RMS: Achilles Tendinopathy: Week 14 (4-16-18)

Phase 14 Feedback
- I agree with you Ron, that this would obviously be much easier if I were able to see you in person, but I do not think we are up against something that cannot be overcome. Whenever I get to this point with a patient where I hit a roadblock, I do a couple things:
  - I think about what I would do if this were me and how I would adjust the approach
  - I get back to the basics of what is most important aspect of strength/mobility that needs to be addressed
  - Daily Sequence is going to remain the same
  - Strength sequence is going to focus on a couple movements that are most closely related to your current issues
    - Follow the organization of the week as listed below, including giving me feedback when requested
    - The strength day with incorporate some of the daily stuff but not all of it
    - On strength day, only do what I list….not all of the daily stuff
  - After doing Day 1 and then Day 2…email me
  - I will make any adjustments needed after you do each day…on the third day while you await my email response, go ahead and do the Day 1 movements again. I am going to make some new videos to address the coordination of ankle and hip which will play a role in your gait and other daily activities
- Day 1:
  - 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
    - 26.2) Plantar Foot Ball Roll VIDEO
      - MAKE SURE NOT TO DO THIS ON AREAS THAT ARE REALLY SENSITIVE, TRY TO WORK JUST NEXT TO THE MORE PAINFUL AREAS AND KEEP IT LIGHT FOR 1-3 MINUTES
    - 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
      - 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
    - 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, 8-20 reps
    - Cross Leg Contract Relax Posterior Hip VIDEO
      - This is to activate the posterolateral glute in a lengthened position
      - This will be important as we progress into single leg stance
      - Hold each 5 seconds and complete 8-15 reps each leg
      - UPDATE FOR PROGRESSION
        
        171) Side Sit with Rotation and Glute Isometric VIDEO
        
        UPDATE THE INCORPORATES THE ANKLE
        
        43.2) Cross Leg with Ankle Inversion Self Mobilization VIDEO
    - 29.1) Prone to Supine Quad Stretch, Isometric, Active Motion VIDEO
      - Be careful with the isometric portion that there is no pain
- Day 2: Strength
  - Circuit #1: Load the lateral hip: Do 2 sets
    - Sidelying Leg Raise Progression to a Stretch VIDEO
      - really focus on form with this one
      - 8-20 reps
    - 43.1) Cross Leg at Table/Bed Isometric VIDEO
      - hold each 5 sec, repeat 10x
    - NEW:
      - 97) Quadruped with Physio Ball Hip Extension VIDEO
      - HOLD EACH 5 SEC 5-15 REPS
  - Circuit #2: Mobilize and load the foot: Do 2 sets
    - 36) Seated Sciatic Nerve Floss VIDEO
      - This is a movement to mobilize the foot and the sciatic nerve
      - Don’t hold it, just move lightly in and out of the position described
    - 123) Seated Heelraise VIDEO
      - With your knee bent in sitting this with load tib post and soleus more so then the gastroc portion of your achilles
      - Do it very slow and in a range short of increased pain
      - 8-20 reps
    - NEW:
      - 116) Hamstring Isometric with Contralateral Leg Raise VIDEO
        
        HOLD EACH 5 SEC 8-20 REPS