Achilles tendinopathy and tear. Photo Credit William Morrison, MD, @morrisonMSK
Table 1: 4-phase progression of Achilles tendon loading | ||||||
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Phase | Focus | Characteristics | Time Frame | Key Strength Modality | Frequency | Prescription Example |
- Phase 1 | Acute/Protective | Pain/Stiffness upon wakening Pain on palpation Pain during activity Difficulty performing 10 calf raises | 0-2 Weeks | Isometrics | Daily | Single leg Isometric Hold (heel off step) — Body weight x 20-40 sec x 3 sets Progress to loaded holds |
- Phase 2 | Load introduction | Pain/Stiffness upon wakening Pain on palpation Reduced pain during activity Pain below a 4/10 when perfoming 10 calf raises | 2-5 Weeks | Isolated ResilienceControlled Eccentrics | Daily to every second day (the heavier the load, the longer recovery time between sessions) | Single Leg Calf Raises (heel off step) x (build up to 20 reps) x 3 sets Eccentric Heel Lowers (heel off step) — 2 legs up, 1 leg down x 10 reps x 3 sets Progress to loaded eccentrics and loaded calf raises |
- Phase 3 | Strength Accumilation | Pain free upon wakening Reduced pain on palpation Minimal/zero pain with activity Can perform 10 loaded calf raises | 4-10 Weeks | Strength ResilienceReactive Stiffness | Every 2-3 days | Slow Prowler Push x 20 steps x sets BB Step Up — Double Box x 6 reps x sets Mini Tramp Jog x 40 sec ON: 20 sec OFF x 5 sets Knee Drive Hold on BOSU x 20 sec hold x 4 sets |
- Phase 4 | Elastic Tolerance | Pain free upon wakening Reduced pain on palpation Pain free with activity Jump rope pain free | 10+ Weeks | Reactive StiffnessBallistic Stiffness | Every 2-3 days | Linear hop and stick; 6 reps x 4 sets Lateral hop and stick; 6 reps x 4 setsLinear hurdle and hop; 6 reps x 3 sets Lateral hurdle and hop; 6 reps x 3 sets |
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