Staged Rehab From Isometrics to Maximal Strength and Speed

Peter notes that exercise trials for Achilles tendinopathy are mostly positive, but no program, whether Alfredson, Stanish and Curwin, Silbernagel or heavy slow resistance, has proven better than another. He uses the force velocity curve to structure rehab in phases. Isometrics, for painful patients, use seated calf raise or leg press holds of 10 to 30 seconds in mid-range, 5 to 10 repetitions, a 1:1 work to rest ratio and up to 1.5 times body weight added, or calf wall sits and step holds at home. Intensity sits at 6 to 8 on the OMNI scale, which also lets patients regulate load day to day. Strength-endurance uses 3 to 4 sets of 8 to 12, a 1:2 work to rest ratio, two to three times a week, fewer than three reps in reserve, and no dorsiflexion for insertional problems. Maximal strength drops to 3 to 5 repetitions with intent to move quickly, plus isolated eccentrics in a split program. Strength-speed uses sled pushes from 30 to 40% of body weight.