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15. 2. 2012.

Calf and Achilles rehabilitation ladder

      Calf and Achilles top ladder
          1) RICE – Rest, Ice, Compression, Elevation
The first- line principle for treating an acute injury:
a)      Rest for 24-48 hours to prevent the clot spreading and an increase of inflammatory exudate. Mobilization too soon produces thicker scar tissue, which is not easily penetrated by fibroblasts and it may provoke continued bleeding.
      b)      Ice will cool the periphery and shut down local vessels to decrease bleeding. Ice straight from the fridge may be less than 0 degrees and will produce an ice burn, unless separated from the skin by a cloth. Melting ice(wet ice) will be at 0 degrees and may be used as a bath for 20 minutes, but locally applied ice, for 5-10 minutes can have an effect. Reusable cold packs, which may be stored in the fridge, are available, as are some chemicals that freeze on mixing. Frozen packets of peas, which mould to the shape of the body, may prove most cost – effective. Care must be taken with ice placed around nerves, as they can suffer a cold-induced neuropraxia.
     c)      Compression is again designed to reduce inflammatory exudates, and the spread of haemorrhage.
     d)     Elevation prevents tracking of inflammatory products to the periphery, thus requiring less effort to return these products centrally.
     Elevate heels with a heel raise. If appropriate, wear high heels.
2)                  Encourage active plantarflexion, followed by active dorsiflexion to pain
3)                  Stretching. Hold till pain limit, and not less than 15 seconds. Make sure that your stretches are from standing position, and focus to stretch soleus and gastrocnemius muscle which are mostly attacked through this injury
4)                  Buttock strength. On all fours, bring the knee up to the chest, then swing the leg backwards and upwards; the heel swings towards the back of the head. Use gluteal exercise machine in the gym, and all the exercises you know that will increase m. gluteus maximus strength
5)                  Non- impact cross- training via swimming and rowing routines. May have to place pedal under arch of foot and later move to ball or foot
6)                  Heels. Do plantarflexed heel raises with both feet together to 20-25 repetitions. Do not work through pain. When successful, start one- legged heel raise to 20-25 repetitions
7)                  Heel drops on staircase. Stand with balls of feet on staircase. Drop the heels as low as possible below the stair, and then rise to tiptoe, repeat. Start with both legs together. When 20-25 can be done pain-free, use one leg
8)                  Hop test. When 50 pain-free hops can be completed on the injured leg, move to Calf and Achilles top ladder. This is a test, not a training session

Calf and Achilles bottom ladder

 Continue cross- training, for fitness. Start each training session from the bottom of the ladder. Perform six of stage 1, then six of stage 2, etc., until pain or loss of rhythm halts the training. Early ladder steps may be cut from six to two repetitions when working at the higher stages. Check that the leg rhythm is equal and do not gallop. One way to avoid favouring an injured leg is to count from 1 to 9 whilst running, which sets a rhythm for the legs to follow and allows concentration to move from one leg to the other. Match the feel of the bad leg to the good leg; counting 1,2; 1,2; tends to stress any limp. Do stretching exercises between each 100 metres. Check that heel pick up and knee lift are the same height. Stop if any pain lasts for more than 20-30 seconds, and do not progress up the ladders if there is a loss of rhythm.
1)      Limber trot. 6x100m small strides, like a warm-up jog
2)      Jog. 6x100m  normal jogging, or you can try with bigger distances, but not over 200m
3)      Heel flicks. 6x100m, trot with the heels deliberately kicking the buttocks on each stride. This works the hamstring and increases the load on the calf
4)      Run half- speed. 6x100m
5)      High- knee trot. 6x100m. Keep stride length short, knees raised to horizontal or above. Non- sprinters can make do with 25-30m
6)      Run three- quarters speed. 6x100m. Maintain normal stride length, do not bound
7)      Grade 1 sprint. 6x100m. Accelerate over 25m, sprint 50m, slow down over 25m
8)      Grade 2 sprint. 6x100m. Accelerate over 25m, sprint 50m, and decrease the distance required to stop over the next six repetitions. Note: specialist runners should not use this stage, which is for stop- start games( soccer, basketball, volleyball, handball…)
9)      Grade 3 sprint. 6x100m. Increase rate of acceleration over six repetitions. Sprint 50m, stop over 25m
10)  Shuttle run/ wind sprint/ doggies. 10x20m. Sprint out and back between markers 20m apart
11)  Start play. Begin in easy, low- grade match
12)  Fit again. Play at normal grade

"Concise guide to sports injuries, 2nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English

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