Restoring Function With Staged Loading and Why Quick Fixes Fail

Eccentric exercise and heavy slow resistance training have the best evidence, but each covers only part of what is needed: neither trains energy storage and release, compression tolerance, the kinetic chain or the brain. Studies also tend to measure pain and structure rather than return to activity. Jill argues that exercise-based care takes weeks to months, not days, and has to be sold to patients, coaches and other practitioners. The program starts by reducing provocative loads and adding heavy isometrics at 70 percent of maximal voluntary contraction, held for 45 seconds and repeated five times with two minutes' rest. It then moves to strength work for the calf, quadriceps and glutes, functional and endurance strength, slow energy storage exercises such as skipping, and finally running, jumping and change of direction, tailored to each person. Complete rest, bracing and boots are avoided. Interventions do not change how someone moves, and repeated PRP injections each need three weeks' rest. PRP also pushes cell and proteoglycan levels further from normal than saline, while neither changes collagen.