Sports rehabilitation for an Achilles tendon rupture and repair is one of the more difficult treatments for a physical therapist. The Achilles tendon is the strongest and thickest tendon in the body but is the most common tendon to rupture.
Rupture of the tendon usually occurs in sports that requires jumping, running or change of direction. A ruptured Achilles tendon is one of the most devastating injuries that an athlete can experience.
Aside from the pain, inability to ambulate and decreased mobility the worry that the injured leg will not return to pre-injury levels of performance is very common. Here we will explore the phases of recovery from this repair as well as the sports rehabilitation steps that physical therapists use to bring the athlete back into the game.
The first phase of sports rehabilitation is within one to two weeks post surgery. During this period the patient is in a boot and partial weight bearing with crutches is performed. Patient is shown toe wiggling to reduce swelling. Patient uses an upper body ergometer for cardiovascular work. It is very important in this phase to monitor wound healing and prevent infection.
The second phase of sports rehabilitation for a S/P ruptured Achillies tendon progresses ambulation on crutches to weight bearing as tolerated in protective boot. Active ankle range of motion exercises, ankle isometrics/pumps, and ankle alphabet is shown. Stationary bike is used in this period as well as strengthening exercises for the hip and knee. Modalities are utilized to reduce edema in the foot and ankle.
The third phase of sports rehabilitation weeks 4-8 starts weaning the patient off the protective boot. The therapist provides gentle stretching of the calf musculature and ankle balancing. The patient is instructed in squats that bear 50% of the body weight to start increasing the strength of the repaired tendon. Ankle strengthening utilizing resistive tubing is implemented. Balance exercises are started without the boot to normalize gait pattern. At the end of this phase the goal of ambulating without boot is towards a normal gait pattern.
The fourth phase of sports rehabilitation focuses on more intense physical therapy including plyometrics, agility drills and aggressive resistance strengthening. This phase is between 8-16 weeks after the surgery. Ankle strengthening centers on the calf muscle by the introduction of single leg stand, lunges and squats. In this phase patient can use a stair master and proprioceptive apparatus.
Another one of the exercises that will serve as a benchmark for healing is the ability of the patient to put full weight upon the repaired tendon without pain and full motion. When the patient is able to do these things with the complete confidence of the physical therapist, they will progress to the fifth phase.
Sports Rehabilitation in this period goes into more advanced balance and proprioceptive drills. Aggressive calf stretching and strengthening needs to be continued. Impact conditioning utilizing a treadmill is recommended. It is extremely important in this phase to duplicate specific sport or work demands on the involved lower extremity.
The final phase is completed by the patient alone and with the opinion of the physical therapist. This involves returning to full physical function with minimal pain and stiffness.
Sports Rehabilitation following this repair depends how well you dedicate your time and effort to completing your rehab program and listening to the advise of a qualified physical therapist.