RMS: Achilles Tendinopathy: Week 12 (3-26-18)

  • Email Follow UP (My responses in bold below)
    • Positive trend this week with Monday-Thursday going well but some soreness on Friday and Saturday but improved today
      • Anything specific you did Thursday that may have contributed to the weekend soreness
    • Pain of bottom of foot almost went away Wednesday but then returned
    • Doing runner stretches 2x20sec
      • This is fine as long as it is not painful
      • Be careful not to over stretch, I would rather you rock gently in and out of stretch for 20 sec rather then a static hold
    • Increase in loading gradually with raise at wall and leg press
      • This is great and a good way for you to measure progress
      • The leg press: Once you are able to hold 90sec…try to do the heel raise in a small range
    • Make sure you are only doing the raises/leg press every other day…not every day
    • Lets continue to hold on elliptical and keep up with the swimming
    • I didn’t want to change too much
      • I gave you a couple new options for daily stuff and some clarifications for the strength sequence
    • Week 12 Updates below in BOLD
      • Daily Sequence
      • Strength Sequence:
        • Now we will begin to separate out 2 strength circuits
        • i want to focus on getting to fatigue without significant pain
        • To do this we are going to minimize standing activities for right now
        • Circuit #1
        • Circuit #2
          • Band Plantarflexion/Gastroc Activation VIDEO
            • NOW REMEMBER FOR THIS ONE THAT YOU ONLY DO ONE OF THE OPTIONS…BAND IS THE EASIEST…THEN YOU PICK BETWEEN THE WALL OR THE LEG PRESS AS THE BEST ONE TO LOAD THE ACHILLES WITH THE LEAST AMOUNT OF PAIN
            • There are a variety of band resistances
            • Try to start with something that allows you to get through as much ROM as possible
            • If you have significant pain with any motion, try to start with just an isometric hold for 30sec-2 minutes
            • If you are able go through as much range as possible with minimal pain, go really slow on the negative 4-5 sec as you slowly load into the stretch
            • DURING THE STRENGTH SEQUENCE, TRY TO PUSH YOURSELF WITH THE ENDURANCE OF THIS ONCE
              • LETS TRY TO GET YOU UP TO 3-4 MINUTES BEFORE WE GO BACK TO OTHER LOADING OPTIONS
            • WHERE ARE WE AT WITH THIS ONE….I WOULD LIKE TO TRY THE LEG PRESS AS A WEIGHT OPTION THAT IS LESS THEN YOUR BODY WEIGHT
            • 126.4) Heelraise Loading Overview Isometric to Increased Range VIDEO
              • AT THE END OF THE VIDEO I SHOW AND DISCUSS THE LEG PRESS OPTION
              • LEVEL 1
                • THE LIGHTEST WEIGHT, 2 FEET HOLD ISOMETRICALLY FOR 30SEC TO 2 MINUTES
              • LEVEL 2
                • SAME WEIGHT TRY TO PROGRESS MORE OF THE LOAD ON THE INJURED SIDE, STILL HODING ISOMETRICALLY (75% INJURED SIDE AND 25% NON-INJURED SIDE)
              • Level 3
                • This will be full single leg holds with possible progression for very small heel raises 
          • 94.1) Tibialis Anterior Band VIDEO
            • Activates the antagonist or opposite of achilles
            • MAKE SURE TO STAY IN A COMFORTABLE RANGE OF MOTION
            • THIS SHOULD NOT ACTIVATE THE ACHILLES AT ALL BUT CAN CAUSE SORESS IF YOU GO TOO DEEP INTO THE RANGE OF MOTION
            • YOU CAN EVEN HOLD THE FOOT STILL AGAINST RESISTANCE AND DO AN ISOMETRIC IF THAT IS MORE COMFORTABLE
            • I would go for a time goal with this of 30sec-2min
          • 98.1) Quadruped Hip Extension progression VIDEO OR 98) Hip Extension Over Table/Bed VIDEO
            • OVER THE BED OR OVER THE BALL TRIES TO MINIMIZE WEIGHT ON THE FOOT
            • CHOOSE WHICH EVER ONE WORKS BEST
          • 91) Rolling with Side Lying Rotation VIDEO
            • Slow and controlled rolling with a thoracolumbar stretch in between each
            • Tightness in the low back can often contribute to the achilles sensitivity so I like to include some lateral trunk stability which we will start off with in a non-weight bearing position
          • 63.1) Supine Straight Leg Raise VIDEO
            • Hip flexor activation in supine with abdominal control
            • 8-20 reps
          • 157) Band Extension Deadlift VIDEO
            • THIS IS MORE OF A GLUTE AND HAMSTRING EMPHASIS WHILE ALSO INCORPORATING UPPER BODY INTO A PULLING MOTION
            • 8-20 REPS SLOW