The Center for Podiatric Care and Sports Medicine

What Goes on During Tendonitis Rehab: Stages of Therapy Your Physical Therapist Uses for Tendonitis Rehab

Posted by on Friday, December 4th, 2015


Tendons have a rather difficult job. They function sort of like a thick rope holding soft muscle tissue to hard bone — and, like even the best rope, the more force it’s sustaining and the more it’s used, the more likely it is to fray and sometimes even snap. You can always go out and buy yourself another good rope, but what can you do for a torn tendon? Here are three stages of physical therapy (and types of tendon exercises) that physical therapists and sports medicine doctors use to facilitate patient recovery.

tendonitis rehab
The Achilles tendon takes much of the strain during walking, running, and other activities, which can make it prone to injury. Image source: Flickr CC user HeelsandFeet

3 Stages of Therapy for Foot and Ankle Tendons:

Stage 1: Isometric Exercises for Tendonitis Rehab

Isometric exercises are one form of exercise long-associated with tendonitis rehab. We often begin isometric stretches when tendonitis is particularly flared up and painful because these movements are low-stress on the body. In the fitness world, you’ll see isometric exercises done in Pilates and martial arts, as well as physical therapy sessions, where participants hold a position against an immovable weight (be it a wall, railing, or machine).

Since tendon pain likely affects muscle function, isometric exercises are an important method for reducing pain and maintaining muscle strength throughout the recovery process.1 A study of tennis players with knee tendinopathy published in The British Journal of Sports Medicine found that “a single resistance training bout of isometric contractions reduced tendon pain immediately for at least 45 min post-intervention,” while also notably increasing muscle strength.2

We’ll take you through a range of fairly straight-forward exercises you’ll be able to do in our office and at home. For instance, one of the exercises involves pushing up from a flat floor position into a mid-level calf raise on both feet simultaneously, holding for 30-60 seconds for 3-4 reps, 1-2 times a day.3

To find out more about ways to avoid Achilles tendon injuries, take a look at our blog post about recurring achilles injuries.

Stage 2: Eccentric Exercises

Next, we look to build more strength and speed during the rebuilding processes. For reasons unknown, eccentric exercises speed collagen rebuilding–at least, according to a 2004 study conducted by the University of Umea in Sweden.4 Heel drops, eccentric calf muscle strengthening, and eccentric squats on decline boards, in particular, are a great eccentric exercises for injuries to the Achilles tendon.

“Eccentric” refers to the downward portion of movement in an exercise where the muscle lengthening occurs. For instance, in a basic heel raise where you rise up  on your toes and lift your heels of the ground, it’s the lowering back down portion of the exercise that is eccentric, and is most important.

Typically, we take patients through a progressive routine. Start with three to five 30-second reps of static stretching, followed by three sets of 10 eccentric exercises, stretching, and 10-15 minutes of icing. Days 1 and 2 are slow, days 3 to 5 are more moderate intensity, and days 6-7 involve faster reps still. Contact us to learn more about eccentric training programs in NYC. We also offer complementary therapies using the latest technology to aid in the rebuilding phase.

Stage 3: Performance-Specific Exercises

We do a lot of rehab training with athletes, from high school to pro and Olympian levels. Therefore, we find it to be particularly helpful to engage in sport and performance-specific exercises to maintain sharp skills and fitness while the patient recovers. This is the very last stage of therapy after the window of acute trauma has well passed, but it’s an important aspect nonetheless.

One study published in the British Journal of Sports Medicine in 2004 concluded that “Running exercises can improve the strength of partially ruptured Achilles tendons at 30 days after injury.”5 We believe that active recovery is the best way to maintain functionality, though that doesn’t mean stubbornly sticking to your usual routine. Our team understands your need to get back to the sports you love, but we can also show you how to do it safely–if you follow a well-designed regimen, you’ll be back to sports in no time. Here’s a success story of how we helped a runner manage chronic Achilles tendon issues.

Here at The Center for Podiatric Care and Sports Medicine offices in Manhattan and Westchester, we customize a speed, agility, proprioception, and power program to prepare you to return to training. Contact us to learn more about tendon repair in NYC.




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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.