RMS: Achilles Tendinopathy: Week 9 (3-5-18)

Email Follow Up

• Pain in the 6-8 range
• Very little progress
• Ability to walk is painful and frustrating
• Tibialis anterior band movement challenging
• unable to complete kneeling pallof press due to pain
• Elliptical for 4 minutes went well
• My reply
  • I understand your frustrations as you have made progress but probably not as quickly as you would like
  • While pain is an important consideration and option to measure progress, Progress can also be measured in the ability to tolerate more activity or exercise
  • I am encouraged to hear the elliptical went well. Let’s use that as a benchmark for progress
  • My greatest challenge with you right now is progressing into standing activities so there is some load on the ankle without some much that it causes pain
  • I like the pallof press because it challenges lateral stability, the movement you mentioned may also do that
  • I am also going to try to add some movements that address other aspects of the posterior chain like the glute and hamstring which work with the calf during functional actvities
  • Elliptical Progression:
    • LEVEL 1(WHERE YOU ARE NOW)
      • 4 minutes
    • LEVEL 2
      • 6 minutes
    • Each level will continue to increase by 2 minutes…now this is not rocket science but I want you to follow the soreness rules below that I use to progress athletes back to running. This will gove you guidance in regards to frequency and level progression
    • SORENESS RULES LINK
  • Weekly Organization
  • Day 1: Daily Movements + Strength Circuit #1 (2-3 sets)
  • Day 2 : Daily Movements
  • Day 3: Daily Movements + Strength Circuit #2 (2-3 sets)
  • Day 4: Daily Movements
  • Day 5: Daily Movements + Strength Circuit #1 and #2 one set of each
• Week 9 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:
    • 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
      • 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
        • PHASE 2
          • 110) Heels to Butt on Floor Marching Phase 2 VIDEO
          • 8-20 REPS
      • 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
      • NEW
        • 88) 1/2 Kneeling PALLOF PRESS Variation VIDEO
          • If this bothers the achilles when the foot is behind you, you can prop a pillow or foam roll under the front of the ankle to take pressure off toes
          • If you need , I can make a video of this
          • Start with the band press 5-15 reps
          • ALTERNATE
            • 86) Standing Press in Lunge and Terminal Stance VIDEO
              • NOW THIS CAN BE DONE BEGINNING WITH FEET SIDE BY SIDE AND GRADUALLY PROGRESS INTO MORE OF A STAGGERED STANCE, BUT SHORT OF ANY PAIN
              • START WITH FEET SHOULDER WIDTH APART JUST LIKE THE SQUAT
              • IF THAT GOES WELL, THE NEXT TIME TRY TO STAGGER THE FEET A LITTLE WITH THE MORE DISTANCE BETWEEN THE FEET IN THE FRONT TO BACK DIRECTION LIKELY EQUALLING MORE STRESS ON ACHILLES SO BE CAREFUL
    • 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
      • 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
      • NEW
        • 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