Achilles Tendinopathy / Tendinitis / Tendinosis | Heel Pain Rehab (Education, Myths, Exercises)

Рет қаралды 219,471

Күн бұрын

💪 Get our Achilles Rehab program here: e3rehab.com/programs/rehab/ac...
In this video, I discuss Achilles Tendinopathy, dispel the most common myths associated with the diagnosis, and teach you everything you need to know about managing the condition.
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Intro (0:00)
Anatomy & Function (0:13)
Achilles Tendinopathy (0:37)
Mid-Portion vs Insertional Achilles Tendinopathy (2:24)
Why Did You Get Achilles Tendinopathy? (2:54)
Treat The Donut, Not The Hole (4:11)
Understanding & Monitoring Pain (5:49)
Load Management & Activity Modifications (8:48)
Rehab Stages (11:26)
Stage 0: Isometrics (12:35)
Stage 1: Heavy Slow Resistance (13:50)
Stage 2: Energy Storage & Release (16:37)
Stage 3: Return to Sport (18:08)
Achilles Tendinopathy Programming (18:43)
Do You Have To Stop Running? (20:39)
Other Management Strategies (21:32)
Summary (22:29)
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Disclaimer: The information presented is not intended as medical advice or to be a substitute for medical counseling but intended for entertainment purposes only. If you are experiencing pain, please seek the appropriate healthcare professional.

Пікірлер: 266

@E3Rehab Жыл бұрын

Thank you so much for watching! Be sure to check out the blog for all the references! e3rehab.com/blog/achilles-tendinopathy/

@brucewilliamsstudio4932 16 күн бұрын

Have you put together any videos specifically about Insertion Achilles Tendinopathy, with a focus on severe pain levels which prevent even walking? I'd love to hear what you recommend in situations like this. Thanks in advance, Bruce

@AfroIndo Жыл бұрын

I hereby stop watching any other fitness and rehab channel. This video is excellent, this problem has bothered me for probably 20 years and I've absolutely been following the boom, bust, give up cycle. Better than all physio consultations I've had on the issue too. Thank you

@nicholastown2779 9 ай бұрын

thats awesome. Yeah to be honest its the best breakdown I´ve seen for this type of injury. Everyone gas there own way but this just helps us to understand way more without having to worry about how long rather worry about how it feels each session and checking in on the body every session. 20 years..blimey thats long man. hope you get better

@Chavanun555 7 ай бұрын

How is it now?

@blueoct5591 3 ай бұрын

Due to insertional tendinopathy I’m in bad shape at the moment. I’m in a lot of pain and can’t walk without limping. I finally gave in and went to the ortho walk-in clinic yesterday. Long story short, I need to have my insurance send you money for the appointment because this video was so much more helpful.

@mymmont Ай бұрын

I’m a dancer and I’ve had Achilles pain for over 20 years now and I’ve never got everything so well explained like this video! Doctors always suggested treatment with ice, rest and medication. This video opened my eyes and I’m ready and excited to start my own rehab program. Thanks for the amazing explanation! 👏🏽👏🏽👏🏽

@ravkhabra 11 ай бұрын

BRILLIANT VIDEO and by far the best rehab programme on the net. Just one suggestion: if you are suffering from insertional tendinopathy then don't perform deficit heel raises off a step/raised platform as this will inflame your tendon even further. Perform your heel raises on flat ground but as stated in the video, try to increase the load on your achilles by performing a single leg heel raise and by adding weight. My achillles tendons were in extremely bad shape. I was not able to run for more than five minutes before they would flare up, forcing me to stop. By following the advice on the video, gradually, over time (3 months) I have managed to increase my runs to the point where I can now run for nearly an hour, jogging at a moderate pace. I play football (soccer) once a week and my goal is to be able to sprint freely without inflaming the tendons. I am not quite there yet but I feel very confident that if I follow this rehab programme I soon will be.

@EstenSesto 10 ай бұрын

This was my question regarding insertional and lowering the heel. Sounds like doing everything on a flat surface is best.

@ravkhabra 10 ай бұрын

Yes, definitely. Anyway, good luck with your rehab. 🙂@@EstenSesto

@thermoplastischesaethylend1046 7 ай бұрын

If you think "flaring up after 5min of running" is bad shape, then what is with mine If I get extreme pain for just a few minutes of walking. Ive been having it for almost a year. It will probably tear sooner or later... Gotta live with it.

