[Music]
The eccentric
training protocol for Achilles pain is
probably one of the most commonly
prescribed
exercise protocols to help improve
Achilles tendon problems.
The reason is that it works well for
a lot of people,
but for some people it doesn't. And in
this video I want to just try and
explain
a few of the things that contribute to
why perhaps it's not always the answer
for everybody.
I'm Steph. I'm one of the physios at
treatmyachilles.com,
where you can get an online assessment
if you need one... if you... this is something
you want, then have a look at the
description for this video and you'll
find the details there.
So, firstly, we have to consider how long
you've had your Achilles pain for. If
you've only just injured your tendon, and
it's only been painful for
say, a few days to a week, because of
perhaps a sudden change or a sudden
increase in your training load,
then you might have what we call an
acute reactive tendon, which means the
tendon's reacted
to the change in load by giving you pain,
and
it's your tendon's way of telling
you that it's done too much.
And in this case, it's not the time to do
any eccentric heel drops
or like the Alfredson protocol or...
any sort of calf raises with weight,
because it's telling you it's overloaded.
So the last thing it wants to do
is be overloaded even more. However,
if you've had your tendon pain for
months or even years,
and perhaps calf raises don't give it
any trouble, but it hurts when you run,
then maybe eccentric heel drops - so,
eccentric is just the downward motion -
...and maybe eccentric is not enough and
actually you need to be adding
concentric to your movement
so that you can increase the strength
pushing off for running.
And you might well need to be adding
weight, if you're not doing that already,
because
running is a much higher load and
requires more strength.
The range of movement is also important,
because it depends on whether the tendon
is irritated in the mid portion,
which is the middle of the tendon, or
down on the insertion which is down
on the heel. The insertion of Achilles
tendons tend not to like being on a
stretch so much.
So these are also ones that you don't
necessarily want to start in the early
stages,
with going full range into a heel drop
off a step.
You might want to keep them at a lower
range of movement that doesn't irritate
them quite so much.
However, if you're a runner who runs up
and down hills a lot,
and you're at the later stages in your
rehab, then this is where you might want
to do
larger ranges of movement: so, off a step,
full range, because
actually when you're running up and down
hills you will need more range of
movement.
Another point I want to make is about
sets and reps
and weight. So, a lot of the eccentric
training protocols
will follow the 3 x 15 twice a day
program, because that's what was
researched and
published. But when you think about
it,
it really does depend on what each
individual can tolerate. So
if, for example, a marathon runner who has
a long training history
of a lot of muscular endurance, just
three lots of 15 reps,
that might not be enough and it might be
too easy for them, in which case they
won't be getting the same training
stimulus that they...
need. Whereas somebody else who's
reasonably sedentary
might find that three lots of 15 is too
much and end up flaring up their
Achilles.
So you do need to bear in mind different
people's individual differences.
Secondly, when you're adding weight...
rather than pick,
say, 10 kilograms, you really need to also
take into consideration what percentage
of that person's body weight that is. So
10 kilograms to a 50 kilogram female is
going to be a lot more
than 10 kilograms to a 100 kilogram male,
for example.
So it's another consideration that might
mean that
using a very rigid standard protocol
might not be the best way
to deal with your Achilles pain.
I hope this has helped you to understand
why there are so many different things
we need to think about
when choosing what exercise to give you
for your Achilles pain,
and it hopefully will help you
understand why perhaps you haven't been
getting anywhere if you've just been
doing
one type of exercise and that doesn't
necessarily apply
exactly to what you need your Achilles
to do.
If you want any more information, please
do take a look at our website,
treatmyachilles.com. Otherwise, good luck
with it and
I hope you found this useful.