RMS: Achilles Tendinopathy: Week 11 (3-19-18)

  • Email Follow UP
    • Increase in foot pain
    • Feels increase in walking may have contributed to increase in foot pain
    • Focused on non weight bearing exercises
    • Pain is localized to the ball of the foot and some in the heel and achilles feeling somewhat bruised
  • My reply
    • Some of the pain in the bottom of the foot could be plantarfascia
    • As I continue to reflect on your symptoms and limitations, your greatest limitation is still a lack of gastroc/calf strength
    • I am glad you are progressing with hip strength and I may add a few others in that department
    • The focus now is progressing from the band which seems to be fine to a continuum of loading that progressing more towards supporting your body weight which is much more then a resistance band. I think the leg press, beginning with the holds an then progressing to small heelraises in a short range progressing to single leg when able is the next step in the process
    • Let’s go bike with no elliptical this week
    • Week 11 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
            • 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