Today's video covers the primary exercises we use in physical therapy to treat achilles tendinitis or tendinopathy. Not only do these exercises work to reduce pain, but they will also strengthen the tendon and the two calf muscles (gastrocnemius and soleus).

Achilles tendinopathy describes a condition in which the tendon that connects the calf muscles to the heel bone (calcaneus) becomes irritated, resulting in pain and limited function.

Achilles tendinopathy can be subdivided into two categories based on the location of symptoms. These two subdivisions include mid-substance and insertional variations. Pain associated with mid-substance tendinopathy is experienced several centimeters above the heel bone, whereas, insertional pain is experienced at the calcaneus.

The management of both types is very similar where appropriate loading, through the use of calf raises, serves as the intervention of choice. The major difference when implementing the calf raise is that individuals with insertional tendinopathy will initiate calf raises on the ground and only progress to a raised surface when tendon irritation has reduced.

So, based on this information here is the progression:

1. Isometric Holds - raise up on both legs, shift body weight over to the painful side and hold for 30-45 seconds. Perform 4-5 repetitions daily.

2. Eccentric Contractions - raise up on both legs and slowly lower down on the painful side. Perform 3 sets of 15 slow repetitions every other day. Insertional cases should stay on the ground during this phase.

3. Full Calf Raise - perform the full calf raise on the painful side. 3 sets of 15 reps every other day.

For the soleus calf raise, aim to complete 3 sets of 15 repetitions.

Reference: Malliaras P, et al. Achilles and patellar tendinopathy loading programmes : a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Med. 2013.

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