Achilles Tendinopathy Exercises

[lehughes]

Hi Laurie,

I’ve been working back through my vet rehab emails and I noticed this reply from you regarding a case of Achilles tendinopathy. I was reading through the rehab program you suggested and I couldn’t help notice that you do concentric exercises ahead of eccentric strengthening. I was wondering if there was a reason for that. Is it that canines may not be able to control the speed and force of the eccentric exercise and will therefore strain it more. In the human world the current consensus is that training eccentrically is preferred before concentrically when treating Achilles tendinitis. I refer to the Alfredson protocol for humans in that they perform multiple reps every day to help strengthen the tendon using different starting positions depending on whether its mid tendon or at the insertion. Anyway I was just curious whether this is different in the canine model.

Thanks for being such an inspiration,

A

[lehughes]

Hey A,

My apologies for the delayed response!

So, from the perspective of canine rehab, I sometimes play it just a little bit more conservatively in the beginning for a couple of reasons.
1. Knowing that the eccentric exercises may (or should) cause some discomfort and sometimes lameness, owners might have doubts about the rehab process and/or the therapist’s credibility if we start with something that makes the dog more sore. Same can be said for the referring veterinarian.
2. Because a rupture means surgery, I figure it’s okay to start with something ‘easier’ on the tendon as a way to ’test it out’. Test owner compliance. Test resiliency. Test reactivity… and so on.
3. Because dogs don’t self limit… and simply by standing, walking, moving into a sit, they are doing a wee bit of eccentrics already.

So, really, it’s a bit of a ‘gut’ call as to how fast / when to transition into eccentrics based on canine-specific peculiarities! Not a hard and fast rule.

I hope this helps the thought processing a little…

Cheers,

Laurie