RMS: Achilles Tendinopathy: Week 4 (1-29-18)

  • Email Follow Up
    • Some confusion over judging pain symptoms and exercise
      • Pain is not the best marker, but it is all we have in regards to conveying to an individual what is helpful versus feeding into making the problem worse
      • Given the amount of time you have had pain, your brain starts to have a more difficult time truely sensing what is happening in your achilles or where it attaches, especially given the more recent trauma to it with the procedures you have had that seem to have worsened your symptoms
      • A couple important points in regards to pain
        • One resource I want you to check out is a quick tutorial that explains the pain process
        • If your pain is constantly at a 7/10 or higher, you should not be doing any weight bearing exercise
        • I will discuss your case with Dr. Rothenberg, but pain that high, the most important intervention is removing activities or movements that increase pain
        • Even if I give you the best rehab program of all time, it won’t matter if every time you step onto that foot it hurts that bad
          • Taping was one option to reduce the load on the tendon, but it sounds like that is not quite doing the trick
          • I am not sure what your recent history has included in regards to using a walking boot
          • If the pressure is removed, that area should calm down
          • Let’s see how you do this week with less weight bearing and focus on increasing endurance with the band
          • Really try your best to avoid stuff that hurts this week
            • That includes your daily life
            • If standing and walking hurts it, try to minimize the amount you have to do it
      • Goal this week
        • try to get the pain down a little…maybe a 5-6
    • 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
    • Strength Sequence
      • i want to focus on getting to fatigue without significant pain
      • To do this we are going to minimize standing activities for right now
      • Complete every other day
        • Band Around Knees Bridge Progression VIDEO
          • Keep tension in the stomach as you raise up
          • 8-20 reps slow and controlled
          • If you have any knee pain bend your knees less as discussed in the video
        • Squat Pulses In Short Range VIDEO
          • 30sec to 2 min is the goal
          • You can keep the band around your knees with this one as well similar to the bridge
        • Sidelying Leg Raise Progression to a Stretch VIDEO
          • really focus on form with this one
        • 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