Hi guys! In this video, I want to talk about how quickly you should be progressing through your
exercises for your Achilles tendinopathy. So, my name is Maryke. I'm one of the physiotherapists
from treatmyachilles.com, where you can get online physiotherapy assessment as well as
treatment for your Achilles injuries. Have a look at the description of this video if you
want the link to our website. Okay, so when we look at a rehab plan for Achilles tendinopathy,
a proper plan can take … Well, it always takes 12 weeks and longer, because tendons just take
a very long time to react. And there are certain targets that we want to hit in a typical rehab
plan that we create for our patients before they can move on to the next level. But now,
I find that I sometimes forget to properly explain to patients that you cannot rush that
rehab stages by really pushing how much weight you use every time, because essentially,
the body first has to react to every stage in it and repair the cells and build new cells,
and that takes time. So, it's a mix between doing the correct exercises at the correct level,
plus time that needs to pass, but you need to progress. So, let me explain this a little bit
more in detail. So, if I take a typical runner who sees me with Achilles tendinopathy. They come in,
we have to establish their baseline, so, how strong is that tendon at the moment, how sensitive
is that tendon at the moment, because that will determine what exercises I prescribe to them.
Now, say we've got somebody who has a really sensitive tendon. We may have to start with
double leg heel raises first and move on to single leg ones with just body weight
until that tendon has calmed down and accepts it all. Now, once they can do three sets of their
single leg heel raises on a single leg, they are ready to usually move on to using some weights.
But now, see that calculation you already did in your brain? ‘Okay, so if I can get to three
sets of 15 single leg heel raises as quickly as possible, I can start with the weights, and then
I'll get better more quickly.’ No! It's a target we know is significant, because at that point
we can make a change in the program. But it's not a target that you can really push to get to
despite your tendon being painful. So, you've got to observe how your tendon
reacts to the exercises you do. So typically, I would take somebody and first say to them,
‘Start with three sets’ ... Well, this is now for a painful tendon; if you're
somebody who can run on your tendon already, it's not this painful, you'll start at a higher level.
But for somebody with a really painful tendon, I will start them off and say,
‘Okay, let's test and see how many heel raises you can do today on double legs without pain.
Say for instance, they get to 12 or 13, I'll start them off with three sets of ten. So,
it's fewer than what they can do in one go, because they're going to do more sets now. And
once they've done that three times on three different days and they feel, ‘No, it's okay,
tendon doesn't get an increase in pain after, it feels fine,’ we start increasing those reps
until they can hit their three sets of 20 with double legs without an issue. Then we say, ‘Okay,
let's test a small set of single leg ones.’ If the tendon accepts it, then we start building those
single leg ones up over several sessions, never adding more than two or three, depending on how
easy or difficult they were. So I never … You know when you're training for fitness, you can really
push those last two reps out to get the most gains? I find it's best not to do
that with a sensitive tendon or a tendon in general, because they won't tell you at
that moment that it's painful or gonna be too much for it; they will tell you 24 hours later.
So, I usually get my patients to work to where they're tired but not super super fatigued. So,
they then have to build that up slowly over time to get to that three sets of 15,
where they can add weight. And then we start adding weight, and usually we want to build
up ... Well, again, depending on the patient and depending on how their tendon responds,
we need to start using … If they're a runner, we're looking for weights between … that's equal
to between 20 to 50% even of their body weight eventually. So, let's take me for
example. I weigh 72 kilos, so 10% of my body weight is 7.2 kilos, so 20% would be 14 to 15
kilos – roughly – that I have to build up first before I can go on to the next step of my rehab.
Now if I jump in with, say, 8 kilos at the start, then there's a very big chance that my tendon will
go, ‘Whoa mate! You've just strengthened us up to be able to cope with three sets of 15
with body weight, and now you're giving me 8 kilos!’ So, I would flare it up because the
difference between the strength we've trained to and the strength and the volume of exercise
I'm asking it to do is just too big usually. So again, we know that you want to get to that 20%
weight, but we've got to do it really slowly in increments. And you cannot, even if you do,
say, 3 kilos you start on today, you can do three sets of 15 and it was okay,
don't immediately jump to more kilos the next time. Do at least one more session to allow that
tendon to properly adapt, properly settle into the exercises. So, don't let it become a race. And
that's why it's useful with to work with a physio as well, who can guide you
what is the right speed for you to increase your exercises at to get to those heavy levels. There
was something else I was going to say … Oh yes! So, it's also useful to think about why is it
necessary to pause for a moment on those weights and do it for a few sessions before moving on.
And that's because of the process that happens in your Achilles tendon when you do exercise.
So remember, whenever we exercise, we get micro damage in our tissues – and that's absolutely
normal – and that's the process through which we rebuild them stronger. If we look at the Achilles
tendon, it's mainly made up out of collagen fibres. Now, collagen fibres take longer to
rebuild and restore after exercise and rehab, and they reckon anything between 48 to 72 hours even,
depending on your training status. So, people who are fitter and well-trained will recover a
bit more quicker than people who are untrained or less trained or have a very injured tendon.
And what happens in that period of time is, the body has to replace the old fibres with new,
stronger fibres, and that's a process that takes time. And it doesn't mean that just because you
didn't have pain after that one session, it doesn't mean that your body already repaired it
fully after that one session. That's why I find a safety check of repeating it for a few sessions
before you move on to the next one is a very good way of avoiding flare-ups, so that you can
really make sure that the body had enough time to recover. And that's also why it's useful to have
enough rest days in your week. So typically, when I start my runners off with their heavy strength
training and they're not doing any running or jumping and things yet – so, just strength
training – I don't get them to do the heavy stuff more than three times a week, because that means,
say for instance, they're doing it Monday, Wednesday, Friday, they then have a Tuesday
and a Thursday between those sessions to recover. And then we give them two days over the weekend
to make sure that if the body didn't quite repair all those tissue ... those fibres, they've got two
days to now repair properly before Monday comes again. So, it's important to understand that,
yes there's targets that you want to hit between your stages of rehab, but those targets are not
to be rushed to get there, because it's not going to make you recover more quickly; it may actually
mean that your body doesn't get the time to repair the tendon properly after each exercise bout,
and you may get a flare-up. Okay, hope that made sense! Let me know if you've got any questions.
And if you need more help with your Achilles injuries, remember, you can always consult one
of us by video call – the link to the website is in the description of this video. Take care!