I do like ASTYM treatment but add this.
Show this to your PT
Try this. It will work
But do wrist concentric extension with eccentrically lowering exercises
Habets, B, van Cingel, R. Eccentric exercise training in chronic mid-portion Achilles Tendinopathy: A systematic review on different protocols. Scandinavian Journal of Medicine and Science in Sports. 2015: 25 (1): 3-15
Background: Tendinopathy describes a condition in which the tendon is injured to due an overuse mechanism. The presentation is typically pain with activity, tenderness, decreased ability to tolerate tension, and decrease strength. These overuse injuries represent 7% of all PCP visits and 30% of sports injuries arise from tendinopathy.1 Eccentric exercises for lower leg tendinopathies have been shown to be effective in managing pain, improving function, and returning patients to work and sport. This systematic review was performed to determine which eccentric training parameters are most effective for reducing pain and improving functional outcomes in patients with Achilles tendinopathy.
Methods: 12 studies that met all inclusion criteria and were used in this study. They reviewed eccentric training protocols to determine if there was an optimum treatment regimen that had favorable patient outcomes.
Results: Strong evidence was found for the original Alfredson eccentric protocol from multiple high quality studies.2 This protocol is as follows:
Concentric heel raise with Eccentric lowering of the injured LE both with knee bent and straight
3x15 reps for each position twice daily for a period of 12 weeks
Once the exercise is performed without pain, weight was added
There was also strong evidence to utilize a gradual onset of exercise during the first week. This protocol is as follows:
o During the first week, patients initiated heel raises with 1x10 reps and gradually increased to 3x15 reps by day 7
o Weeks 2-12 followed according to the Alfredson protocol.
Clinical Implication: Based on the research, the above mentioned Alfredson protocol has been shown to be effective in targeting the affected area and should be implement to treat painful Achilles tendinopathy. Patients should be educated that reproducing pain during the exercise is acceptable, but it should not be progressive or disabling. The affected LE should perform the eccentric lowering and the exercise should be initiated slowly with speed increasing as the patient is progressed through the rehabilitation protocol.
Additional References:
1. Murtaugh, B, Ihm, J, Eccentric Training for the Treatment of Tendinopathies. Current Sports Medicine Reports. 2013: 12 (3): 175-182
2. Alfredson, H., Pietilä, T., Jonsson, P., & Lorentzon, R. (1998). Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. The American Journal of Sports Medicine, 26(3), 360-366.
