LP: Chronic Achilles Tendinopathy post PRP and Tenex Procedure: Month #2 Week 4 (2-26-18)

Follow Up from our last conversation
- You reported that the new movement I gave you, you were able to complete without any issues
- At this point I would like you to progress the rate of loading with some faster paced movements
- You will notice the cardio addition to the organization below 2 days per week
- We will begin with bike and gradually transition to ellptical and running/jogging
- First week:
  - Bike
    - Phase 1: 5-10 minutes low resistance RPM at 75-90 RPMs
    - Phase 2: 10-15 min
    - Phase 3 15-20 min
    - Phase 4 5-10 min, resistance intervals, 1 minute low resistance level 2-3 and 1 minute higher resistance 3-5, then the next 10 minutes low resistance
    - Phase 5: 10-15 min resistance intervals, 5-10 minutes low resistance
    - Phase 6: 20 min alternating intervals each minute
Organization
- Monday: Daily Sequence +Strength Circuit #1 + Strength Circuit #2
- Tuesday: Daily Sequence + Cardio
- Wednesday: Daily Sequence + Strength Circuit #2 +Strength Circuit #3
- Thursday: Daily Sequence
- Friday: Daily Sequence+ Strength Circuit #3 + Strength Circuit #1
- Saturday: Daily Sequence + Cardio
- Sunday: Rest day
The daily sequence should be done lightly, 8-15reps for each movement
- This can be done 2x/day on the non-strength day
- Do 1x on the strength circuit day
Strength circuits
- Goal is a minimum of 5 reps max of 20reps OR 30 sec-2minutes as specified per exercise
- Focus on doing all reps slow and controlled as opposed to moving too quickly and doing a higher amount
Daily Sequence
- Self MFR Calf VIDEO
  - use a tennis ball or lacrosse ball
  - Hit 2-3 spots on the calf, NOT ON THE TENDON for 30to 60sec
- Band Plantarflexion/Gastroc Activation VIDEO
  - There are a variety of band resistances
  - Try to start with something that allows you to get through as much ROM as possible
  - Go really slow on the negative 4-5 sec as you slowly load into the stretch
- Self MFR Hamstring VIDEO
  - Same concept as above
- Hamstring Isometric with Contralateral Leg Raise VIDEO
  - This can be done with an exercise ball of feet up on couch/chair
  - Try not to push directly onto heel as it is likely tender
  - Push more so into the calf
  - hold each 5sec
- Hands Elevated Childs Pose Variation VIDEO
  - prop a small roll under your ankle like a yoga mat or a thick towel roll to keep excessive pressure off the ankle…I will make a video if needed if you have issues with this
- Bridge Band Around Knees Progression VIDEO
  - can do with or without band
- Standing Thoracic Rotation with Band Around Knees VIDEO
  - Use a mirror to maintain lower body position as you rotate
- Side Lying Thoracolumbar Rotation Stretch VIDEO
  - Good movement to improve thoracic rotation for the golf swing
Strength Circuit#1
- Upper Body Assisted Squat VIDEO
  - Assist of hands should minimize excessive pressure on the achilles
  - Slow and controlled descent into the squat 4-5sec on the way down
  - PHASE 2-Progress if you are able to get 20 reps of movement above
    - Squat with Forward Reach Band Around Knees VIDEO
  - PHASE 4 PROGRESSION
    - Goblet/Front Squat VIDEO
      - Start with 10lbs-20lbs
      - Goal: 8-20 reps, if you get to 20reps, increase weight and lower reps
    - 120.1) Tibialis Posterior Band VIDEO
      - THIS SHOULD WORK CLOSER TO THE AREA YOU POINTED TO
      - TRY FOR ENDURANCE GOAL OF 1-3 MINUTES
- Double Leg Bridge Phase 3 VIDEO
  - 8-20reps
  - May Progress to (only when you are able to do 20 reps of the movement above)
    - Double Leg Bridge With Hamstring Curl Phase 4 VIDEO
- Heelraise Loading Overview Isometric to Increased Range VIDEO
  - 30SEC-2 MIN FOR EACH
  - LET ME KNOW WHERE YOU FATIGUE
  - Prior to this one do the tennis ball on your calf myofascial release (30sec 3 spots) and Seated Heelraise VIDEO (8-10 reps slow)
  - NEW OPTION FOR LOADING THE HEELRAISE
    - 127.2) Step Heel Raise Short Range VIDEO
      - This position mimics the position you typically stress the achilles with walking/running
      - Try for time with this and let me know how long you go
Strength Circuit #2
- Basics of Bear with Leg Lift VIDEO
  - Start holding bear position for 30-60sec
  - Once you are able to hold 60sec…progress to part 2 with the small leg lifts holding each for 5 sec for 30-90sec
- 161) Reverse Lunge Towel Slide VIDEO
  - GOAL OF 8-20 REPS EACH LEG
- Lying Down Weighted Pullover Feet Elevated VIDEO
  - Start with a light weight, make sure you can do a slow and controlled descent into the overhead position
- Standing Press in Lunge and Terminal Stance VIDEO
  - Start with the press from chest and straight out…4 positions as mentioned goal of 30-60sec each position
  - PHASE 4 PROGRESSION
    - Band Horizontal Abduction VIDEO
      - 8-20REPS
  - You want to feel a little unstable but not out of control
Strength Circuit #3
- Bear Mountain Climber Speed VIDEO
  - Start slow for 30sec to 2 minutes
  - If that goes well progress to intervals as shown
- Pre Run/Walk Single Leg Balance Drill VIDEO
  - 30SEC TO 2 MIN
  - Prior to this one do the tennis ball on your calf myofascial release (30sec 3 spots) and Seated Heelraise VIDEO (8-10 reps slow)
- 179) Standing Adductor Slide VIDEO
  - PROGRESSING INTO LATERAL MOVEMENTS
- Sidelying Leg Raise Progression to a Stretch VIDEO
  - SLOW AND CONTROLLED 5-20REPS
- ICE AFTER 10-15MINUTES