At FC Barcelona a range of treatments are used to manage acute tendon pain. While the following treatments are generally used, it is critical that the treatment plan is individualised. For example some athletes with a more ‘reactive’ tendon may not always perform eccentric exercises.
- General treatments
- In the acute phase, the priority is to get the tendon to acquire the adequate extensibility and viscoelasticity. Therefore, before introducing eccentric exercise to the protocol we condition the tendon in accordance with the following steps:
- Bicycle or exercise without impact to warm the tendon.
- Manual therapy:
- Mobilisation of the articulations of the ankle and foot.
- Transversal and tendon extensibility exercise prior to eccentrics.
- Stretching in active tension of the calf muscles prior to eccentric exercise.
- Relaxation massage of calves/soleus/sole of the foot.
When there is associated inflammation of the paratenon, there is also a need to treat the inflammatory component of the sheath.
- Eccentric exercises
- The athlete is advised to start performing eccentric exercises. They are advised that these exercises may be painful – and that they can continue to perform the exercises even if they are painful. They are expected to suffer from delayed onset muscle soreness during the first sessions, but as the exercise is repeated in the following sessions, the effect disappears. It is important for the intensity of the proposed exercises to progress more gradually if they are very painful.
The exercises should be completed for 12 consecutive weeks (if the player is in the final stage of recovery, 12 weeks shall be maintained from this moment on).
- Exercises should be done twice times a day, seven days a week.
- The exercises comprise six sets of ten repetitions with downward movement (eccentric phase) on the affected leg or two legs, and the upward movement (concentric phase) on the healthy leg or two legs.
Icing is a useful analgesic following activity
This can be a useful adjunct to treatment
This modality is used as part of a warm-up before exercise
This can maintain joint range of motion
Isometric exercise - TA
Isometric exercises are used in the acute phase
Isometric exercise - TA
Machine exercised provide more control
Isometric exercise - patella tendon
An example of an isometric exercise for the patella tendon
After 12 weeks of eccentric training, the pain is reduced and the sportsperson returns to their level prior to the injury.
In addition to the eccentric exercise, we also add the following treatments:
- partial weight-bearing exercise using the anti-gravity treadmill – adjusted to the patient’s level of disability and function;
- electrotherapy following sports activity or treatment sessions;
- cryotherapy applied in the initial phase three or four times a day.