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Rehabilitation Protocol for Achilles Tendon Repair - stretches for achilles tendon

Rehabilitation Protocol for Achilles Tendon Repair-stretches for achilles tendon

Rehabilitation Protocol for Achilles Rupture Repair
This protocol is intended to guide clinicians through the post-operative course for Achilles tendon repair. This protocol is
time based (dependent on tissue healing) as well as criterion based. Specific intervention should be based on the needs
of the individual and should consider exam findings and clinical decision making. The timeframes for expected outcomes
contained within this guideline may vary based on surgeon's preference, additional procedures performed, and/or
complications. If a clinician requires assistance in the progression of a post-operative patient, they should consult with
the referring surgeon.
The interventions included within this protocol are not intended to be an inclusive list. Therapeutic interventions should
be included and modified based on the progress of the patient and under the discretion of the clinician.
Considerations for the Post-operative Achilles tendon repair program
Many different factors influence the post-operative Achilles tendon rehabilitation outcomes, including type and location
of the Achilles tear and repair. Consider taking a more conservative approach to range of motion, weight bearing, and
rehab progression with tendon augmentation, re-rupture after non-surgical management, revision, chronic tendinosis,
and co-morbidities, for example, obesity, older age, and steroid use. It is recommended that clinicians collaborate
closely with the referring physician regarding intra-operative findings and satisfaction with the strength of the repair.
If the patient develops a fever, unresolving numbness/tingling, excessive drainage from the incision, uncontrolled pain
or any other symptoms you have concerns about, the referring physician should be contacted.
Rehabilitation ? Protect repair
Goals ? Maintain strength of hip, knee and core
? Manage swelling
Weight Bearing Walking
? Non-weight bearing (NWB) on crutches in splint and/or Achilles boot.
Intervention Range of motion/Mobility (in boot/splint)
? Supine passive hamstring stretch
Strengthening (in boot/splint)
? Quad sets
? Straight leg raise
? Abdominal bracing
? Hip abduction
? Side-lying hip external rotation-clamshell
? Prone hip extension
? Prone hamstring curls
Criteria to ? Pain < 5/10
Rehabilitation ? Continue to protect repair
Goals ? Avoid over-elongation of the Achilles
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? Reduce pain, minimize swelling
? Improve scar mobility once incision is healed
? Restore ankle plantar flexion, inversion, and eversion
? Dorsiflexion to neutral
? Normalize gait as much as possible while in boot by utilizing a Shoe Leveler for the uninvolved
side to prevent secondary musculoskeletal complaints.
Weight Bearing Walking (**Weight-bearing, wedge use/weaning, and boot types may vary by surgeon/practice.)
? Week 4: Begin partial progressive weight-bearing on crutches in an Achilles boot with 3
wedges (~1" in height each). Suggest gradually progress weight-bearing by 25% of body weight
per week as tolerated until Full Weight-bearing (FWB) through the surgical side without pain.
? Week 5: Wean one heel wedge leaving 2 wedges remaining in Achilles Boot.
? Week 6: Wean 2nd heel wedge, leaving 1 wedge remaining in Achilles Boot.
Additional Range of motion/Mobility
Intervention ? Initiate ankle passive range of motion (PROM), active assisted range of motion (AAROM) and
*Continue with active range of motion (AROM) - DO NOT dorsiflex (DF) ankle past 0 degrees
Phase I o Ankle pumps (do not DF ankle beyond neutral/0 degrees)
interventions o Ankle circles (do not DF ankle beyond neutral/0 degrees)
o Ankle inversion
o Ankle eversion
o Seated heel-slides for ankle DF ROM (not past 0 degrees)
? If stiff from immobilization, initiate great toe DF and PF stretching (by patient or therapist) - Do
not exceed neutral (0 degrees) DF when performing this stretch.
? Foot and ankle joint mobilizations: per therapist discretion
o Modify hand placement to avoid pressure on healing incision
? May begin gentle scar mobilization once incision is healed - NO instrument assisted soft tissue
mobilization (IASTM) directly on tendon until at least 16 weeks post-op.
? Upper body ergometer
? Continue proximal lower extremity strengthening as in Phase I
? Lumbopelvic Strengthening: planks (in Achilles Boot)
? Once able sit with foot flat on the floor with ankle close to neutral DF:
o Seated heel raises
o Seated arch doming
o Exercises for foot intrinsic muscles to minimize atrophy while in boot
? Joint position re-training
Criteria to ? Pain < 3/10
Progress ? Minimal swelling (recommend water displacement volumetry or circumference measures such
as Figure 8)
? Full ROM PF, eversion, inversion
? DF to neutral
? Optimal gait in Achilles Boot with 1 wedge, crutches and Shoe Leveler on uninvolved side
Rehabilitation ? Continue to protect repair
Goals ? Avoid over-elongation of the Achilles. No overt stretching of the Achilles.
? Normalize gait in Achilles Boot without wedges using a Shoe Leveler for the uninvolved side.
? Restore full range of motion including DF
? Safely progress strengthening
? Promote proper movement patterns
? Avoid post exercise pain/swelling
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? FWB in boot without wedges, without crutches, with good tolerance and normalized gait pattern
by week 8
Weight Bearing Walking
? Week 7: Remove final heel wedge from Achilles Boot.
o WBAT/FWB with one crutch/no crutches as needed for normalized gait pattern in
Achilles Boot without wedges, with Shoe Leveler on the uninvolved side (remove
one layer of the Shoe Leveler)
? Week 8: FWB in Achilles Boot (no wedges) with Shoe Leveler on uninvolved without crutches
Additional Range of motion/Mobility
Intervention ? Continue seated heel-slides for DF ROM to tolerance - DF ROM no longer restricted but
*Continue with continue to gently progress.
Phase I-II ? Continue toe stretching as needed
Interventions as ? Gentle stretching of proximal muscle groups as indicated: (Examples: standing quad stretch,
indicated. standing hamstrings stretch, kneeling hip flexor stretch, piriformis stretch)
? Ankle/foot mobilizations (talocrural, subtalar, midfoot, MTPs) as indicated
? No overt stretching of the calf in NWB or weight-bearing. NWB stretches such as calf towel
stretch should only be implemented if DF ROM progression is delayed
? Stationary bicycle (in Achilles boot)
? 4 way ankle with resistance band
? Lumbopelvic strengthening: bridges on physioball, bridge on physioball with roll-in, bridge on
physioball alternating
? Gym equipment: hip abductor and adductor machine, hip extension machine, roman chair
o Progress intensity (strength) and duration (endurance) of exercises
Criteria to ? No swelling/pain after exercise
Progress ? Normal gait in Achilles boot without wedges or need for crutches
? ROM equal to contralateral side
? Joint position sense symmetrical (

What are the best Achilles tendon exercises? Physical Therapy Exercises for Achilles Tendonitis Flexibility Stretches. Tight calf muscles put extra strain on the Achilles tendon during daily movements and intense physical activity. Eccentric Strength Techniques. Eccentric exercises refer to moves that build strength in a muscle by applying tension to the structure as it is lengthened. Heavy Resistance Exercises. ... A Word from Verywell. ...