Achilles Loading

[Michael McMurray]

Here is an interesting article on loading of the achilles tendon during different weight bearing activities. Please post your clinical thoughts and how can you apply this to your patient population? Any surprises?

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[Jennifer Boyle]

This article reminds me of the presentation during the art and science conference on RTC loading that was very helpful. I feel that this article helps break down the appropriate exercise progression/ regression based on what stage of healing a patient is in. In the course series we always spoke about progressive tendon loading and we talked about some ideas we could utilize in the clinic, however, I have had a hard time identifying what exercises were most appropriate to a specific phase of healing. This article helps break this idea of tendon loading down even more with explanations of how varying the speed of motion or magnitude could help provide the stimulus needed for adaptation. Right now I have a young boy with severs and I believe most of these concepts and ideas would carry over well to his treatment plan but I am unsure. Does anyone have any ideas of applying this article to this population?

[Tyler France]

I agree with Jen that this article evokes memories of Tim Uhl’s presentation on rotator cuff exercise progression. I was interested in the data presented on stress through the Achilles tendon with squatting and lunging. I currently have two patients who are ~3 months s/p Achilles rupture and repair who are stuck in the phase between being able to do bilateral heel raises easily but being mostly unable to perform single leg heel raises. I would like to use some of the information presented in this article to load their Achilles tendons a little more without having to try unilateral heel raises over and over.

[Katie Long]

I agree with Tyler in relationship to Tim Uhl’s presentation on RTC exercise prescription. I always find articles like this helpful in laying out exercises in regards to load for potential progression/regression. I often find that I have an end goal, but sometimes have a hard time filling in the gap between that end goal and the current patient presentation.
I also thought the segment on running vs. U-HR was very interesting. The point they make that it takes 482 unilateral heel raises to mimic the overall impulse of the achilles tendon during a 30 minute run was very interesting. I thought that was a surprising connection/comparison, although it makes sense when you think about it. It really made me think about exercise prescription in this patient population, who are often runners.
I do wonder about applicability of this study to my patient population. These patients were young (mean age 22.1 +/- 1.8 years) and it made me question the generalizability to those with more degenerative tendinopathy as compared to those who are younger with over-use tendinopathies. I don’t know that there is a difference, but it made me consider how this may be applied to my older patients.

[Sarah Bosserman]

I thought it was interesting that they pointed out the review by Couppe et al that it may matter less the type of contraction you are using (eccentric vs concentric) and more on the # of reps at the appropriate load, speed, and duration for the specific patient. Thinking about the AT force and stress during running is much higher than typical dosage used in the clinic and needs to be a factor when developing a return to running program. A previous 2015 JOPST article I have used in the past, “A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation” highlighted the importance of education in return to sport to modulate expectations and prevent exacerbation of symptoms. This current article will also be useful in helping to explain the loading progression and how certain functional exercises (lunges, squats, etc) may place different loads on their tendon.

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