilitation has yet to be determined. Therefore, no definitive conclusions can be made regarding whether or not the performance of eccentric exercise alone is superior to concentric-eccentric training or concentric-minimized training."

Also, as far as how eccentrics work physiologically, as far as I know has not really been studied. There are theories of course, but I'm not sure someone has taken tissue samples and studied the before and after so to speak to prove them.

Its has been studied. Google "physiology of eccentric contractions".

My explain-it-like-I'm-a-5-year-old:

Imgaine a bunch of fibers in your tendon. When healthy, these fibers all line up in the same direction, producing a strong and flexible tendon. It's like a bunch of thin strings together forming a strong rope.

When scar tissue is formed, these small fibers are damaged and scrambled. Rather than neatly lined up in the same direction, they look like a bowl of spaghetti, all in different directions. They heal like this, and produce scar tissue. The overall tendon is much weaker, and less flexible.

Eccentric heel drops bascially help line up all the small fibers again, so the overall tendon is stronger and flexible. Each time you do the heel drops, a few more fibers are straightened out, and heal properly. Over 6-10 weeks of performing the rehab, you have systematically straightened out the scrambled, spaghetti fibers and straightened them out so they run in the same direction and form a nice strong, flexible tendon.

I realize you've already heard a bunch of explanations, but I'll add one more. This one is from Hakan Alfredson, the guy who actually developed the eccentric heel drop protocol:

http://www.runnersworld.com/running-tips/mechanotherapy-movement-rehab-instead-strengthen

The key thing to understand is that the point is NOT to strengthen the Achilles:

"the movements are designed to physically stimulate the cells in the tendon as they move relative to each other, causing the cells to initiate tissue repair processes like the production of growth factors... This general process, in which physical forces such as tension, compression and sheer stress act on cells to stimulate chemical responses, is known as 'mechanotherapy...'"

Nobody really knows the answer for sure at this point, and there may well be multiple factors at play. But if Alfredson is right, then the heel drops SHOULD be painful (unlike strengthening-focused rehab protocols), and you should keep doing them for at least 12 weeks.

You guys are full of BS as usual. 12 weeks?

On Feb. 7, 2007, I had Achilles Tendon surgery by a competent orthopedic surgeon overseas. Cost me all of $2,000.00

On April 9, 2007, I was able to run a full marathon.

My tendon has never been stronger.

Heel drop video:

http://www.youtube.com/watch?v=wSXIr93ESrE&feature=player_embedded

Most patients do not have this type of response. I have had to use Graston on numerous patients who did not heal properly from achilles surgery. Did you have a rupture or just tendonosis?

Rocky Balboa wrote:

You guys are full of BS as usual. 12 weeks?

On Feb. 7, 2007, I had Achilles Tendon surgery by a competent orthopedic surgeon overseas. Cost me all of $2,000.00

On April 9, 2007, I was able to run a full marathon.

My tendon has never been stronger.

Among other explanations here, you work on strengthening the surrounding muscles and tendons, helping to give the achilles tendon more support and enduring less strain.

Rocky Balboa wrote:

You guys are full of BS as usual. 12 weeks?

On Feb. 7, 2007, I had Achilles Tendon surgery by a competent orthopedic surgeon overseas. Cost me all of $2,000.00

On April 9, 2007, I was able to run a full marathon.

My tendon has never been stronger.

By early December 2008 my chronic Achilles issues had become so bad that I was having trouble walking. Started doing eccentric contraction exercises. Was back training by the end of the month. Ran a PR marathon time at end of February 2009. Cost me all of $0 with no risk of complications, infections, etc. My tendon has never been stronger.