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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