@harveywinks8640 6 ай бұрын

Did you eventually get there? I have had a chronic tendonopathy for 2.5 years and I am about to stop the raised heel off a step exercise. I just what to get back to tennis

@ravkhabra 6 ай бұрын

@@harveywinks8640 Yes, I did get there! I am able to play football pretty normally now. Now and again I do get flare-ups in both Achilles tendons but the pain is very manageable. I try and do heel raises at least twice a week on flat ground. If I am doing single heel raises, I will do 3 x 15 sets. If I am doing double heel raises I will do 3 x 25 sets. Just depends on how my Achilles tendons are feeling. Single heel raises have more load on them, double heel raises less so. Anyway, my improvement in function was very gradual. At worst, I was not able to run for more than a few minutes before my Achilles tendons started flaring up and feeling inflamed. But gradually over the weeks and months, my function improved. Yes, there are still some weeks when my tendons do feel a bit aggravated, but by and large I am nearly back to normal. If you do the heel raises consistently and patiently you should steadily improve. Good luck with your recovery and I hope you're back on the tennis court soon. 🙂

@jys0527 3 ай бұрын

Literally the ONLY channel anyone needs for rehab. Thank you so much! 🙏🏻🙏🏻

@andrewdemarco6923 7 ай бұрын

This is the most erudite, most well conceived, and best executed discussion of the topic of Achilles tendinopathy I have come across. As a teaching physician, I intend to share this with both patients and residents. Well done!

@SebastianMuriel Ай бұрын

I can’t believe this is available for free. Thank you so much. Incredibly helpful, actionable information.

@DawnSandalcidi-l7b 17 күн бұрын

As a PT (pediatric) myself I really appreciated the evidence provided and how easily I can implement this program myself! Thank you so much!!

@stephenlever419 10 ай бұрын

I wish this was the 1st video I had found !! Absolutely the best

@logicsenseboy Ай бұрын

Thank you so much. I just stopped my training (running) for about over two weeks and started working out for insertional Achilles Tendon. My pain, which was at a 10, has reduced to a 2. I thought I should stop my activity, but after watching this video, it makes sense. I need to get back to running with load assesment and understand the load and intensity, so my injury will get better.

@n_k_s_b 4 ай бұрын

keep doing the exercises after you recover - stop the pain from coming back

@FeelgoodThreads 4 ай бұрын

I wish I saw this video when I had Achilles tendinopothy. Tore my Achilles not understanding why i kept falling in that cycle of inflammation. Now all my rehab exercises are similar to your rehab here. Great content.

@anthonyencarnacion7203 Жыл бұрын

The time frames are the most shocking part of injury management.. thank you again.. for the critical reminder of living with pain, and when it's too much pain.. your speaking about therapy but it's hitting me like deep philosophy.. I'm 51 years old and am constantly surprised by the length of time it takes to recover.. your channel is the support group critical to the path forward (through) the pain.. I appreciate you..

@philipkim9779 Жыл бұрын

I was struggling with Insertional Achilles Tendinopathy on my left Achilles tendon but I'm not too worried anymore thanks to you. Thank you for providing great explanation and making it simple for us. The quality of this video is so good that it's helping me more than doctors. I often get impatient and do too much too soon. I will try to build my load capacity by improving my tolerance to various forms of loading and restore the function slowly without rushing the process. Thank you so much for providing great quality content like always.

@andrewkreuter3147 Жыл бұрын

Any updates ?

@EnlightenedBro105 25 күн бұрын

@@andrewkreuter3147he died

@tatianapetrov6206 6 ай бұрын

Best video on the topic I have come across. Well done!

@karinjessop1046 Жыл бұрын

Thank you so much for this quality content! Achilles problems just showed up for the first time in my athletic career - ironically when I got too busy with all the holiday mayhem to do my foot/ankle/post chain work! Back at it again!

@zsofipapp 9 ай бұрын

This is just what I needed. Have been struggling with heel pain at the insertion point for about 3 months. I have been doing the Stage 0-1 exercises and I completely stopped running (ultrarunner here). Now I feel confident that I can incorporate a little jog into my rehab, and proceed to later Stages. Thank you!

