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INJURY REHABILITATION


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Achilles tendinosis (RH09) ACL rehabilitation (RH10) Ankle sprains (RH11) Hamstring strains (RH12) Groin strains (RH13) Osteoarthritis of the knee (RH14) Patellofemoral pain syndrome (RH15) Sinus tarsi syndrome (RH16)


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Tennis elbow (RH25) Shoulder impingement (RH26) Carpal tunnel syndrome (RH27) Rheumatoid arthritis (RH28) Chronic lower back pain (RH29) Sporting back (RH30) Stretching the upper body (RH31) Stretching the lower body (RH32)


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Advice handout


YOUR REHABILITATION PROGRAMME This programme has specific exercises to help stretch and strengthen muscles which may be weak. It is really important to ensure the exercises are performed with good technique and good postural control. Make sure to repeat the same number of exercises on both legs, that you are pain-free at all times and take care not to progress too quickly. We have given suggested sets and repetitions, but everyone is different so your practitioner may give guidance that is more specific to you.


STRETCHING EXERCISES


GASTROCNEMIUS STRETCH Lean against a wall or chair for support, take a small step forward with one leg, stand with both heels in contact with floor. Bend the front knee (keeping the back knee straight) and your head up and hips forward. You should feel a stretch in your calf. Hold for 20-30 seconds.


SETS 1


REPS 8


SOLEUS STRETCH Keep the same position as above but bend the back knee (instead of keeping it straight) while keeping the heels on the floor. Again you should feel this stretch in your calf area, although this stretches a different muscle. Hold for 20-30 seconds.


SETS 1


REPS 8


FLEXOR HALLUCIS LONGUS STRETCH Sit on a chair in the position shown in the picture. Pull your toes back towards you so that your heel points outwards and you feel a stretch in the muscle that runs down the back of your calf and attaches to your big toe. Hold for 10-20 seconds. Perform on both feet.


SETS 1


REPS 8


ANKLE INVERTOR AND EVERTOR STRETCH In the same position as above, this time turn your foot gently so the sole is facing the ceiling and then reverse the movement so the sole of your foot is turned towards the floor. Hold for 10-20 seconds. Perform on both feet.


SETS 1


IMAGE TO COME


REPS 8


Achilles tendinosis


WARM UP AND COOL DOWN If muscles are tight, weak or injured, it is particularly important to warm up (unless advised otherwise by your practitioner) with a fast walk or a gentle jog at a pain-free pace for 5 minutes before you start your exercises. This increases your circulation and helps prepare the muscles for the activity to come. When you have finished your exercises, end the session with a 5 minute gentle walk or slow jog to allow your heart rate to slow down gradually.


STRENGTHENING AND STABILITY EXERCISES continued overleaf


DOUBLE HEEL RAISES WITH SUPPORT (GASTROC MUSCLE) Use a wall or chair for support. Rise up on your toes using both feet together and then lower your heels slowly to the floor. Rise up on two counts and lower on two counts. As long as you are able to perform this exercise without pain, move onto the next exercise.


SETS 3


REPS 15


DOUBLE HEEL RAISES WITH SUPPORT (SOLEUS MUSCLE) Standing on a stair using the bannister for support, bend your knees and then rise up on two feet for two counts and lower for two counts. Don't let your heels drop below the level of the stair and keep your knees bent. If you can do this exercise without pain, move onto the next exercise.


SETS 3


REPS 15


DOUBLE (OR SINGLE) HEEL RAISES WITH SUPPORT Stand on a stair using the bannister for support and rise up on two feet for two counts, then lower for three counts. As long as you are pain-free try lowering so your heels so they drop below the level of the stair. If this is pain free progress to one foot (as shown in the picture).


SETS 3


REPS 15


ECCENTRIC KNEE SQUAT Facing a wall with the feet shoulder width apart and toes a few inches from the wall, bend your knees keeping your body straight until your knees touch the wall (heels remain on the floor).


SETS 3


REPS 15


WHY YOUR REHABILITATION PROGRAMME IS IMPORTANT


The cause of Achilles tendonosis is often associated with overuse. However, if this is coupled with weakness of some muscles and tightness of others, this could place extra strain on the Achilles tendon, making the problem worse. It is therefore essential that the exercises


you have been given are performed correctly and at the required frequency as your practitioner will be relying on your input to achieve a successful outcome. A home exercise programme is usually effective in achieving successful rehabilitation of Achilles tendinosis.


Exercises for


achillestendinosis CONTACT DETAILS OTHER INFORMATION


YOUR INJURY Achilles tendonosis is a condition that affects the lower part of your Achilles tendon which connects your calf muscle to your heel. Achilles tendonosis (which may also be referred to as Achilles tendinopathy) involves degeneration of the tendon. The symptoms include: n a gradual onset of pain during and after exercise over the tendon


n stiffness in the morning n pain when you do a heel raise.


It is important that this injury is not allowed to become a long-term problem as this may lead to permanent tendon damage.


TREATMENT If the injury is treated early (i.e. at the inflammatory stage often known as


Achilles tendon


Attachment of Achilles tendon to heel


Heel bone Diagram showing the ankle and Achilles tendon


Achilles tendinitis) then rest, ice therapy and ultrasound may be used to treat the inflammation. If the condition is more chronic then massage, ultrasound and stretching exercises may be employed to help break down the scar tissue which has built up. Your clinician may also recommend orthotics (shoe inserts).


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