LP: Chronic Achilles Tendinopathy post PRP and Tenex Procedure: Month #2 Week 1 (1-22-18)

Feedback from our text conversation
- The exercises cause significant fatigue and burning into the calf an other aspects of the ankle without significant increase in achilles pain…this is more so in regards to the loading off the edge of the step
- The single leg balance feels better sometimes and hurts other times
Also how is walking going?
- Continue to use: Rock Tape Achilles VIDEO
Phase 4
- Organization
  - Monday: Daily Sequence +Strength Circuit #1 + Strength Circuit #2
  - Tuesday: Daily Sequence
  - Wednesday: Daily Sequence + Strength Circuit #2 +Strength Circuit #3
  - Thursday: Daily Sequence
  - Friday: Daily Sequence+ Strength Circuit #3 + Strength Circuit #1
  - Saturday: Daily Sequence
  - 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
  - NEW:
    - 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
  - 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)
- 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
  - 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)
  - Sidelying Leg Raise Progression to a Stretch VIDEO
    - SLOW AND CONTROLLED 5-20REPS
  - ICE AFTER 10-15MINUTES