@bikerdude6119 7 ай бұрын

I'm also an ultra runner and I felt some sharp pain out of nowhere during one of my trail runs and it been lingering since. Not as sharp but it's still there but transitions around my ankle so I'm not sure what it is. I got an xray but no fractures. I have physical therapy next week and I'm getting a mri next

@ShinChan-ry4nm 5 ай бұрын

How are you this time your fully ready for running

@cian3299 10 ай бұрын

This is the most comprehensive video on tendinopathy I've seen. And I've been watching them for years! Thanks!

@tamasholics 9 ай бұрын

The best and most complete video. Awesome production quality. Thank you and congrats!

@TheRealThilo 11 ай бұрын

This is honestly the best video on this topic. Thank you.

@simranchandani4796 6 ай бұрын

Fabulous video! Thank you for putting together a detailed & implementable video.

@cameron3344 7 ай бұрын

This is a very well put together video, thank you for making it.

@UnlimitedUF2 Жыл бұрын

really love these renewals, i think doing remakes of rehabs videos like these are essential for human evolution, thank you, your content like theses means more than you realize, thank you again for sharing your work with the world.

@jamiejones7039 10 ай бұрын

This has to be the best overall video out there. Yes there are other videos that have bits and pieces of what is mentioned here, but this has everything combined. Excellent work, looking forward to trying some of the exercises myself

@deathbycolor 7 ай бұрын

Such a well put together and delivered video!

@tarancourchesne1947 8 ай бұрын

This video is so great man I CAN'T EVEN SAY HOW GREAT! You're just awesome, and I think you know this, but you're killing it.

@mick947 26 күн бұрын

The most comprehensive and practical video on tendinopathy I’ve come across. Brilliant. Thank you.

@carlosalonso4814 Ай бұрын

This is one of the best videos I have seen on a physical issue

@nicholastown2779 9 ай бұрын

Thank you so much for this awesome breakdown. It just helps relieve stress caused from injury just looking and being able to set my guidelines accordingly and simply focus without getting anxious about doing too little or too much. Huge thanks. I wish you all the best.

@christinasmith1598 10 ай бұрын

Thank you so much. The information you present is so easy and simple to follow. Very much appreciated 💚

@caninbar Ай бұрын

This is wonderful!!! First video I've found with complete information clearly presented. Thank you! Now I have to get organised!

@davidiagmon 7 ай бұрын

So much knowledge in such a short time. I love your channel. You helped me overcome multiple injuries. Thanks!

@silverpippin9051 7 ай бұрын

thank you so much. Excellent video, great and clear presentation. Finally found the information that I have been looking for for months.

@timmori2811 Ай бұрын

This is so much more comprehensive than all of the content I found in German! Thanks a lot!!

@arsalanafrakhteh7226 10 ай бұрын

This is the best video I watched on this subject and I am dealing with this problem on and off for a few months now and it matches my experience as well.

@ashishmsukhadia Жыл бұрын

Superbly explained and great video! And always great to see these types of videos include actual study results so that we can have confidence in the recommendations! Thank YOU and your channel for the great work and information and guidance.

@otgod6694 8 ай бұрын

thank you so much for this detailed video. for the first time in a long time i'm very hopeful that i can finally heal.

@hannahpain3671 Жыл бұрын

This is the best video I have found for explaining the progression of tendinitis/tendinopathy rehab. Please can you do more for tennis elbow and shoulders? I will be sending these to my clients for sure! Thank you

@alperu 7 ай бұрын

Incredibly helpful video! Thank you for sharing! I am living with bursitis pain on my heel for years and I think this video is more helpful than my previous doctor visits... Thank you.

@Iaapwm 4 ай бұрын

Well delivered information. I like visual with a well-informed voice in the background. there were no shaming or doooooom. just a clear plan on how to deal with your problem,,,, and solution driven. Thank you very much from Lismore NSW Australia.

@chumaakuchie1634 26 күн бұрын

Honestly cannot thank you enough for sharing this information. The way the content is presented and broken down is perfect and just what I have been looking for! I've had achilles tendinopathy for years, most likely to a lack of rehab and strengthening of a pulled calf muscle I had years ago, and have been managing it without a proper program. This the back to basics program I need. Thanks again 🙏🏾

@kdub3562 3 ай бұрын

Suffering with mid point tendinitis and this is by far the most comprehensive and complete program I've discovered. Several options and the exercises within each stage is very helpful. Definitely gonna subscribe.

