UNIT 2: Week 4

• recent change in activity/load • localized pain (point) • pain may initially decrease (warm up phenomenon) • load related to pain (faster they run=more pain) • increased pain the morning after activity

• heel raise/hopping • pain localized to mid portion of achilles/insertion at calcaneus

• single leg squat/jumping • pain localized to mid portion patellar tendon/inferior pole of patella

• single leg stance • pain localized to mid portion gluteal tendon

*same as muscle rehab 1. Relative rest 2. Early mobilization 3. Early strengthening

F: 2 x day, 7 days per week x 12 weeks I: non disabling pain T: eccentrics V: 3 sets x 15 reps, 3sec/rep, 3 min rest P: once no pain, add load until non-disabling pain

• NO • they do work, but not in the way we thought

• at least 12 weeks due to slow metabolic activity

No pain –> acceptable zone –> high risk zone 1. Pain is allowed to reach 5 on the NPRS during the activity 2. The pain after completion of the activity is allowed to reach 5 on NPRS 3. The pain the morning after the activity should not exceed a 5 on the NPRS 4. Pain and stiffness is not allowed to increase week to week

• yes

• Symptom management (weeks 1-2) • Recovery (weeks 2-5) • Rebuilding (weeks 3-12) • Return to sport (month 3-6)

• Pain with all activities, pain when performing 10 one legged heel rises • Pain with exercise, morning stiffness, pain when performing heel rises • Tolerates program with no pain • Minimal symptoms

• Progress loading up to 100% body weight w slow motion - 3x10 once a day (inner range) • Increased speed and external resistance- 3x15 once a day (outer range) • Progress external resistance and initiate plyometrics- 3x15 2-3x/week (add load) • Sport-specific loading speed and movement patterns - 3x15 2-3x/week (add speed)

• plyometrics • initial rapid eccentric contraction followed immediately by rapid concentric contraction

• the faster a tendon is loaded, the stiffer is becomes and the more elastic energy it stores

• good for safely resuming activities that require power bc it generates high tensile forces without much external load

F: 3x/week, 12 weeks I: 15-6 RM T: isotonics V: 3-4 sets, 15-6RM, 6sec/rep, 3 min rest/set P: increase volume, increase intensity

• yes in one study

• HSR bc eccentric exercises can be time consuming and high volume

• no SD in pain or function

• loading intensity (must be >70%) NOT contraction type • needs to be longer durations (>12 weeks)

• induces analgesia (reduces pain for short period of time) • reduces inhibition for short time

• isometric • strength (isotonics) • functional strength • speed • plyometrics • return to play

• if there is pain with isotonic exercise