Stretching forms a key part of a partial rupture of the Achilles rehab program. It should begin when pain allows and swelling has gone down.
Stretching exercises following a rupture of the Achilles tendon should be done very gently to begin with especially if the Achilles has a significant tear. Active stretches can be done initially and later on deeper stretches can be introduced.
A good starting point is to assess the flexibility of the calf muscles. One method of assessing calf muscle flexibility is to apply gentle pressure to the forefoot with the patient sitting with the leg out straight in front.
There will be a point where the resistance noticeably increases as the muscle begins to stretch. It is likely the therapist will feel this before the patient feels a stretch on the calf muscles.
Active calf stretch
Active stretching is a good exercise to begin with as it applies only a gentle stretch to the muscle. Muscles work in pairs and by contracting the muscles in the front of the lower leg, the muscles at the back must relax.
In order to stretch the gastrocnemius, sit on the floor or a chair with the leg straight out in front of you. Pull the toes and foot back towards you, hold for a couple of seconds and relax. Repeat this 10-20 times.
To stretch the soleus muscle, sit with the knees bent and feet on the floor. Raise the toes and foot up towards you, keeping the heel on the floor. Hold for a couple of seconds, relax and repeat 10-20 times.
To stretch the big gastrocnemius muscle the back leg must be kept straight. Stand with the leg to be stretched at the back and hands on a wall at shoulder height. Bend the front knee and lean forwards, keeping the back knee straight and pushing the heel down into the floor.
When you can feel a stretch, hold for 20 seconds. If the stretch eases, lean further forwards until you can feel it again. But do not push too far in the early stages. Perform 3 repetitions and repeat this 3-5 times a day.
Soleus muscle stretch
To stretch the deeper soleus muscle the knee of the leg to be stretched needs to be bent. This is because the soleus muscle attaches below the knee and bending the knee allows the gastrocnemius muscle to relax leaving the soleus on stretch.
Lean against a wall with the leg to be stretched at the back. Bend the knee keeping the heel in contact with the ground until a stretch is felt. Hold for 15 to 20 seconds and repeat three times. If a stretch is not felt then another method is to place the ball of foot against the wall and bend the front knee until a stretch is felt.