@ThePhysioCoach Жыл бұрын

Thank you! I am a Physio in Germany and I love your videos! You're helping me keeping up to date with your great content.

@lavidapeligrosa 9 күн бұрын

this is amazing! I've been having this issue for a long time, and this is exactly what I needed. I feel like I owe you money :D

@Swarrenii 6 ай бұрын

You got me sold sir. This will help with translating to my patients!!!

@nilouvakil6807 2 ай бұрын

Lots of information! Thank you for a very thorough presentation with reliable research components. The explanation of exercises are very beneficial 😊

@miso532546992 Ай бұрын

THANK YOU! THANK YOU! THANK YOUUUU SO MUCH FOR THIS ❤❤ This is literally the best video I have ever seen for Achilles Tendonitis. I REALLY APPRECIATE THIS AWESOME WORK 🙏🏻

@gaurichess 6 ай бұрын

This channel is a godsend. Thank you so much! Give me so much hope for a full recovery

@gavinli2013 9 ай бұрын

Thanks so much for the excellent video, I am a marathoner who ran a time with 2hr51mins, I have been suffering achilles problem for over the past 2 years, I am really confident on breaking my PB after watching your video. I will adjust my training program as well. Thanks and keep up the good work please!!

@James-J-J-J 2 ай бұрын

Excellent video! Thank you. I’ve fallen into the trap in the past of trying to do too much too soon - too keen to rekindle past running glories. Thank you for grounding me again with this info 👍🏻👍🏻👍🏻

@jennyjones319 4 ай бұрын

Amazing video and such detailed and clear advice. Thank you so much for your help.

@shamelesschic9491 10 ай бұрын

Yes, makes so much sense! Thanks for the detailed, thorough vid, even providing possible weekly schedule. Cause deteriorating into sedentary slug is not desirable 🙂

@curiousmonkey8485 3 ай бұрын

Great, thanks! Seems like a pretty comprehensive guide. Feeling confident equipped with this :D

@agrocerygeek1323 11 ай бұрын

I cannot thank you enough for this video. I have been in excruciating pain and did not understand why, since none of the advice I was seeking addressed SEDENTARY midportion tendinopathy -- they all address runners and other athletes and assume they have overworked the tendons. Meanwhile I literally did *nothing* and was immobilized due to another condition, and I then found I was in so much pain I could not even walk. Ice, anti-inflammatories and stretching were all tried and did not work. At this time, all I can do is sit on the edge of my bed and raise my heels about 1-2 inches, but I already feel a difference. Thank you so much -- you are a lifesaver!!!

@philsteamwork Жыл бұрын

after years of tendinosis i can say this is the best description on 'how to proceed' i've ever seen. there is stuff mentioned in this video, that i discovered after long time that worked for me. wish i'd have discovered the channel earlier. top content, big thank you.

@saifnz5430 6 ай бұрын

Hi how’s the recovery going I got insertional tendinosis as well, physios say do eccentric loading on flat surfaces not decline step, I did also 6 session of shockwave therapy, def helped a lot. My exercises are 1 towel stretch the calf for lengthening 2 eccentric loading calf single leg flat surface 3 balance on one leg for 90seconds 4 Abduction/addiction exercises as the eccentric loading targets glutes muscles also. 5 calf stretches 6 bent calf raises for soleous muscle. 7 biking for 45 mins Been doing this for 2 months now, I still have 3/10 pain

@philsteamwork 6 ай бұрын

I ended up doing a The ACP (Autologous Conditioned Plasma) or PRP (Platelet Rich Plasma) therapy. That was the first thing that had an effect and fortunately the healing was super fast after that. It took only 3 injections (of your own blood into the tendon) and I could feel a significant improvement. The 3 Injections happend over a time period of 6 weeks.

@philsteamwork 6 ай бұрын

@thermoplastischesaethylend1046 5 ай бұрын

@@philsteamwork so you were not able to heal your tendinopathy alone?

@philsteamwork 5 ай бұрын

@@thermoplastischesaethylend1046 There was a process of healing without ACP/PRP but the speed was super super slow. So I searched around if there are other options and found ACP/PRP which really helped.

@rayalgar 7 ай бұрын

Excellent evidence-based diagnosis and treatment advice. I’ve just take up Padel tennis which is really loading my achilles so will now be using your staged protocol. It’s also so helpful to know that you can exercise within tolerable levels of pain and that rest is not always best.

