Isotonic calf raises should be performed at the mid-range of the muscle’s movement. The benefit of performing this exercise in the mid-range, is that it will avoid the compression of the tendon at end of range that can occur with exercising with heavier loads. For example at the very end range of ankle plantar flexion (toes pointed), or dorsiflexion (think letting the heel drop off the edge of a step) the achilles tendon is subject to compressive loads against the heel bone (calcaneum) which can be potentially irritating and pain producing.

Instructions:

• While taking a ‘one size fits all’ approach to the prescribing of these exercises has its limitations, I generally prescribe 3x 8reps for all runners to begin with. Variations of this prescription of reps and sets can be prescribed for specific sports, activity, or individual requirements.
• Take 2mins recovery between sets.
• The repetitions should be performed slowly (3-6 seconds per repetition). Start with 3s repetitions and build to 6s repetitions.
• Typically these exercises will be performed 2-3 x week, or every second day.
• Completion of these exercises typically will require gym access. I often coach runners that while you can get so far being ‘creative’ with loading at home (eg dumbells, sand-bags, children!), getting into a stable Smith rack in a gym/strength and conditioning facility is the gold standard.
• Perform at mid range.
• Weight/load wise I suggest starting at 10-15% of your body weight. For example a 70kg runner would commence with 7-10kgs. Runners are often surprised at how challenging this is!
• To progress incrementally add weight each week eg 2-5kgs per week.
• The ultimate target for strength is to be able to complete 8 reps taking 6 seconds per rep, pushing 0.4-0.5 times body weight. For example for a 70kg runner, this would be 28-35kgs.
• Gradually increase the load with the repetitions while closely monitoring pain, in particular the pain and stiffness on getting out of bed the following morning. A sudden flare in symptoms may indicate that the weight used was too heavy. It’s important to increase the loads incrementally.
• The key here is that over a period of weeks and months the load needs to be heavy. Heavy slow resistance (HSR) exercise creates adaptation in the tendon matrix, crucial for effective tendon rehabilitation.

Note: These exercises can be done seated if the tendon is highly irritable. Seated isotonic calf raises can serve as a stepping stone to doing the exercise in standing.

Note with isotonic calf raises be sure to avoid these common mistakes:

• Performing their repetitions too quickly. Each repetition will ideally be 3-6 seconds in length. The benefit of slowing the repetitions down is that the tendon is under tension for longer, increasing the likelihood of greater tendon adaptation to the exercise. Performing the raises off a step edge. The problem here can be compression of the tendon at end of range with the heavier loads. It is also very difficult to stabilise the body enough with the loads required for this exercise to induce the required tendon matrix change.

2. The ‘hopskotch’ with an activation band.