Skip to main content

Table 2 Defence rehabilitation Achilles and Patellar tendinopathy best practice management pathway

From: Study protocol: a double blind randomised control trial of high volume image guided injections in Achilles and patellar tendinopathy in a young active population

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.

  1. RM Repetition Maximum, VISA-A Victoria Institute of Sport Assessment-Achilles, VISA-P Victoria Institute of Sport Assessment-Patella