Graded Exercise Progression, Dosage and Isometric to Isotonic Loading

The progression works like graded exposure, guided by the activities the patient fears. Isometrics suit very painful tendons, isotonic loading follows, and stretch-shortening cycle work also requires adequate strength. Patients can skip or mix stages depending on tolerance. The dosage has four levels. Isometrics are 5 to 30 second holds, 5 to 10 repetitions, daily. Strength endurance is 8 to 15 repetitions, three to four sets, three seconds up and three down, two to three times a week. Maximum strength is six repetitions with a fast concentric and two second eccentric, once or twice a week. Level four covers hopping, plyometrics and running. Effort should reach 7 to 8 out of 10 on the OMNI scale. Isometric options include the calf wall sit at 45 degrees, standing holds and the seated calf raise or leg press, aiming for about 1.5 times body weight seated or 0.5 added in standing. Soft surfaces help with forefoot pain, and home loading can use bags of pool salt, bricks in a backpack or a person sitting on the knees.