Aggressive Athletic Rehab for Achilles Tendon
One technique for rehab for the Achilles tendon rupture is aggressive athletic rehab. This process is focused on faster mobilization following an Achilles tendon rupture repair. Once the wound is healed, patients are encouraged to actively move their ankle through a series of exercises designed to fire the calf muscle and to use the Achilles, but doing so in such a way without putting a significant amount of force through the Achilles. Patients still have to significantly limit their activity, but rather than using a cast, patients are using a boot. This program, however, has potential advantages and disadvantages:
- Faster recovery
- Less calf strength is lost
- Less leg strength is lost
- Risk of stretching out the repaired Achilles. The elongated Achilles will be weak and a revision surgery may be necessary.
An example of Aggressive Athletic Rehab for Achilles Tendon is below:
Accelerated Rehabilitation Program for the Non-Operative Management of Achilles Tendon
Traditional conservative (non-operative) treatment of acute Achilles tendon ruptures consisted of casting (with the foot point down) and immobilization for a minimum of 6 weeks. A recently introduced accelerated rehabilitation program consisting of specific exercises, combined with explicit instructions for weight bearing and bracing, leads to improved recovery essentially equivalent to the results treated with surgery for most patients.
The outline for the exercises, bracing, and weight-bearing for the treatment of Achilles tendon ruptures is as follows (adapted from Willets et al, Journal of Bone and Joint Surgery (JBJS) 2011):
The ankle is braced at 20 degrees of plantar flexion (or a 2 cm lift is placed under the heel in a boot-type brace). No weight is placed on the foot. In the case of surgery, a wound check will occur in this interval.
The ankle remains braced in plantar flexion. Exercises begin, several times per day out of the brace. The exercises consist of gentle up and down motion of the ankle, taking care not to stretch the Achilles tendon past neutral (90 degrees). Also, inversion and eversion of the ankle is performed, again with the ankle in slight plantar flexion.
25% weight-bearing in a boot with a heel lift is allowed at week 2-3
50% weight-bearing in a boot with a heel lift is allowed at week 3-4
Increased weight-bearing is permitted. he exercises continue as above, and the brace is still worn day and night.
75% weight-bearing in a boot with a heel lift is allowed at week 4-5
100% weight-bearing in a boot with a heel lift is allowed at week 5-6
The heel lift is removed and brace wear continues. Exercises progress, with slow stretching of the tendon past 90 degrees. Some strengthening of the calf occurs with the addition of resistance exercises.
Full weight-bearing is allowed in a walker boot with the heel lift removed
The brace is gradually weaned, using crutches only as needed. Range of motion, strength, and proprioception are gradually optimized.
November 12, 2018