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. 2024 Sep 1;19(9):1152-1165.
doi: 10.26603/001c.122643. eCollection 2024.

Rehabilitation and Return to Sports after Achilles Tendon Repair

William Marrone  1 , Robert Andrews  2 , Aaron Reynolds  3 , Patrick Vignona  2 , Snehal Patel  2 , Martin O'Malley  2
Affiliations

Rehabilitation and Return to Sports after Achilles Tendon Repair

William Marrone et al. Int J Sports Phys Ther. .

Abstract

Rehabilitation protocols post-Achilles tendon repair vary widely, particularly regarding weight bearing (WB) and immobilization duration, impacting recovery trajectories significantly. This commentary focuses on rehabilitation strategies following acute Achilles tendon repair (ATR), emphasizing early mobilization and progressive loading. Techniques such as blood flow restriction training (BFRT) and progressive loading to restore strength and tendon mechanical properties are discussed in the context of optimizing recovery, minimizing tendon elongation and facilitating safe return to sport (RTS). This manuscript highlights current evidence and clinical insights to guide practitioners in optimizing rehabilitation protocols for athletes recovering from ATR, aiming to improve functional outcomes and support safe return to athletic activity.

Keywords: Achilles Tendon Repair; Physical Therapy; Rehabilitation; Return to Sport.

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Figures

Figure 1.
Figure 1.. Resting position of the ankle. Can be used as proxy measure for tendon elongation. Excessive elongation would result in resting position being in relative dorsiflexion compared to the contralateral side.
Figure 2.
Figure 2.. Sub-maximal plantar flexor isometrics in shortened muscle length (combined knee flexion/ankle PF). Using Forceframe (VALD) for biofeedback.
Figure 3.
Figure 3.. Seated ankle plantar flexor isotonics (PRE’s)
Figure 4.
Figure 4.. Sample ankle plantar flexor progression.
Figure 5.
Figure 5.. Standing bilateral heel rise with emphasis on loading through the first MTP. Encouraged to achieve maximal heel height without compensation.
Figure 6.
Figure 6.. Standing bilateral heel rise isometric with force plates for biofeedback and asymmetry monitoring. Can be used for both training and testing.
Figure 5.
Figure 5.. Band Assisted single leg pogo jump. Commonly used as introductory exercise for SL plyometrics. Band facilitates bodyweight assistance to reduce demands on lower leg.
Figure 6.
Figure 6.. Triple extension wall drill. Phase 1 includes holding A frame position while in triple extension. Can be progressed to marches and then switches to gradually increase demands in preparation for running.
Figure 7.
Figure 7.. Isokinetic testing of ankle plantarflexion and dorsiflexion strength.
Figure 9.
Figure 9.. Standing Heel Rise Test: measure of muscular endurance. Limb symmetry indices for number of reps or total work (# of repetitions x height of heel rise)
See this image and copyright information in PMC

References

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