Rehabilitation of Partial Achilles Tendon Tear

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A structured rehab program is important for a full recovery of a partial rupture of the achilles tendon.

The following guidelines are for information purposes only. We recommend seeking professional advice before attempting any self help. The aims of rehabilitation are to control initial pain and swelling, improve mobility and strength then gradually return to full fitness.

Controlling pain and swelling

Apply cold therapy. This can be in the form of ice. Do not apply directly to the skin - place a wet tea towel around the ice or use a specialist product. Apply compression after or during the cold therapy to help reduce swelling.

NSAID (Non Steroidal Anti Inflammatory Drugs (e.g. Ibuprofen) may help reduce the inflammation in the early stages. It is important to always check with your Doctor before taking any medication. You should not take Ibuprofen if you have asthma. Avoid taking medication for more than a week. The effectiveness may be reduced later in rehabilitation and may even hinder healing.

Rest the injury from aggravating activities. If the athlete cannot walk without pain then they may need to use crutches. When the athlete can tolerate walking, place a 2cm heal raise into shoes which will raise the heal, shorten the achilles tendon and reduce the load on the tendon. Continue to rest the tendon until able to tolerate a strengthening programme. With an injury of this kind it may be a month or more before the athlete can attempt strengthening of the tendon.

Taping the achilles tendon may help to reduce the load on it as the athlete returns to walking, especially if they have no choice and have to get about for example at work.

It may be a month before swelling is reduced and the injury has healed enough to progress into stretching and strengthening exercises.

Increasing mobility and flexibility

When swelling has gone down and pain is reduced the athlete may be able to begin to stretch the tendon. It may be as soon as a week after injury but it may be up to a month depending on severity.

Begin with mobility exercises as soon as pain will allow. This may be within a few days but could be over a week depending on how bad the injury is.

Balance exercises should be performed as early as possible in the rehabilitation of this injury. When a tendon or ligament is torn balance is usually impaired, leaving the ankle more at risk of future injuries. Balance boards are great for this.

Strengthening

When pain and swelling has gone then strengthening exercises can begin. Start very slowly and progress slowly (double leg heel drop taking most of the weight on the uninjured leg). It is important that the tendon is strengthened in the stretched position by allowing the heels to drop below the toes.

Continue stretching throughout the rehabilitation process. Stretch well before and after strengthening sessions. Stretching exercises can be done on a daily basis, especially if the loads are light in the early stages.

Strengthening should be continued for many weeks after you have returned to full fitness. Apply ice to the tendon at the end of a strengthening session to help prevent inflammation.

Returning to full fitness

When the ankle has regained full flexibility, there is no pain or swelling and strengthening exercises can be tolerated without adverse reaction then a gentle running programme can begin. This may be up to three months after the initial injury depending on severity.

Start gentle jogging on a firm surface. Gradually build up until you can comfortably jog for 45 minutes. It is unlikely that you will be able to return to competition within four to six months. Below is an example of a gradual return to running program.

Day 1: walk 4 minutes jog 2 minutes repeat four times
Day 2: rest    
Day 3: walk 4 minutes jog 3 minutes repeat three times
Day 4: rest    
Day 5: walk 3 minutes jog 4 minutes repeat 4 times
Day 6: rest    
Day 7: walk 2 minutes jog 6 minutes repeat 4 times

Continue this gradual progression until you can confidently run and resume normal training. Gradually increase the duration of your runs. No more than 10 % per week is usually recommended. If your sport demands sprinting then gradually increase the speed.

Continue with the stretching and strengthening programme. It is important to do these even if you do not gain pain at this stage. Continue for at least three months. Continue to ice the tendon after training. You should now be ready to start back in full training but never neglect stretching and strengthening of the achilles tendon or the injury might return./

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