RMS: Achilles Tendinopathy: Week 3 (1-22-18)

  • Email follow up
    • New exercises caused no problems/soreness
    • Heelraise Loading: Chose to do against wall versus steps
      • H/o increased pain with heelraise edge of step even though not painful during exercise
    • Bear push off to plank pain the next day
      • Pain has gone away but reluctant to try exercise again
      • Did Downward Dog instead
      • I am taking this movement out
      • You are already working on hamstring and calf flex with some other movements
      • I am going to replace it for something for your glute
    • My reply
      • Continue to monitor your symptoms right after and the following day. If symptoms are greater then a 4-5/10 then something needs to be adjusted
      • I know you have done heelraises in the past as it is likely the most common exercise you can do for this
      • The movements that I show in the loading progression are meant to load the calf with the least amount of achilles discomfort
      • Over this week I want to know where you get to in that loading progression
        • This begins with an isometric in mid range
        • I would stick with increasing endurance in that isometric position
        • Use ice immediately after to minimize the risk of pain/soreness the following day
      • Another pain relieving option I want to include is kinesiotape
    • Below is the sequence for week 3 with some adjustments and advancements built in as able
    • Do them as listed below
    • Monday: Daily + Strength Circuit #1(2 sets, second set do 1/2 as many reps or time as first set, so if you hold the iso heelraise for 90sec, second time through circuit you hold it for 45sec)
    • Tuesday: Daily
    • Wednesday: Daily +Strength Circuit #2 (2 sets, 1/2 as many reps second set)
    • Thursday: Daily Sequence
    • Friday: Daily + Circuit 1 and Circuit #2( 1 set of all exercises)
    • Saturday: Daily
    • Sunday: Rest and email me
  • 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
      • 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