24 Nov Telehealth PT Following Achilles Tendon Repair
Achilles was a great warrior, nearly invincible. He was one of the greatest warriors that ever lived, but he died from a poisonous arrow that lodged in his heel. Kobe Bryant, Klay Thompson, Kevin Durant, David Beckham, and Dwayne “The Rock” Johnson each ruptured their Achilles Tendon during their illustrious career. The athletes’ ruptured tendons did not kill them and each of them actually returned to their respective sports. This is a testament to modern surgical repair techniques and the surgeons who perform them, to the physical therapists who manage the rehabilitation of these large repairs, and to the fortitude of the athlete on the comeback trail.
The Achilles Tendon is the thickest and strongest tendon in the human body. It connects the gastrocnemius and soleus muscles of the calf to the back of the calcaneus or heel bone. Walking places significant stress on this tendon with every walking step. Running, squatting and jumping are even more strenuous.
Achilles Tendon ruptures are most common among male recreational athletes in their 30s and 40s. When the tendon ruptures, the muscle will furl up slightly, like a window shade and form a ball in the middle of the calf. Patients often report feeling like they were “shot or punched in the calf.”
Once while playing tennis with a good friend of mine, he spun around during a point and shouted “who just hit me in the leg with that ball?!?!?” It was a bizarre moment. There was no extra ball on the court and he couldn’t step with his left leg. I knew right away what had happened and told him to sit down. We carried him off the court and sure enough he had torn his achilles.
Following a rupture, an orthopedic surgeon will immobilize the patient in a cast or boot for several weeks, until most of the swelling goes down. Both surgical and non-surgical management have proven to be effective for long-term recovery following a rupture.
Following immobilization or repair, the patient should begin a structured physical therapy (PT) program. PT includes mobilization, reduction of swelling, pain management, gradual strengthening, gait and balance training, and other functional activities.
At the Telehealth PT Initial Evaluation, after taking a thorough history from the patient, the therapist will assess the lower leg and ankle. They’ll make observations and measure:
- The overall size, shape, color, temperature and skin integrity of the ankle region
- Ankle and leg Range of Motion (ROM)
- Leg Strength
- How the patient walks – probably with crutches or other assistive device
- The patient’s ability to perform activities of daily living (ADLs)
Taking that data, the PT will devise appropriate goals and a comprehensive plan to help the patient return to pre-injury form. Following an Achilles Tendon rupture, return to athletics usually requires 6-9 months depending on the severity of the injury and demands of the sport.
The treatment plan typically involves:
- ROM – first gentle, non-weight bearing and progressed to weight-bearing, and ultimately to aggressive stretching
- Strengthening – initially isometric which involves no movement and ultimately to concentric and eccentric strengthening exercises through the available ROM
- Progressive Weight Bearing activities – from non-weight bearing, to partial weight bearing, to full weight bearing, the objective is to gradually load the tendon without putting enough strain on it to interfere with healing. The Telehealth PT will always consider safety first when progressing weight bearing on the injured leg.
- Massage – utilized to reduce swelling and promote fresh blood flow in the lower leg area; in the telehealth setting, we train every patient to perform massage and soft tissue mobilization on their own. Techniques include using your hands, massage devices and a foam roller. It’s easier than you may think and it’s an extremely valuable skill.
- Functional activities – once a patient is safe to stand on their injured leg, we can introduce everyday activities, making them more challenging as tolerated; the benefit of Telehealth PT is practicing these activities in your own home with the assistance of your PT. Examples include getting up from a low sofa or bed, going up and down your stairs and maneuvering in tight spaces in your home.
- Athletic simulation – eventually an athlete will want to get back on the field or court and they should work on the elements of their sport in a controlled environment. We add progressively challenging activities to the program to ensure safety and increase game readiness. The PT and patient meet for Telehealth PT sessions in a home gym, outdoors or at a fitness center.
Overall, the prognosis following a ruptured Achilles Tendon is very good. Whether a surgical repair or non-surgical approach is taken, most patients fully recover within a year. Rehab takes a great deal of work on the part of the patient and the Telehealth PT. Working together, there’s a great chance of recovery and continued success.
If you’ve injured your Achilles Tendon and you require Physical Therapy, schedule an appointment here or call 917.268.4480