Part II: Achilles Tendinopathy How to start an exercise program?

In Part I of this blog series, we talked about what things don’t work and what temporary changes to make when treating an achilles tendinopathy. If you asked me, what’s the MOST important thing in rehabbing my Achilles tendon? I’d say, load the tendon! A.K.A A targeted calf strengthening program!

Before we dive into some specific examples, here are a few things to remember:

Before we dive into some specific examples, here are a few things to remember:

• Perform strength sessions on non-running days and allow 1-2 days of rest between strength sessions

• If you continue to run, perform strength sessions on a different day

• Assess response and track progress using a daily load test

  • Daily load test = 10 single leg calf raises @ 30 beats per minute

  • Perform daily at the same time, first thing in the morning

• We want “some” discomfort (0-4/10) (0=no pain, 10= worst pain) while performing the exercises, to make sure we are loading the tendon, as long, as symptoms return to baseline levels in 24 hours (0-2/10=safe, 2-5/10=acceptable, >5/10= high risk)

General guidelines:

• Start with bilateral heel raises —> progress to single leg heel raises

• Start on the floor —> progress to a step

• Start with bodyweight —> progress to adding load

• Once you can complete 3x15 with bodyweight, progress to 3x10 with load that feels like effort 7/10 (0=easy, 10= hard) after all sets.

PT TIP : Each person is going to have a different starting point, and that’s why the goal of the first PT session is, to find the appropriate level!

Here’s a sample of the exercises we include in the early stages of rehab:

• Isometric bilateral heel raises on floor 

• Eccentric heel raises on floor —> Eccentric heel raises off step

• Single leg heel raises on floor —> single leg heel raises off step

We include plyometrics (jumping, hopping, skipping) in the later stages of rehab. This will help retrain the Achilles tendon’s ability to “store and release” energy, it’s main function in running! A good starting point is bilateral jumping and progressing to single leg hopping.

• Bilateral jumping

Thank you for taking the time to read! If this sounds like something that you might be dealing with and you’d like to learn more about how to rehab an Achilles tendinopathy and come back a stronger, more resilient runner schedule a complimentary call today!

References

Silbernagel KG, Gustavsson A, Thomeé R, Karlsson J. Evaluation of lower leg function in patients with Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2006;14:1207-1217.

Silbernagel KG, Crossley KM. A Proposed Return-to-Sport Program for Patients With Midportion Achilles

Lunsford BR, Perry J. The standing heel-rise test for ankle plantarflexion: criterion for normal. Phys Ther. 1995;75:694-698.

Alfredson H. Chronic midportion Achilles tendinopathy: an update on research and treatment. Clin Sports Med. 2003;22:727-741.