‘Achilles Tendon Pain – Loading Program for Return to Sport’
By Tomás Ryan BSc.AHS,Ph.Th. MIAPT, Registered Physical Therapist based in Thurles
Last week I spoke about the Stage 1 Low Load Isometric Strengthening Program of 1 inch heel lifts held for 20-40 seconds. Once this is successfully accomplished, we can then progress to the following stages under the guidance of your Registered Physical Therapist.
Stage 2 (Medium Load)
Progress to Concentric / Eccentric strength loading exercises which are of greater load than the previous isometric loading stage. Single Heel raises whilst standing on the floor, slowly raising heels off the floor and then slowly return heels to the floor, a 5 second count up and down. Performed with no pain for approximately 6-8 repetitions x 3 sets every 2nd day. When the amounts of repetitions are increased and the exercise feels a lot easier, the athlete can then progress to greater eccentric loading of the Achilles tendon by slowly performing the exercise on the edge of a step. These exercises are performed every 2nd day. Heel raises exercises can then be progressed to weights in a ruck-sack bag around athlete’s shoulders.
Stage 3 (High Load)
The Heel raises from the step are now performed at a faster pace without pain, the athlete is in a forward leaning position against the wall with the prescribed repetitions. Gentle light-load feet tapping jogging exercise x 10 ft is included for 30-60 seconds x 4 reps, again without pain. Progress is made to Double Leg Skipping, followed by single leg skipping and then box-jumps, double leg hopping drills, with no pain. Performed every 3rd day.
Loading Exercise Program for each week
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
High Load Low Load Medium Load High Load Low Load Medium Load Day of Rest
Stage 4 (High Load)
Return to Running Training, a further increase in elastic Achilles load. Stage 4 joins Stage 3 as the High Load Day, consisting of 5 minute jog and half pace 60 second run x several pain free repetitions, followed by 5 minute warm-down jog. This is progressed from twice per week to 3 times per week overtime. As progress is noted, speed is progress to ¾ pace and then full sprinting for 20-60 second durations as directed by your Physical therapist. A further loading progression is incline training. Stage 4 high load training now involves, Bounding running patterns instead of Box-Jumps, Single Leg Multi-directional Hopping drills. Stretching involves foam rolling.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy (MIAPT) and is based in Thurles. Contact Number: 0504 26672 Email your queries to: email@example.com