@EastTiger32 9 ай бұрын

This is an excellent video. Very informative and straightforward. Thank you

@joaobranco3397 6 ай бұрын

Thanks man this was very helpful

@adrientalon63 Жыл бұрын

Incredibly well put ! Thank you so much ! I like how you don't try to give false hope and you give precise explanations with examples and variations for each exercise. Best video on the subject by far 👍

@nicholastown2779 9 ай бұрын

agreed

@AceTheFirePunch Жыл бұрын

I'm in 7th Week after ACL-Reconstruction, finally able to start doing exercises (mostly mobility). - Your videos are very helpful (especially the ACL-Series..), thank you very much, you've been a great inspiration and ressource of motivation to me ! One thing i miss on your videos (helpful to almost every Ankle / Knee recovery plan) is WALKING BACKWARDS, intentionally rolling of your toes, pushing yourself back more and more as your leg-function allows it. Also doing Tibialis Raises (can be done loaded, so the heel doesn't have to be on the ground, for Heel-Painers) helped me a ton, in regaining control, mobility & muscle-symmetry! Kudos

@trevorm3181 7 ай бұрын

Promising video. I’ve been dealing with this sh*t for 5 years.

@RajasekharUK 25 күн бұрын

Wonderful and Useful video. Thanks a ton!

@juandavidrojasperdomo4303 6 ай бұрын

Excellent video! It´s very difficult to find people expert about anything. You are expert in this topic! Congraulations"! GO on

@shwetasah8009 2 ай бұрын

Wow!! This is such an informative video, explaining the whys behind the whats! Thank you so much!!!

@lauramartinez6060 5 ай бұрын

This was excellent!! I have been to two doctors within the last year 1/2 and I’m still not healed. Never said anything about these kinds of exercises. Just had laser treatments, Acupunture, and still not 100%. This was so valuable and so easy to follow along with a plan in place. You did an amazing job!

@hugomotaprego5268 Жыл бұрын

my Tendinitis flared up yesterday because I played in a tournament. Today this video pops up on my feed... I will incorporate this advice

@seanyar9648 Жыл бұрын

GREAT JOB, very professionally made

@linkchiu007 6 ай бұрын

great video, very clear and helpful! thank you

@nixsearcy5547 5 ай бұрын

Wow! thank you for this. Fantastic explanation.

@soulc4ster 10 ай бұрын

amazing video been strugle with this for some time and first explanation that makes sense in a while hope in a year this problem is solved with your method

@AaronAlexander49 29 күн бұрын

Great video, thank you!

@conradpaul5145 Ай бұрын

Awesome video, thanx guys very helpful and informative breakdown.

@anrylmediadero2236 3 ай бұрын

Thank you so much for the enlightenment.

@Heffiemonster Жыл бұрын

As someone who has had on and off AT for a couple of decades, I can say that this is top notch advice, and very up-to-date. Mine has massively improved via Heavy Slow Resistance training with a weighted vest, incorporating both concentric (heel raise) and eccentric (heel drop) portions. However, most physios still prescribe the Alfredson protocol which focuses on eccentric. This seems to work for some people, but for me they did virtually nothing as they were not "treating the donut" (lovely analogy). I think that many physios approach this in an overly conservative way, as they are concerned that the client may complain about pain. A couple of queries. I recently had a bout of insertional tendinopathy (right down on the ankle). My physio suggested this resulted from "deficit" exercises where my heel went below the level of the step, so I have cut these from my rehab. Has anyone else had a similar experience? Secondly, I really enjoy skipping / jump rope, and was wondering whether this could be used for the plyometrics? I find it more enjoyable than just plyometrics, and it also gives a more cardiovascular workout. Many of the plyometric exercises could be incorporated into a jump rope routine. It involves much higher reps than standard plyometrics, but at the same time movements need to be quick and efficient if you use a fast rope.

@ravkhabra 11 ай бұрын

I have insertional tendinopathy and found that deficit exercises caused more issues. So instead, I perform my heel raises on flat ground. This seemed to do the trick. I also concur with what you said about heavy slow resistance. Doing these activities have made a huge difference. I have been following the rehab programme for the last three months and have seen huge improvements.

