Table 2.
A Comprehensive Achilles Tendon-Loading Protocol7
| Symptom-management and load-reduction phase: wk 1 to 2 (or longer if needed) | |
| Patient status | |
| Pain and difficulty with all activities, difficulty performing 10 one-legged heel rises | |
| Loading intensity | |
| Progress loading up to 100% body weight with slow, controlled motion. If needed, begin with aquatic therapy, body-weight support, or isometric plantar flexion. | |
| Goals | |
| Start to exercise and understand nature of the injury and how to use the pain-monitoring model | |
| Treatment program: Perform exercise once a day | |
| Pain-monitoring model information and advice on exercise activity | |
| Circulation exercise (moving foot up or down) | |
| Two-legged heel rises standing on the floor (3 × 10 to 15 repetitions) | |
| One-legged heel rises standing on the floor (3 × 10 repetitions) | |
| Eccentric heel rises standing on the floor (3 × 10 repetitions) | |
| Sitting heel rises (3 × 10 repetitions) | |
| Recovery phase: wk 2 to 5 (or longer if needed) | |
| If pain at the distal insertion of the tendon, continue standing on the floor | |
| Patient status | |
| Pain with exercise, morning stiffness, pain when performing heel rises | |
| Loading intensity | |
| The load on the Achilles tendon is increased by increasing the speed of movement and by adding external resistance. External resistance is introduced once the patient can complete the body-weight treatment program without difficulty. | |
| Goals | |
| Start strengthening | |
| Treatment program: Perform exercises once a day | |
| Two-legged heel rises standing on edge of a step (3 × 15 repetitions) | |
| One-legged heel rises standing on edge of a step (3 × 15 repetitions) | |
| Eccentric heel rises standing on edge of a step (3 × 15 repetitions) | |
| Sitting heel rises (3 × 15 repetitions) | |
| Quick-rebounding heel rises (3 × 20 repetitions) | |
| Rebuilding phase: wk 3 to 12 (or longer if needed) | |
| If pain at the distal insertion of the tendon, continue standing on the floor | |
| Patient status | |
| Tolerates the recovery phase exercise program well, no pain at the distal tendon insertion, possibly decreased or increased morning stiffness | |
| Loading intensity | |
| Continue to progress external resistance and initiate plyometric exercises according to patient tolerance. | |
| Goals | |
| Heavier strength training, increase or start running or jumping activity | |
| Treatment program: Perform exercises every day and with heavier load 2 to 3x/wk | |
| One-legged heel rises standing on edge of step with added weight (3 × 15 repetitions) | |
| Eccentric heel rises standing on edge of step with added weight (3 × 15 repetitions) | |
| Sitting heel rises (3 × 15 repetitions) | |
| Quick-rebounding heel rises (3 × 20 repetitions) | |
| Plyometrics training (sport specific) | |
| Return-to-sport phase: 3 to 6 mo (or longer if needed) | |
| If pain at the distal insertion of the tendon, continue standing on the floor | |
| Patient status | |
| Minimal symptoms, some but not daily morning stiffness, can participate in sports without difficulty | |
| Loading intensity | |
| Progress from previous phase to include sport-specific loading speed and movement patterns on high-intensity days. | |
| Goals | |
| Maintenance exercise, no symptoms | |
| Treatment program: Perform exercises 2 to 3x/wk | |
| One-legged heel rises standing on edge of step with added weight (3 × 15 repetitions) | |
| Eccentric heel rises standing on edge of step with added weight (3 × 15 repetitions) | |
| Quick-rebounding heel rises (3 × 20 repetitions) | |