RMS: Achilles Tendinopathy: Week 6 (2-12-18)

Email Follow Up
- Pain continues to be in the 6-8 range but more frequently at a 6
- Daily exercises are not a problem and has noticed some carryover to improvement in symptoms climbing stairs to exit pool
- Strength Exercises
  - Having some knee pain with the squat pulse so unable to progress to forward reach squat
    - I will add a movement that will help to hopefully reduce knee pain. I will label below as NEW
    - Try it before the squat pulses and let me know if it helps and I will include it as an option in your daily sequence
- Exercise reps: Previous week in italics and current update regular print
  - hip ext over table: 3×12
  - sidelying leg raise: 3×12, 2×12, x15 no pillow under foot
  - squat pulse 75sec x2, held due to knee pain
  - Bridge: 3×12, 3×15
  - Band plantarflexion 3:15, 3:15, 3:30, 3:45
- Taping
  - Tape can be used as needed but you should find that you need it gradually less
  - It will be helpful to reduce any acute flare ups but you can attempt to wean off of using it as you feel comfortable
- Cardio
  - Using bike as a warm up and for 10 minutes
  - Elliptical 2x 4 minutes 13min mile pace with no issues
  - Continue to gradually increase the elliptical as tolerable as long as there are no significant negative after effects
  - I typically progress cardio gradually following the soreness rules listed below:
    - *These rules are meant to guide your progress through a walking/running program in an effort to allow individuals to progress safely without over training. They are based on the symptoms that you experience during and after workouts. These rules are based on an article in the Journal of Orthopedic & Sports Physical Therapy that set up a program for individuals returning to running following ACL repair.
      - Soreness during the warm up that continues during the session = 2 days off, drop down a level
      - Soreness during the warm up that goes away = Stay at that level
      - Soreness during the warm up that goes away but redevelops during session = 2 days off, drop down a level
      - Soreness the day after (not muscle soreness) = 1 day off, do not advance program
      - No Soreness = Advance 1 level once there is no soreness for 3 consecutive attempts at that level
- Week 6 Updates
  - 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
    - NEW
      - 29.1) Prone to Supine Quad Stretch, Isometric, Active Motion VIDEO
        
        Be careful with the isometric portion that there is no pain
  - 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
        
        TRY DOING THE QUAD STRETCH RIGHT BEFORE AND SEE IF YOU ARE ABLE TO GET BACK TO THE PULSES
        
        30sec to 2 min is the goal
        
        You can keep the band around your knees with this one as well similar to the bridge
        
        PHASE 2 PROGRESSION
        
        150) Squat with Forward Reach Band Around Knees VIDEO
        
        8-20 REPS
      - 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
      - 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
      - NEW
        
        74) Bear Pelvic Control VIDEO
        
        THIS WILL BEGIN TO PROGRESS INTO A PLANK POSITION
        
        ONCE YOU HAVE THE PELVIC CONTROL CONCEPT DOWN, TRY LIFTING KNEES OFF GROUND
        
        START WITH 5 SEC HOLDS FOR 10-15X