4. Return to normal fitness
As I have told you a thousand times, there isn’t a protocol that works for everyone. Everybody is unique and so his/her treatment and recovery. Always follow the “golden rule”: to start to practice your sport, you have to be pain-free.
In this post I will talk about Achilles tendinitis and with this injury I have a second “golden rule”: you can’t think about return to your sport if your morning stiffness hasn’t disappeared completely.
Usually, the longer the rest period, the slower the return to exercise. You shouldn’t do straight away as much as you were doing before the injury.
Should you return to exercise?
Obviously, I am talking about returning to sports that require the use of your legs bearing weight (running is going to be the sport I will talk about). You must have been exercising during all the treatment, but exercises with no impact, like swimming or cross trainer (as long as you are pain-free during the exercise and for the following days after the exercise).
- To return to exercises with impact you need to have ankle full range of motion (as well as knee and foot joint full range of motion. Usually, the most limited movement is dorsal flexion.
- As I told you previously, you have to be pain-free. A bit of discomfort is allowed as long as it doesn’t become a pain. If you start to exercise and pain is back, stop straight away and try to analyse, with your physio, why this happened.
- No inflammation. It is important to know the difference between inflammation of the tendon and thickening of the tendon. Inflammation should be temporal and acute (although might become chronic), while thickening is present in chronic tendinitis and it is a sign of degeneration.
- You should have good ankle stability and no giving way or locking.
- Don’t trust your lungs. You might feel that your breathing is great, but it doesn´t mean that your Achilles tendon is that great and you should push it all the way your lungs allow you to go.
Also, you might need to change your running technique and/or wear insoles or orthotics to modify your landing, in case it was the cause of you getting Achilles tendinitis.
How to start?
It depends on your age, injury, sport, and general health, among others (have a look at this post blog which gives you more useful information). I am going to tell you the way to start to run, as it is an impact sport as well as the base of many sports. These are the steps to follow:
- Go for 2 fairly high-speed 25 min walk to see how your legs feel (not the same day, but 2 days in a row).
- If you feel okay, you can start with 3 lots of 10 reps of single leg squats on stable surface to begin with (unstable surface, later on), heel raises, tip toe walk and hops.
- Now, start with a “walk-run-walk” to find your baseline (to find out how much your legs can handle at this stage). Your baseline is the distance you can run with no pain during the run and for the following two days. Once you know what your baseline is, make sure that you run a bit less than your baseline to reduce any possible risk of setbacks. Then, start from there, increasing your mileage progressively (10% week).
Another way I recommend, which is quite slow and therefore less risky is as follow:
|Week 1||10 min walk, 2.5 min run, 10 min walk, 2.5 min run/rest day/10 min walk, 3.5 min run, 10 min walk, 3.5 min run/rest day/10 min walk, 5 min run, 10 min walk, 5 min run|
|Week 2||7.5 min run/rest day/10 min run/rest day/12.5 min run|
|Week 3||15 min run/rest day/17.5 min run/rest day/20 min run|
|Week 4||22.5 min run/rest day/25 min run/rest day/27.5 min run|
|Week 5||30 min run/rest day/32.5 min run/rest day/35 min run|
|Week 6||37.5 min run/rest day/40 min run/rest day/42.5 min run|
|Week 7||45 min run/rest day/42.5 min run/rest day/45 min run|
|Week 8||47.5 min run/rest day/50 min run/rest day/52.5 min run|
As always, comments are welcome, as they will make learn from each other.
If you have any questions, do not hesitate to contact me on The Physical Therapy, Physiotherapy Clinic based in Southampton, and I will be happy to help you.