Phases and time frames are designed to give a general sense of progression. A closer look at a new protocol to manage achilles tendon. A closer look at a new protocol to manage achilles tendon rupture. Achilles tendon rupture accelerated functional rehabilitation protocol 0 2 weeks aircast boot with 2 cm heel lift nwb with crutches 2 6 weeks aircast boot with 2 cm heel lift protected weightbearing with crutches as required active plantar and dorsi flexion to neutral, inversion eversion below neutral. Rehabilitation guidelines for achilles tendon repair the achilles tendon is the strongest and thickest tendon in the body. Please use extreme caution when using assistive devices such as crutches, walker or rollabout. As such, it should be stressed that this is only a protocol and should not be a substitute. Acute achilles tendon rupture is a traumatic injury that causes significant functional deficits. For this reason, when the achilles tendon is ruptured, there is a drastic loss of strength and. Acute versus chronic, as well as, concomitant procedures, and physiologic age of the patient. Avoid aggressive active and passive range of motion of the achilles for 10 12 weeks. Over 15 years ago, researchers reported a more aggressive protocol for managing the achilles rupture, moving the patient out of an equinus position at the ankle within four weeks after surgical repair. Achilles tendon rupture nonsurgical and surgical protocol. Brian grawe, md progression is based on healing constraints and functional progression specific to the patient.
However, it does occur less commonly in the highlevel competitive athlete. This is generally in the weekend warrior, recreational athlete, in his late 20s to early 40s. Despite its size, it is also the most frequently ruptured tendon. Most achilles tendon ruptures occur in sports that require running, jumping and change of direction. Postop days 1 10 bracesplint watch for skin breakdown crutches non weight bearing nwb active motion arom hip and knee wiggle toes straight leg raise slr x 4 lower extremity le stretches hamstring, quads, itb, hip flexors ice. If it does, rest the patient until pain level is clearly decreasing. Mar 15, 2016 this protocol for achilles tendon repair work is developed to supply the rehab professional with a basic standard for patient care. Rehabilitation guidelines for achilles tendon repair. It is designed for rehabilitation following post operative achilles tendon repair. Achilles repair protocol northwestern medical center. Achilles tendon repair rehabilitation postoperative guideline. Achilles repair rehabilitation protocol key considerations. Insertional achilles tendon repair rehabilitation protocol home.
This protocol for achilles tendon repair work is developed to supply the rehab professional with a basic standard for patient care. The achilles tendon connects the calf muscle, composed of the gastrocnemius and soleus muscle, to the heel bone. Achilles tendon rupture repair return to sport protocol keys for achilles tendon rehabilitation. Achilles tendon repair protocol sheet for clinicians alterg. Rehabilitation guidelines for achilles tendon repair uw health. The typical age for rupture occurs between 3040 years of age. Pad placement medial and lateral gastrocnemius 2,500 hz modulated at 75 bursts per second 2 second ramp time 10 on 50 second off 1015 contractions. Achilles tendon repair rehab guidelines dr brian grawe. These deficits have been found to persist for as long as 10 years postrupture. The intent of posting these standards of care and protocols is to provide clinicians and patients.
Achilles tendon scars reach only 57% of the normal maximum stress values after 12 months. Table e1 achilles tendon rupture rehabilitation protocol time frame activity 02 weeks posterior slabsplint. Physical therapy guideline for achilles rupture repair. Rehab practice guidelines for achilles tendon repair. Time frames mentioned in this protocol should be considered approximate with actual progression based upon clinical presentation. Microsoft word achilles tendon rupture nonoperative rehab protocol prescription. It attaches the calf muscles soleus and gastrocnemius to the heel bone calcaneus. The achilles tendon is a strong tendon that connects the calf muscles to the heel. Insertional achilles repair sports medicine center. The objective of the swansea morriston achilles rupture treatment smart protocol was to create rationalised decisionmaking for patients with a ruptured achilles tendon and a rationalised and comprehensive rehabilitation regimen. Achilles tendon repair rehab protocol below we outline the steps that we have our patients take to recover from achilles tendon repair surgery.
Department of physiotherapy department of sport and. Achilles tendon rupture atr usually occurs due to overloading of the tendon, often in a sport setting 2,3,4. Calf girth, plantar flexor strength and ankle rom are all keys to full recovery. The ideal is to achieve full symmetry in all 3 areas.