@nicholastown2779 9 ай бұрын

this might help too for insertional tendinopathy. Good luck. I'm in the same boat haha. kzfaq.info/get/bejne/iMmSpLSZm9Sro58.html

@michaelmaldonado9914 5 ай бұрын

would love another diagnosis, I currently run alot and have been for over almost a year. I stopped running seriously back in 2020 after i was on a long run and was running forefoot and felt sharp pain in my Achilles and turned out to be tendinitis. I have since changed to heel strike and built my weekly mileage slowly. In doing this i barely have any pain but i have found good use of implementing these workouts in my day to day so thank you very much!

@nielsvandervelden3063 3 ай бұрын

I have been running for years with severe Achilles pain. Tried everything from resting to implementing exercises but the pain always came back. What made a real difference was getting a pair of running shoes with very thick heel support. I now run virtually pain free.

@user-gf4ji7rp5v Ай бұрын

I would love to know what shoes you got. I'm working through this too and very discouraged

@ramtirth7422 17 күн бұрын

Yes I would also like to know the brand name of the shoes. Thanks

@buttermashpotatoes4617 6 ай бұрын

The idea to keep the load tolerable instead of completely resting, then going too hard and making things worse is something I've not heard anywhere else, thank you so much for this advice

@mushbro10 Жыл бұрын

Wish I would have watched this months ago. Perfect!

@Rajasunny188 5 ай бұрын

Thats a great job sir. Tq for making such a detailed video

@tonysoler Ай бұрын

Great job explaining this in layman’s terms. Very helpful

@lyndonsumbeling6490 2 ай бұрын

Thumbs up for this video this is the best by far. Been struggling for Tendinopathy for almost 3 years. Playing basketball in a decreased level since then. Hopefully be able to manage capacity through to this process and consistency.

@arivirtanen2568 Ай бұрын

Amazing video. This really helps

@Cutest1TheGame Жыл бұрын

I love long videos with lots of detail!

@ralphjones4583 8 ай бұрын

Thank you for this very informational video. In 2007 at age 43 while playing basketball I tore an achilles and had it surgically repaired. I woke up a couple weeks ago feeling similar pain in the other achilles after seemingly doing normal day to activities such as walking and climbing ladders. I started resistance training about 10 days ago and its working! This video is very detailed and I’ll be using this information to help further my recovery. Thank you. so much.

@debbiedebbie9473 2 ай бұрын

What exactly are you doing for resistance training ?

@matthewmclaughlin6532 8 ай бұрын

Excellent video and explanations.

@piotrmusialek5691 Жыл бұрын

Great video mr Surdykapt!!!

@e2d909 8 ай бұрын

Excellent video. Thank you

@yato8940 7 ай бұрын

Thank you for this. I am experiencing this right now due to increasing LOAD of exercises recently.

@beverleycheshire5437 7 ай бұрын

The absolute BEST video I have watched for Achilles Tendinopathy. Definitely a keeper and refer to it often as I progress. Thank you 🙏🏽

@paulbbareil6080 3 ай бұрын

Simply the best video on the subject out there! I would only add that runners should also toe off the hip and knee extended. The soleus endup taking the beating alone if you toe off with the leg bent. The gastroc is slack when the knee is bent.

@Flampo 3 ай бұрын

Great video.

@liljemark1 Жыл бұрын

I wish all physios would increase their knowledge like you guys are doing ❤️ Do you have any comments on "surgical cleaning" of Achilles? I hear several track & field or distance running athletes opt for this. I guess you did comment that surgically changing the structure does no good. I'm happy to have taken care of my Achilles tendinopathy with your stage 0 and 1 tips. That gave me enough capacity to do my level of distance running as 40-yo dadbod 🤣

@aidanscrooby Жыл бұрын

Awesome, easily digestible source of information! - Third year physio student :)

@oguzaliekinci 11 ай бұрын

Great video, I have been running regularly for last 3-4 years. I bought carbon plated shoes and after my first run, boom… I pushed for my 1k pr on first day. Now I have a problem 😢 I will try those recommendations, video contain all answers to my questions 🙏 thanks a lot 🙏

@petertaylor9763 2 ай бұрын

Your explanation was great. Now I now what to do. 😊

@katesel 6 ай бұрын

THANK YOU. i am having a horrible time getting out of the boom, bust cycle. Incredibly frustrated because I was successful treating this a few years ago. The exercise progress was what i have been trying to find. (p.s. I am a PT ;) )