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EPISODE 36: The Journey to Recovery - Rehabilitation Techniques after Achilles Tendon Repairs

Aaron Rodgers tearing his Achilles tendon

If you watch the NFL or play fantasy football, you must have heard about the devastating news of Aaron Rodgers tearing his Achilles tendon. We are only 2 weeks into the season and have had multiple Achilles ruptures including Aaron Rodgers, JK Dobbins, Marlon Mack, and Eno Benjamin to name a few. Achilles tendon ruptures are among the most dreaded injuries for athletes and active individuals due to their potential for long-lasting consequences. However, advances in medical science and rehabilitation techniques have made it possible for many to regain strength and mobility after Achilles tendon repair surgery. In this blog, we will dive into Achilles tendon tears and the crucial role of physical therapy in achieving a successful recovery.

Let's start with some Anatomy!

Achilles tendon tear

The Achilles tendon is a thick, powerful cord of tissue (thickest and strongest tendon in the human body, FYI) that connects the calf muscles, gastrocnemius and soleus, to the heel bone. When this tendon ruptures, it can result in significant pain and loss of function.

There are two common types of Achilles tendon tears:

1) Partial Tears: In these cases, the tendon is damaged but not completely severed. Partial tears may be less severe but still require attention and rehabilitation.

2) Complete Tears: A complete rupture means the tendon has torn entirely, creating a gap. This injury typically demands surgical intervention for optimal healing.

Next let's get into Symptoms!

Some of the things our patients tell us they feel with this injury include:

- feeling of having been kicked in the calf

- inability to push off of the injured leg when walking

- inability to stand on toes

- popping or snapping sound upon injury

- pain is dependent on the degree of the tear (some complete tears do not cause pain)

- in some cases, it is preceded by discomfort in the Achilles tendon or calf prior to the incident (achilles tendinopathy)

You might be asking...okay well how does an Achilles tendon rupture occur?

The most commons Mechanisms of Injury are as follows:

- acute loading during acceleration or deceleration

- landing from a jump

- quick change of direction

-or lastly, degenerative changes in the tendon

Let's talk Rehab! Physical therapy is a cornerstone of recovery following Achilles tendon repair surgery. It plays a pivotal role in helping individuals regain strength, flexibility, and function. Here's what you can expect during the post-surgery rehabilitation process.

Phases of Rehabilitation

Phase 1: Early Post-Op

- Non-Weight Bearing: You will be instructed to keep weight off the affected leg with a boot on. Crutches or a knee scooter may be necessary.

- Pain Management: Pain medications will be prescribed, and icing is recommended to reduce swelling.

- Strength Training: Exercising all areas outside of the calf complex including abdominals, hip musculature, quadriceps, etc.

- Blood Flow Restriction Training: utilizing BFR to reduce muscle mass loss as well as facilitating the healing process

Phase 2: Late Post-Op

- Protected Weight Bearing: You'll start putting partial weight on the repaired leg under the guidance of your healthcare provider.

- Range of Motion Exercises: Gentle ankle movements are introduced to prevent stiffness but only allowing dorsiflexion to a neutral position.

- Heel Wedge Progression: Slowly removing the heel wedges and progressing towards a neutral position

- Continue Strength Training: adding in foot strengthening as well as seated calf raises once able to remove all heel wedges

Phase 3: Transitional

- Dorsiflexion Progression: Gently start to progress dorsiflexion range of motion

- Gait Training: Normalizing the individual's walking pattern

- Calf Strengthening: Gradually increasing the heel raise weight distribution

- Balance Training: Progression of stance positions to challenge balance and working towards single leg balance

- Strength Training: Introduction to compound movements including squats and deadlifts (progressing from symmetrical stance to asymmetrical stances)

Phase 4: Strengthening and Functional Rehabilitation

- Continued Calf Strengthening: Working towards single leg calf raises in a knee extended and knee bent position. Another key here is to work on calf raises that also go below the neutral position to build capacity in elongated orientations as well.

- Strength Training: At this point, your physical therapy sessions should look like a normal athlete's training routine including all strength patterns (push/pull/hinge/lunge/squat/carry).

- Introduction of Plyometrics: Starting off of symmetrical stance light tier plyometric work and gradually increasing the intensity and adding variety of foot positions

Phase 5: Return to Athletic Patterns and Return to Sport

- Athletic Patterns: Training patterns including acceleration, sprinting, deceleration, lateral shuffles, lateral runs, change of direction

- Reactive Drills/Cognitive Demands: Challenge the athletes with decision making while performing the above patterns

- Gradual Return to Sport: Based off of various tests performed in the clinic, gradually returning to the sport starting from self drills and progressing towards contact drills

As you can see the rehab process requires patience, time and commitment from both the athlete and expert guidance by the rehab team.

Here are some other things to consider:

1. Early Sports Specialization - research shows NCAA female gymnasts have highest incidents of Achilles ruptures and most gymnasts have been involved in gymnastics for 13 years by that point. Hypothesized that specializing in gymnastics before age 10 would qualify as a risk factor for future achilles ruptures

2. Over-Specialization - defensive ends and linebackers are most common positions with Achilles ruptures. Achilles tendon injuries can be caused by a load management issue with players performing similar movement over and over again based on the positions they play.

3. Practice and Playing Surface - field surface type has not shown direct correlation to achilles rupture injuries (grass vs turf). However, field surface experts did also mention that the NFL uses 30 different fields for games and may be more of a problem of variability than specific field types.

4. Footwear

  • Stiffer soles - can improve performance but can increase demand on achilles tendon

  • Foam designs - intention is to unload the leg upon ground contact but also effects proprioception, timing, and coordination and can also detrain the tendons

  • Enhanced traction - similar to the stiffer sole, can increase demand on achilles tendon and other soft tissue due to potential increase in ground contact time

  • Lighter weight - can help with mitigating fatigue but also accelerates break down of the shoe itself

At the end of the day, physical therapy is the linchpin of successful recovery, helping individuals regain not only physical strength but also the confidence to return to their active lifestyles. By following the prescribed rehabilitation program and working closely with healthcare professionals, many individuals can overcome the challenges posed by Achilles tendon tears and ultimately achieve a full and robust recovery.

If you have Achilles tendon pain have had an Achilles tendon repair and you are looking for some help, we got you! We work with clients on site and virtually through Telehealth. Click here if you are interested in booking a a session or getting more information!

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The PTSP Docs

Dr. Daisuke, Dr. Brown, Dr. Bay & Dr. Sandoval

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