Phase 1: 1-2 weeks post procedure:
Isometric strengthening, muscle activation, and firing of muscle-tendon unit
Joint mobilizations and gentle stretching of the muscle-tendon unit
Evaluate and treat other regional weaknesses and imbalances in the kinetic chain
Desensitization of the tissues with deep tissue and myofascial release work
Phase 2: 2-6 weeks post procedure:
Progressive strengthening of the muscle-tendon unit and regional muscles; fix atrophy
Controlled low-load, high repetition concentric followed by low load eccentrics
Tissue remodeling with deep tissue work in line with collagen fiber orientation of tendon
Basic sport-specific skills reintroduced without loading tendon significantly
Phase 3: 6-10 weeks post procedure:
More dynamic and balanced concentric and progressive eccentric loading of the tendon
Some early sport-specific, less ballistic skill reintegration with moderate tendon loading
Likely will need a recovery day after more significant loading
Phase 4: 8-12 weeks post procedure:
Return to sport-specific skills in a progressively more dynamic and ballistic fashion
Progressively load tendon cyclically (recovery dictates daily vs every other day loading)
May begin a phased return to a running program if indicated (separate handout)
Game/Activity simulation with a therapist to recreate the environment
**Consider progression to a personal trainer if more training needed prior to returning to sport
**Note: Pain up to 3-4/10 is acceptable so long as it remits on the recovery day