Rehab for an achilles tendon is much different than your typical ‘muscle strain’. From full ruptures, to nagging tendinopathy it can be a long road to heal. It’s good to remember the basics on how the tendon functions. It needs:
💪Muscle Strength (Gastrocs/Soleus)
⚙️Elastic Energy Storage
💥Elastic Energy Release
If the tendon is extremely painful, or just off surgery you might just start off with isometric exercises (aka resist the foot, but no actual movement). After healing begins, the video above shows my usual progressions:
1️⃣Seated Calf Raises
2️⃣Standing Bilateral Calf Raises
3️⃣Assisted Unilateral Calf Raises
4️⃣Unassisted Unilateral Calf Raises
5️⃣End-Range Plantarflexion Raises
6️⃣Eccentric Heel Drops (not shown)
📣There’s been endless debate and study on what gives you the greatest healing response: concentric, eccentric, isometric exercises for achilles. The argument is going to go on forever.
Personally, we've found a progression of slow reps, building into faster and more elastic reps does the job. Any type of controlled tissue gliding should reduce some pain and up their resilience.
🏀Achilles ruptures are the most well-known and dramatic Achilles injuries however they aren’t the most common type. Most pain in the area stems from overuse, ‘Achilles Tendinopathy’. Runners are actually at 30x at greater risk to suffer these tendon problems.
Similar to plantar fascia pain (the achilles continuously feeds into the plantar fascia), it’s characterized by:
🔻Pain at the start of the activity
🔻Recent activities of jumping and landing
🔍I’ve always found getting to the root of these problems, involves talking to the patient.
🔹What new shoes are you wearing? (often minimalist)
🔹You were playing basketball how long??? This was the first time you’ve played all year?? 🤦♂️
🔹How many jump squats did you do in that workout?
🏥Management depends on what portion of the area is affected:
Myotendinous Junction ➡️ Mid-Portion ➡️ Insertion
❇️Shoulder Rehab Basics
📖The human shoulder is incredibly complex, we try to not complicate it in the early stages of rehab more than it needs to be.
👆The exercises here are the BASICS. They’re not fancy, but when we’re talking non-athletes, they’re simple and effective if done with the right cues. Here are some of our go-to exercises with a couple tips:
1️⃣Kettlebell-Row (Works Rhomboids, Lats, Mid Traps)
-Bent-Over supported position
-Driving elbow to the sky
-Ensure not to pull with biceps, or over-extend arm
2️⃣Side-Lying Exercise (Works Infraspinatus, Teres Minor)
-Elbow supported -Upper Traps and Neck Relaxed
-Leaning slightly forward with the torso
-Should feel it distinctly in the back of the shoulder
3️⃣Full-Can Raise (Works Supraspinatus, Serratus anterior)
-Thumb Up, elbow locked
-Raise arm to just above shoulder height
-Ensure you’re sweeping the shoulder blade up not locking it ‘down and back’
You might assume that the most common complaint that comes into our offices is low back pain or neck pain. I’d say its actually shoulder pain.
📖The shoulder is inherently unstable. Also known as the Gleno-humeral joint, it’s a Multi-Axial ball and socket joint. I give the analogy of it being like a golf ball and tee, but its more similar to balancing a basketball on your finger.
⭕️How does it not come flying off your body when you move it? It’s held in place by two categories of tissues:
1️⃣Static Stabilizers (Glenohumeral ligaments, the Labrum)
2️⃣Dynamic Stabilizers (Rotator Cuff, Scapular Stabilizers)
👉The first of which we don’t have much control over, and it’s why having a labrum problem or a shoulder dislocation that stretches the ligaments can have long-standing consequences.
🏎However the dynamic stabilizers we can rehab, condition and prepare for the unpredictability of sports or life. They act as the brakes on the Ferrari that is your upper body mechanics, and I recommend pro-actively strengthening these if you play a shoulder-vulnerable sport or are approaching your 40’s.
Knee pain is a common complaint affecting patients of all ages. Knee pain can be caused by structural problems, such as sprained ligaments and meniscus. However it can also be caused by medical conditions such as arthritis, gout and infections. Most cases of knee pain can be improved by physical therapy, however in rare cases may require orthopaedic procedures.
The severity and location of knee pain can vary, however you should consult one of our specialists if you suffer from any of the following:
Types of Knee Pain:
A number of factors can increase your risk of having knee problems. Excess weight increases stress on the knee joints during every day activities and can increase knee pain. Lack of muscle flexibility and strength can increase the risk of injuries, as the same areas of the knee will have to absorb load during tasks. Certain sports such as basketball, skiing and soccer place increased demand on the knee joint and are a factor in causing knee pain.
Prevention and Treatment
It is impossible to completely prevent knee pain, however a few strategies can prevent recurrent knee injuries.
