RMS: Achilles Tendinopathy: Week 7 (2-19-18)

Email Follow Up

• Foot feeling better on tuesday at a 5 level on wednesday and into thursday afternoon, but exercises irritated it on thursday evening which returned pain to a 7-9 level
• Prone quad stretch went well and helped with knee pain
• Held on squat pulses
• Pain in the foot on the bottom at the heel and ball of foot
• Stiffness in the lower calf area impacted by the bear and quadruped position
• My reply
  • The bear and quadruped position do load the arch of the foot which may contribute to lower calf and plantarfascia/foot stress
  • I am trying to be somewhat creative in my approach to having you load the foot and achilles pre standing
  • In a push up position or the bear position you share the load with your upper extremities but there is still tension on your foot and calf.
  • In this lower position there is a little more stretch on the arch of your foot which is likely why you are feeling what you did
  • Since pain was improving, I am going to remove the bear position
  • I am going to have you try the original program from the previous week
  • I am going to give you one new movement that focuses more so on trunk control in supine and mixes in a self mobilization for the lower back
  • From favoring the ankle, you are likely tight in your low back on that side
  • Try the new movement below
  • I want to use it as a precursor to something I will have you try in kneeling
• Week 7 Updates below in BOLD
  • 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
    • 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
        • CAN RETURN TO THIS WHEN YOU FEEL READY
        • 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
      • 91) Rolling with Side Lying Rotation VIDEO
        • Slow and controlled rolling with a thoraclumbar 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