Part 5 - Continue heavy slow resistance training PDF

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Summary

Additional information for treating patients - using slow heavy resistance ...

Description

Objectives   

Differentiate different loading strategies to specifically target the Achilles tendon versus the plantar fascia Be able to describe the best treatment stratagem for individuals with patellofemoral pan Differentiate return to run programmes for runners recovering from knee injuries versus Achilles tendon injuries

When are Achilles tendon forces the greatest? 

Achilles tendon load highest at max dorsiflexion

When ate plantar fascia loads the greatest?  

Need to engage the windlass mechanism Need to be in metatarsal phalangeal extension

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Initially when loading a we want to be in the middle range to avoid loading too soon Depending on injury, plantar fascia or Achilles, decides if we load into plantarflexion or dorsiflexion Plantarflexion with toe extension is for plantar heel pain Dorsiflexion is for Achilles tendinopathy

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Stage 3: Begin plyometric programme – add speed before load  

Speed through movement – calf raise Bilateral progressing to unilateral

Stage 4: Load and speed   

Start with stationary hop and progress to forward hop Large load on Achilles tendon due to tibia translating anteriorly - controlled by the soleus Programme initially completed for stationary hop and progressed onto forward hop

Patella femoral pain 

Hip strengthen has been shown to greatly decrease pain

Stage 1: Pain dominant stage (1-4weeks)       

Initially can’t tolerate much loading through patella femoral joint – focus on hip strengthening Carry out an intense isometric programme Reach failure within 10 reps 4 sets of each exercise Reduce running volume Slight incline on a treadmill will decrease patellofemoral joint loads Cross training/ walking on days not running

Stage 2/3: Load dominant stage (4-12 weeks) 

Introduce resistance raining o Leg press o Knee extensions – avoid full extension

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o Split squat Plyometrics introduced Must have energy storage and release components

Adjuncts that work – Use if single leg squat pain decreases Patellar taping  

Best effect 1st 12 weeks of quadriceps strengthening Bracing has no effects

Foot orthoses 

Improve outcomes at 6 and 12 weeks

Iliotibial band pain     

Early loading of the IT band plus hip strengthening Heavy strengthening programme targeting the hip musculature Limit downhill running Gait retraining if needed Benefits the most from a slow graded return to running

Retuning the runner to full activity 

Walking is great cross training

Achilies, foot and ankle considerations     

Treadmill running Hills Speed work sessions Soft surfaces e.g. trails Complete the above in isloations then combine

Knee considerations    

No difference to treadmill running or overground running Downsills – uphill treadmill running can help 3-5% gradient Speedwork seems to reduce patelafemoral joint loads Slower longer runs are worse

Increase in cadence is very benificial Key points for anmy gait retrainig programme    

Targated to specific mechanics Sufficient pracrtoce is needed >196 structured sessions Go with Increases cadence as forst option Changed don’t need to be perminant...