Exercise Program for Achilles Tendon Rupture

Components of a Program for Achilles Tendon Tear

If you have suffered an Achilles tendon rupture, then you know how painful and debilitating the injury can be. An Achilles tear can prevent you from walking normally and can limit your normal work and recreational activity.

You may benefit from physical therapy for an Achilles tendon rupture. The goals of PT after an Achilles tendon tear are to restore normal range of motion (ROM) and strength to your foot and ankle and to improve your overall pain-free functional mobility. Your therapist may use various modalities and exercises to help achieve those goals.

While treatments like heat, ice, or massage may feel good, exercises should be the main focus of your Achilles tendon rehab. Why? Because exercise gets things moving, and if done properly, they can safely get you back to your normal mobility and activity. Plus, exercise puts you in control and can have the long-term benefit of preventing future problems with your Achilles tendon.

So what does a PT exercise program for an Achilles tendon rupture look like? The basic components include gradually improving ROM in your foot an ankle, and then progressing strength and functional mobility until you are fully healed. Keep in mind that a sample exercise program may not be appropriate for your specific condition, so check in with your doctor before starting any exercise program for an Achilles tendon tear.

When to Start Exercise for An Achilles Tendon Rupture

One question that many patients have is: when is it safe to start exercising after an Achilles tendon rupture? Starting too early may increase your risk of re-injury, and waiting too long to get moving may make gaining ROM and strength difficult.

In general, you can expect to be immobilized initially after your Achilles tendon tear. Depending on the severity of your injury, you may be required to weak a CAM boot or removable cast for four to six weeks. During that time, you may take the boot off to start some of your Achilles rehab exercises. In general, physical therapy is started about four weeks after injury.

Keep in mind that you should stop any exercise that causes pain or swelling around your Achilles tendon. This may be a sign of overdoing it, and you may need to rest a bit before continuing.

1

Range of Motion Exercises

Photo of a physical therapist examining a patient's Achilles tendon
Jan-Otto / Getty Images

Exercises for an Achilles rupture usually starts with gentle range of motion exercises. These progress from ankles passive ROM to active ROM exercises. Exercises may include:

Motions should be done in a slow and controlled way. It should take you about three seconds to perform each motion, and you can do the exercises for 15 repetitions up to three times a day.

2

Flexibility Exercises

When you suffer an Achilles tear, scar tissue will form around the tendon as it is healing. This, coupled with a period of immobilization, can make the tendon (and surrounding muscles) feel tight. Flexibility exercises for your ankle and lower extremity can help stretch these tight muscles out and get things moving better. Gently pulling on the scar tissue that has formed along your injured Achilles can also help remodel that tissue and get it functioning normally.

Exercises to do to improve flexibility after an Achilles rupture may include:

Your physical therapist may also perform manual stretching for the muscles surrounding your ankle.

Each stretch should be held for 30 to 60 seconds, and five to 10 sets can be performed.

3

Progressive Ankle Strengthening

Once you have regained some ROM around your ankle, it may be time to improve the strength of the muscles there as well. By placing progressive stress through your Achilles with strengthening exercises, you may be able to bolster the tendon (and surrounding muscles) to improve your overall function. Strengthening can also help reduce the risk of future injuries to your Achilles tendon.

Exercises to strengthen your ankle and Achilles tendon may include:

Exercises can be done for 10 to 15 repetitions, and two to three sets may be done to fully challenge the muscles around your leg.

An advanced exercise to try once your Achilles tendon has sufficiently healed is the Alfredson Protocol. This program of eccentric strengthening of the gastroc and soleus muscles on a step has been shown to decrease the risk of future Achilles tendon problems.

4

Balance and Proprioception

After an Achilles tendon tear, your balance and proprioception may become impaired. This can occur as a result of the injury or due to the period of immobilization while your tendon was healing. Your physical therapist may have you work on specific exercises to improve your balance.

Exercises that can be done to improve balance and proprioception after an Achilles tendon rupture may include:

Working on balance requires you to find exercises and situations that challenge your balance. This may increase your risk of falling down, so make sure you remain safe while performing balance and proprioception exercises for your Achilles tendon rehab.

5

Plyometrics

If you are looking to return to high-level sports and recreational activities, your physical therapist may have you work on plyometrics as part of your Achilles tendon tear rehab program. Plyometrics are specific exercises that require you to quickly jump and land in specific—and safe—ways.

Plyometric exercises may include:

  • Hopping in place
  • Hopping over lines, first with two feet, and then with only your affected foot. Hopping can be done forward and backward and side to side.
  • Single leg jumping
  • Box jumping
  • Shuttle runs
  • Single leg hop in straight lines and diagonals 

You must remain safe while performing plyometric exercises. ​Jump and land properly with your feet shoulder width apart and do not allow your knees to buckle inwards or outwards while performing the exercises. These are advanced exercises, and if your Achilles tendon is not fully healed or ready for this kind of stress, you may risk getting re-injured. It's a good idea to visit your PT to ensure you do the right exercises for your specific situation.

6

Aerobic Conditioning and Getting Back to Normal

When you injure your Achilles tendon, you will likely face a period of a few weeks being immobile. This can have a detrimental effect on your aerobic capacity. Your PT may have you work on aerobic conditioning to counteract this deleterious effect.

Exercises that you may do to help improve aerobic capacity range from non-weight bearing with minimal or no impact to full weight bearing with some impact. A complete aerobic exercise progression may include:

To get maximal impact from aerobic exercise, you should try to exercise approximately 30 minutes each session at least five days per week. Your PT can tell you which exercises are best for you to be doing in the continuum of your healing process.

As your Achilles rehab program progresses, you may notice your ROM and strength improving, and you should also enjoy improved functional mobility. Walking and stair climbing should get easier, and when you are ready, you should be able to get back to pain-free running.

Keep in mind that everyone's Achilles injury and healing time are different. In general, you can expect to be back to normal about eight to 12 weeks after injury.

A Word From Verywell

An Achilles tendon tear or rupture can be a difficult injury to come back from. Working with a PT is a good idea to help you get back to normal. Your PT can show you which exercises to do—and when to do them—to fully recover. By doing the right exercises for your condition, you can quickly and safely get back to your normal lifestyle.

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Article Sources
  • Habets, B., & Cingel, R. E. H. (2015). Eccentric exercise training in chronic mid‐portion Achilles tendinopathy: A systematic review on different protocols. Scandinavian journal of medicine & science in sports25(1), 3-15. doi: 10.1111/sms.12208
  • Maffulli, N., Via, A. G., & Oliva, F. (2015). Chronic Achilles tendon disorders: tendinopathy and chronic rupture. Clinics in sports medicine34(4), 607-624. doi: 10.1016/j.csm.2015.06.010