An appropriate loading of the tendon, associated with a comprehensive and reasonable plan of return to activity discussed with the patient will be key to enhance the healing process and avoid any risks of relapse.
When loading an irritated tendon, it’s preferable to do it with what is called an “isometric” contraction: the muscle is contracted, but not lengthened or shortened. The exercise can be done standing up, with the possibility to find your balance by placing one hand on an elevated support, such as a desk. Whilst a weight (potentially a dumbbell) is held in one hand, you stand on one leg on the front of your foot, tip-toes, and hold the position for 15-20 seconds. Repeat the exercise 5 times, with a 40 seconds break in between repetitions. This exercise can be done every day as a part of a muscle activation program, and specifically before any physical activity such as running or jumping.
Another type of exercise will be designed to stabilise the ankle and foot mobility. This will ensure the tendons and ligaments in the area are loaded appropriately, with a good absorption of the ground forces by the joints of the foot and ankle on each step of a run, or when landing after a jump.
The 4 key movements that will be reinforced with this exercise are the plantar flexion, the dorsiflexion, the inversion and eversion of the foot. With an elastic band pulling in the opposite direction of the movement done, either with a hand hold of the elastic or wrapped to a stable object, you will need to do the motion against the resistance, and then gradually release your traction for a return to a neutral position. Effectively, this exercise will allow a concentric (shortening) and eccentric (lengthening) contraction of the muscle targeted.
Finally, to plan carefully a return to activity, it is recommended to do lower impact type of runs, preferably on an even soft surface or grass if possible. Running for a smaller distance and at a slower pace in the first 10 days of the program. This will allow the tendon to heal, be strengthened, whilst still active.