One of the most common questions we receive in our office for injuries: 'Do I use heat or ice?'. We treat everything from arthritis to muscle muscles with ice and heat, but what do they actually do?
As a general rule of thumb you use heat therapy for muscle pain and stiffness, and you use ice therapy for acute injuries and pain. However, it is sometimes more complicated which you type of therapy you use.
Heat Therapy works by improving the blood flow and circulation to an area and increasing its temperature. Increasing temperature has the effect of increasing muscle flexibility and relaxing tight muscles. We usually recommend 10-15 minutes for heat therapy to be applied. In cases where the client has diabetes, skin conditions or vascular conditions we do not recommend heat therapy.
Cryotherapy or 'Cold Therapy' works by decreasing blood flow to an area which can act to reduce inflammation and swelling which causes pain. We recommend applying no more than 15 minutes at a time for cryotherapy, as longer can sometimes cause skin irritation. We cannot emphasize enough, although cold therapy can help with pain for acute injuries, in many cases simply getting the area moving is the most effective way of recovering from an injury.
Maybe the most common question we get in the office: 'How can I strengthen my core, and have abs?' Hut do most individuals actually understand what 'the core' really is? Do they understand how to train it properly, and why it plays a pivitol role in physical health?
Most people's idea of the core comes from gym class: doing 30 sit-ups in a row, holding a plank as long as possible. But as you can guess it's more complicated than this. From a functional standpoint your core is much more than your six-pack. It essentially includes any muscle that moves and stabilizes the trunk. This includes what has been described as the core 'engines' which include:
Quite simply this entire area of the body serves as the center of your kinetic chain universe. It's the foundation and the 'engine' of all limb movement. If you have great control of this anatomical powerhouse it has awesome consequences from MLB pitcher, to grandpa:
The key term we use is 'Control'. From the shoulder to torso to hips, we want that nice combination of 'strength and flexibility'. Being able to co-ordinate these components into one fluid act is the true 'CORE.' It allows the transfer of kinetic energy from one part of the body to the other.
❗️I was at the gym this week and saw one of my top 10 incorrectly done exercises ( that I see 👀). @fitnessiq put up the correct form a month ago, check it out:
✏️Note this movement should target the Rear Deltoids. But a lot of the time we see people shrug their traps, and use their biceps for the movement.
❌Avoid elevating the scapula and driving the elbows straight back
✅If your goal is to truly hit the rear deltoids:
🔹Keep the scapula depressed/protracted
🔹Drive back and OUT with your elbow towards your face
Maintain tension through the entire movement. And try to keep neutral head position throughout. Keeping these points in mind will prevent neck pain and shoulder impingement 👌
⬆️⬇️💥DO YOU BOUNCE TOO MUCH WHEN YOU RUN?
We’ve all seen rabbit-like 🐇runners out there. More than anything you can hear them down the road 📢. Runners who bounce a lot up and down 〰️ typically don’t convert as much energy forward ↗️. This is why you hear them clunking on the treadmill, there is more vertical energy being released as sound!
That being said, everyone will have a bit of vertical movement when running. Typically 5-12cm is noted when you film a lot of people running. So when would vertical bouncing be a red flag? 🚩
🔻Injuries (I.e. Shin Splints)
🔹Vertical bouncing (oscillation) when running is more of a symptom, rather than a cause of non-ideal running mechanics. Simply put vertical bounce is related to higher ground reaction forces, and slower cadence. But I like being aware of it because if someone LOOKS 👀 and sounds like they are bouncing a lot, they probably are.
✅So my Tip: If you’re getting shin splints (any impact injury) or not improving your times, record yourself on your phone📽. Do an eyeball test and watch for the vertical movement of your head 🙇stride to stride, and listen to the impact of your feet. My cue is usually just to ‘run more quietly’ 😅which sometimes increases cadence and decreases the bounce.
📈Advanced Core Exercises
If you’re tired of the usual forearm planks, the above vid will be useful ⬆️. Remember core strengthening is more than holding planks for 5 minutes at a time 🔄
🔹Plank Reaches - start in normal plank position, and using a frictionless surface (like a towel or glider) reach forward with one arm into flexion and return to start position.
🔹Bear Crawl with Gliders - Start in ‘bear crawl’ position (on hands and toes). Using gliders with hands, work different directions with your shoulders 🔀
🔹Spider Man Planks - start in straight arm plank position. Slowly bring each hip into flexion and abduction. Make sure the pelvis is as stable as possible during the movement
🔹Straight Arm Plank Reaches - Start in plank pose. Slowly reach each arm into full flexion, I added a lacrosse ball to my Lower back to cue myself to be neutral pelvis
➡️Try these out, and hope these challenge your core workouts more 👍
Milner Chiropractic and Sports Injury Clinic