Achilles Tendon Repair Rehab

Physio Penrith Recommended Rehabilitation

Achilles Tendon Rehab at Sydney Muscle & Joint Physio Penrith

Why have I had an Achilles tendon repair?

The Achilles tendon is the strongest tendon in the body, but it is also the tendon most commonly torn or ruptured during high velocity or explosive contractions such as running, jumping or landing. The most common causes of rupture are:

• Sudden plantar flexion (foot moving downward) such as taking off to jump.

• Unplanned or forced dorsiflexion (foot moving upward) such as landing a jump or stepping into a hole.

• Direct trauma to the tendon.

 

The typical age for rupture occurs between 30–40 years of age and is significantly more common in males than females. Older adults can also rupture the Achilles tendon and are more inclined to have degenerative partial tearing of the tendon. Other risk factors for Achilles tendon rupture include overuse of antibiotics and multiple direct steroid injections into the tendon.

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Why is post-surgical rehab important after Achilles tendon repair?

Physiotherapy-led active rehabilitation following Achilles tendon repair is vital in regaining range of motion, strength and return to  work or sport. Initially a walking boot is used for the first 4–6 weeks, upon which gradual weight bearing and mobility is encouraged to prevent stiffness post-operatively. The rehabilitation progresses slowly into isometric strengthening, isotonic and finally eccentric biased strengthening, normalisation of gait and balancing activities. Rehabilitation guidelines can be given by the treating surgeon and time frames of phases of rehabilitation can be followed. Individual patients will progress at different rates depending on their age, associated injuries, pre-injury health status, rehab compliance, tissue quality and injury severity. Specific time frames, restrictions and precautions may also be given to enhance wound healing and to protect the surgical repair/ reconstruction.

Achilles tendon rupture test Physio Penr
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Achilles tendon repair rehab - what does it look like?

At Sydney Muscle & Joint Physio Penrith our physiotherapists pride ourselves on a high quality, consistent approach and this is very important when you participate in a post-surgical rehab program. High quality physiotherapy at Sydney Muscle & Joint Clinic means:

  • we correspond with your surgeon to ensure we follow the protocols specific to you and the surgical technique

  • we use useful measurements to ensure consistent progress - these include range of motion, muscle strength measurements and grip strength

  • we use research supported outcome measures - FADI, LEFI and PSEQ questionnaires

  • we follow specific phases of rehabilitation that are in line with phases of healing

Phases of soft tissue healing:

  • Acute (2-4 days) – Protection Phase: a soft tissue injury is termed as acute from the initial time of injury and while the pain, bleeding and swelling is at its worst. Your body’s aim at this point is to protect your injury from further damage.

  • Sub-Acute (up to 6 weeks) – Repair Phase: a soft tissue injury is termed as sub-acute when the initial acute phase makes a transition to repairing the injured tissues. This phase commonly lasts up to six weeks post-injury when your body is bust laying down new soft tissue and reducing the need to protect your injury as the new scar tissue etc begins to mature and strengthen.

  • Late Stage (6 weeks to 3 months)– Remodelling Phase: your body does not magically just stop tissue healing at six week post-injury. Healing is a continuum. At six weeks post-soft tissue injury your healing tissue is reasonably mature but as you stretch, strength and stress your new scar tissue it often finds that it is not strong enough to cope with your increasing physical demand. When your body detects that a repaired structure is still weaker that necessary, it will automatically stimulate additional new tissue to help strengthen and support the healing tissue until it meets the demands of your normal exercise or physical function.

Phases of post-surgical Achilles tendon repair rehab

Phase 1 (surgery to 2 weeks) - rehabilitation appointments begin 14-16 days after surgery

  • Rehabilitation goals: protection of the surgically repaired tendon; wound healing.

  • Precautions: continuous use of the boot or splint in locked plantarflexion (20-30°); touchdown weight bearing (TDWB) using crutches; some patients may be non-weight bearing (NWB) during this time (surgeon directed); wound healing.

  • Progression criteria: two weeks after surgery.

Phase 2 (usually 2-4 weeks post-op) - begin after meeting Phase I progression criteria

  • Rehabilitation goals: normalise gait with weight bearing as tolerated (WBAT) using the boot and axillary crutches; protection of the post-surgical repair; active dorsiflexion of ankle to neutral.

  • Precautions: continuous use of the boot with some degree of slight plantar flexion - at the discretion of your surgeon.

  • Progression criteria: six weeks post-operatively; pain-free active dorsiflexion to 0°; nil wound complications.

Phase 3 (usually 6-8 weeks post-op) - begin after meeting Phase 2 progression criteria

  • Rehabilitation goals: normalise gait on level surfaces without boot or heel lift; single leg standing with good control for 10 seconds; active range of motion at the ankle between 5° of dorsiflexion and 40° of plantarflexion

  • Precautions: slowly wean from use of the boot with the use of heel lifts, then gradually remove the heel lifts during weeks 6-8 depending on clearance from the surgeon; avoid over-stressing the repair (avoid large movements in the sagittal plane; any forceful plantarflexion while in a dorsiflexed position; aggressive passive range of motion; and impact activities); some surgeons may restrict dorsiflexion past neutral (0°) for a period of time.

  • Progression criteria: normal gait mechanics without the boot; squat to 30° knee flexion without weight shift using heel lifts to keep ankle dorsiflexion to neutral; single leg standing with good control for 10 seconds; active range of motion at the ankle between 0° of dorsiflexion and 40° of plantarflexion.

Phase 4 (usually 12 weeks) - begin after meeting Phase 3 progression criteria

  • Rehabilitation goals: normalise gait on all surfaces without boot or heel lift; single leg standing with good control for 10 seconds; active range of motion at the ankle between 15° of dorsiflexion and 50° of plantarflexion; good control and no pain with functional movements, including step up/down, squat and lunges.

  • Precautions: avoid forceful impact activities; do not perform exercises that create movement compensations.

  • Progression criteria: normal gait mechanics without the boot on all surfaces; squat and lunge to 70° knee flexion without weight shift; single leg standing with good control for 10 seconds; active range of motion at the ankle between 15° of dorsiflexion and 50° of plantarflexion.

Phase 5 (usually 4 months post-op) - begin after meeting Phase 4 progression criteria

  • Rehabilitation goals: good control and no pain with sport/work specific movements, including impact.

  • Precautions: post-activity soreness should resolve within 24 hours; avoid post-activity swelling; avoid running with a limp.

  • Progression criteria: patients will be allowed to return to sport based on strength testing, movement control, balance testing, and jump and landing mechanics.