Achilles Tendonitis Prevention & Treatment Programme

Following on from a previous Service Your Body Physical Therapy post on Achilles Tendonitis I have included a programme of exercises to help prevent and treat Achilles Tendonitis.

These exercise are taken from Sports Injury Bulletin and are based on evidence based research from clinical experts (Raphael Brandon & Harvey Wallmann)

PREVENTION PROGRAMME

To look at the prevention of achilles injuries we must first understand that there is a relationship that the achilles tendon has with both the calf muscles (gastrocnemius and soleus).
EMG data shows that the calf muscles are most active just before and just after foot strike and then their key function is to control dorsiflexion and pronation. It is in turn these two actions (performed to a lesser or greater degree depending on varying factors in the athletes physiology) due to the force and stretching that cause damage to the achilles tendon.
As well as looking at dorsiflexion and pronation we must also look at the kinetic chain, and if the imbalance is coming from the foot up or the pelvic girdle down.
The four key exercises below mimic the kinetic chain of events within the calf muscles and achilles when you run. (Something that interestingly, some experts believe that calf raises do not)

Exercise 1. Eccentric Knee Squat & Single leg Squat
Exercise 2. Balance and Eccentric Reach with Toes
Exercise 3. Balance and Eccentric Reach with Knee
Exercise 4. Dynamic Achilles Stretch
Follow link to a video of how to do above exercises poor quality!!

The exercises should be progressive, make sure to start with exercises performed in a sagittal direction and progressing onto exercises performed in a transverse direction (right to left that are more dynamic).

STRENGTHENING PROGRAMME

Other factors that must be taken into consideration are incorrect running shoes, hard or uneven running surfaces and unrealistic increases of mileage/training intensity (work on a guideline of 5-10% increase in mileage per week).
The achilles injuries can also be caused by lack of flexibility and strength in the calf muscles, this will become most apparent when running up hill.
It is important to create a training program to increase the eccentric strength of the calf (when a muscle lengthens as it contracts) using progressively faster speeds of movement to increase the forces that the calf can handle.
The rehabilitation exercises should take place after 1 to 2 weeks of rest once pain and inflammation have gone down.
The program below should be performed everyday:
1. Warm-Up – 5-10 minutes of CV – non weight bearing e.g cycling etc.
2. Stretching – For both gastrocnemius and soleus, perform 3 x 30secs stretches on both sides.
3. Eccentric Programme –

Level 1 – Perform a straight legged heel raise with uninjured leg, then place the ball of the injured leg down and lower slowly with both legs until the heels reach the floor. Progress as follows:
Drop time: 4secs 3×10 reps. with 30 seconds rest.
Drop time: 2seconds 3 x10 reps. with 30 seconds rest.
Drop time: 1secs 3 x10 reps. with 30 seconds rest.
Repeat from the beginning (as above) performing a bent-legged heel raise – knee should be bent 20-30degrees.
Level 2 – Perform heel raises with both legs for lowering and raising phases. 3X10reps with 30 seconds rest. Progress as in level 1.
Level 3 – Perform heel raises with the uninjured leg on the raise phase and with the injured leg on the lower phase. 3X10reps with 30 seconds rest. Progress as in level 1.
Level 4 – Perform heel raises with both legs during the raising phase with only injured leg during the lowing phase. 3X10reps with 30 seconds rest.
Level 5 – Perform heel raise lowering and raising with only the injured side. 3X10reps with 30 seconds rest. Progress as in level 1.
4. Stretching – Follow point 2.

Please contact us at Range of Motion Physical Therapy if you need any additional information or advise on this or other injuries.

- See more at: http://www.romphysicaltherapy.ie/index.php/achilles-tendonitis-prevention-treatment-programme/#sthash.G3CzYs4U.dpuf