Nov 03, 2018 achilles tendon scars reach only 57% of the normal maximum stress values after 12 months. Achilles tendon repair postop rehabilitation protocol. Postoperative protocol insertional achilles tendon repair please note these are general guidelines and may change for various reasons on a casebycase basis. There may be a tender lump andor audible clicking from the tendon when you move your ankle. Achilles tendon repair surgery rehabilitation protocol preoperative instructions here are guidelines that will help you in preparing for surgery to repair your achilles tendon. Insertional achilles tendon repair rehabilitation protocol this protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Nonoperative treatment of achilles tendon ruptures phase. Cole,md,mba weight bearing brace rom exercises phase i 02 weeks as tolerated with crutches and brace locked in full extension for sleeping and all activity off for exercises and hygiene 02 weeks. Achilles tendon repair protocol 2012 center for sports. Department of physiotherapy department of sport and exercise. Nonoperative treatment of achilles tendon ruptures phase 1. It has the largest crosssectional area of any tendon in the body, providing approximately 60% of the lower leg push off strength.
Weightbearing has been shown in studies to improve strength of healing with no increase in rerupture rate just protect from any. Accelerated achilles protocol time frame activity 02 weeks posterior slabsplint. The surgically repaired achilles will typically be removed from a cast and switched to a removable cast boot a little sooner than the nonsurgical achilles tendon rupture. Accelerated achilles protocol indiana total therapy. It can occur at any age but is most common between the ages of 30 and 50. As with any muscle or tendon in the body, the achilles tendon can be torn if there is a high.
Achilles tendon repair rehabilitation protocol this rehabilitation protocol was developed for patients who have had a repair of an acute achilles tendon rupture. Rom should be measure in both open and closedchain methods. The doctor or his associate will do a preoperative history and physical examination and complete the necessary. The injury is often accompanied by an audible and palpable pop with limited ability to push off of the injured limb. Specific intervention should be based on the needs of the individual and should consider exam findings and clinical decision making. Achilles tendon rupture affects about 1 in 15,000 people at any one time, increasing to 1 in 8,000 in competitive athletes. As such, it must be stressed that this is just a protocol and needs to not be a substitute for expert clinical decisionmaking regarding a patients development. Achilles tendon repair rehabilitation postoperative guideline this rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. When they contract, they pull on the achilles tendon causing your foot to point down plantar flexionand helping you raise up on your toes. The achilles tendon is the strongest and thickest tendon in the human body 1, 2. Insertional achilles tendon repair rehabilitation protocol. Often the tendon is very tender to touch when gently squeezed. Ckc, progressing unilateral heel raises with body weight or greater gradually increasing df range and resistance.
Specific changes in the program will be made by the. Achilles tendon rupture nonoperative rehab protocol. Define the protocol to be followed for all patients referred from northwestern orthopedics after the above procedure has been performed. Achilles tendon repair protocol 2020 riverside drive 6 p a g e green bay, wi 54301 9202885555 references. Dependent upon the patient and quality of the repair, weight bearing status postoperatively as well as the intensity and time frame of initiation of functional activities will vary. Achilles tendon repair phase i postoperative period weeks 01 nonweight bearing splint immobilization daily icing, compression and elevation home program phase ii weeks weightbearing. We report the results of patients with a rupture of the achilles tendon who were managed using this protocol. This protocol provides you with general guidelines for initial stage and progression of rehabilitation. Modifications to this guideline may be necessary dependent on physician. Insertional achilles tendon repair rehabilitation protocol home patient education insertional achilles tendon repair rehabilitation protocol this protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. This protocol for achilles tendon repair is designed to provide the rehabilitation professional with a general guideline for patient care with the alterg antigravity.
Achilles tendon rupture repair return to sport protocol. The achilles tendon usually rupt ures without warning. Avoid creating pain discomfort is okay but pain should not occur and persist 3 days in a row. This means that the pain settles during exercise but after resting it may then increase. Achillestendon repair postoperative protocol michelle wolcott, md department of orthopedic surgery sports medicine remove heel lifts from shoes 2. This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Rehabilitation protocol general principles this protocol for achilles tendon repair is designed to provide the rehabilitation professional with a general guideline for patient care with the alterg antigravity treadmill. Achilles tendon repair is performed after injury occurs to the achilles tendon. Achilles tendon repair postop protocol penrose physical. Long term results of acute achilles repair with triplebundle technique and early rehabilitation protocol.
Rehabilitation protocol for achilles tendon repair this protocol is intended to guide clinicians and patients through the postoperative course for an achilles tendon repair. Achilles tendon repair open rehabilitation protocol general considerations. Due to the lack of treatment guidelines, there is no consensus about diagnostic methods, primary treatment nonsurgical or surgical and rehabilitation. Table e1 achilles tendon rupture rehabilitation protocol. The information contained in these standards of care or protocols is not intended in any way to be used as primary medical advice or to replace medical advice offered by physical, occupational, speech therapists or other health care professionals. Achilles tendon rupture atr is a common sports injury, with a rising incidence and significant impairments. You may learn more about how the stone clinic repairs achilles tendon ruptures without open surgery in our explanation. Atr has an acute presentation of severe pain, inability to bear weight, and weakness. Avoid all passive motion into df for 1st 6 weeks postop 3.
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