Table 1 Silbernagel’s combined concentric-eccentric program

Patient status: Pain and difficulty with all activities, difficulty performing 10 single leg heel raises

Goal: Start to exercise, gain understanding of their injury and of pain monitoring model

Treatment program: Perform exercises every day:

• Pain monitoring model information and advice on exercise activity

• Circulation exercises (moving foot up and down)

• Double leg heel raises standing on the floor (3 × 10–15 repetitions)

• Single leg heel raises standing on the floor (3 × 10)

• Sitting heel raises (3 × 10)

• Eccentric heel raises standing on the floor (3 × 10)

Phase 2: Weeks 2–5

Patient status: Pain and difficulty with all activities, difficulty performing 10 single leg heel raises

Goal: Start to exercise, gain understanding of their injury and of pain monitoring model

Treatment program: Perform exercises every day:

• Pain monitoring model information and advice on exercise activity

• Circulation exercises (moving foot up and down)

• Double leg heel raises standing on the floor (3 × 10–15 repetitions)

• Single leg heel raises standing on the floor (3 × 10)

• Sitting heel raises (3 × 10)

• Eccentric heel raises standing on the floor (3 × 10)

Patient status: Pain with exercise, morning stiffness, pain when performing heel raises

Goal: Start strengthening

Treatment program: Perform exercises every day:

• Double leg heel raises standing on the edge of a step (3 × 15)

• Single leg heel raises standing on the edge of a step (3 × 10)

• Sitting heel raises (3 × 15)

• Eccentric heel raises standing on the edge of a step (3 × 15)

• Quick-rebounding heel raises (3 × 20)

Phase 3: Weeks 3–12 (longer if needed)

Patient status: Tolerates phase 2 exercise program well, no pain at distal portion of tendon, possibly increased or decreased morning stiffness

Goal: Heavier strength training, increase or begin running and/or jumping

Treatment program: Perform exercises every day with heavier load 2–3 times per week

• Single leg heel raises standing on the edge of a step with added weight (3 × 10)

• Sitting heel raises (3 × 15)

• Eccentric heel raises standing on the edge of a step with added weight (3 × 15)

• Quick-rebounding heel raises (3 × 20)

• Plyometric training

Phase 4: Weeks 12–6 months (longer if needed)

Patient status: Minimal symptoms, morning stiffness but not every day, can participate in sports without difficulty

Goal: Heavier strength training, increase or begin running and/or jumping

Treatment program: Perform exercises every day with heavier load 2–3 times per week

• Single leg heel raises standing on the edge of a step with added weight (3 × 10)

• Eccentric heel raises standing on the edge of a step with added weight (3 × 15)

• Quick-rebounding heel raises (3 × 20)