Tendon loading stage | Type of contraction | Reps/Sets/Holds | Aim of phase | Progression criteria | |
---|---|---|---|---|---|
Load tolerance tests | Outcome measures | ||||
Stage 1 – Low Load Daily exercise | Isometric (may avoid painful range initially) | 5x 15–60 s holds Repeated 4x daily 5 days/week | Inhibit cortical interpretation of pain. Tendon adaptation to load | Able to move body weight double leg with pain less than 3/10 eg, squat, calf raise | Numeric Rating Scale or Visual Analogue Scale On first waking On activity After activity VISA A/P 6 weekly intervals |
Stage 2 – Medium Load Alternate days with Stage 1 | Eccentric/Concentric (may avoid painful range initially) | 3x 10–12 3 s Eccentric / 3 s Concentric | Inhibit cortical interpretation of pain Musculo-tendinous adaptation to load. | Able to move body weight single leg with pain less than 3/10, eg single leg squat/single leg calf raise | |
Stage 3 – High Load Every third day with Stage 1 and 2 on days inbetween | Eccentric/ Concentric Heavy Slow Resistance | 3x15 (reduced progressively as weight increased) 3 s Eccentric /3 s Concentric 60% 1RM (3x15 reps) progressed to 85% 1RM (3x6 reps) in week 12 | Musculo-tendinous adaptation to load through controlled movements | Able to perform low level plyometric test with less than 3/10 pain, eg repeated small hop or split jump | |
Eccentric Loading | 3x15 (double leg, single leg, weighted) Up to 10 s eccentric phase | ||||
Stage 4 – High Load In place of Stage 3 loading, with Stage 1 and 2 inbetween | Plyometric | Restricted to 60 foot contacts when introduced. eg. 3x10 Forward hops 3x10 Single leg hops Increased to 80 foot contacts | Elastic loading of Musculotendinous unit. | Able to perform high level plyometric test e.g. repeated maximal hop and multidirectional hop. |