L2: How to prescribe them part 1

How to prescribe them 

This exercise prescription was designed as a return-to-sport programme for athletes with mid-portion Achilles tendinopathy based on a randomised clinical trial investigating the effect of running and jumping during the rehabilitation process.1 The goal of this exercise programme is to resolve the patient’s symptoms and/or return them to their previous level of athletic performance. Key concepts to achieve this goal include: 

  • Treat minor or early symptoms of tendinopathy promptly with load control (usually by reducing exercise that places tension or pressure on the Achilles tendon but not eliminating it all together). 
  • For athletes who want to continue training the pain-monitoring model is recommended.2 
  • Following mechanical loading the increase in collagen formation in response to strain peaks around 24 hours after exercise and remains elevated for about three days, therefore, if the patient is going to perform high load Achilles tendon activities ensure they have three subsequent rest days.3 
  • Use training diaries – this involves documenting their rehabilitation exercises and other physical activities as well as symptoms and other comments. See Appendix 1 
  • Functional outcomes can be measured using a battery of tests.4 See Appendix 2 
  • The intervention should be of long duration – at least 12 weeks.5 
  • Patients should continue to perform their rehabilitation exercises even if their symptoms have improved or disappeared. This is because lower limb function recovers in only 25% of cases when symptoms disappear.6 Silbernagel et al. speculate that: “One of the reasons … might be that the function of the calf musculature and Achilles tendon has not fully recovered.” 
  • An athlete should complete a full season without symptoms before being considered completely recovered.6 

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