Physical Therapy Tools for Achilles Tendon Tear

If you have had an Achilles tendon tear, then you know how painful the injury can be. An Achilles tendon rupture can limit your ability to walk, run, climb stairs, and participate fully in normal work and recreational activities.

You may benefit from participating in physical therapy if you have an Achilles tendon tear. Your physical therapist (PT) can assess your condition and provide you with treatments and exercises to help you fully recover.

Symptoms

An Achilles tendon tear usually occurs as a result of sudden trauma to your foot and ankle. If you jump up and land suddenly, step into a hole, or run and then perform rapid starts and stops (such as cutting maneuvers in sports), you may rupture the tendon.

If you tear your Achilles, you typically hear a pop in your lower leg and then experience several symptoms. These symptoms of an Achilles tear include:

• Pain in your lower leg
• Swelling in your leg and calf
• Bruising or discoloration in your lower leg
• Difficulty walking or bearing weight on your leg
• Inability to actively point your toes and ankle

Diagnosis

If you suspect you have an Achilles tendon rupture, you must see your healthcare provider right away. He or she can assess your condition and determine the nature of your injury. Diagnosis is made by clinical examination. Your description of your injury and clinical tests can lead your practitioner to a diagnosis of Achilles tendon tear.

A Thompson's test can aid in the diagnosis. To perform this test, your healthcare provider will have you lie on your stomach with your ankles and toes hanging freely off the edge of a bed. A gentle squeeze of your calf is applied. If no motion occurs at your ankle, an Achilles tear is suspected.

Your healthcare provider can make treatment recommendations depending on the severity of your Achilles tendon tear. There are three grades of tendon rupture. These are:

• Grade I: Your tendon is slightly overstretched.
• Grade II: Your tendon is partially torn, but some fibers of the tendon remain intact.
• Grade III: Your tendon is completely severed.

You may be required to have your lower leg immobilized in a cast or removable walking boot initially after your Achilles injury. This allows time for the tendon to start healing. You may be required to walk with crutches during this time as well.

After about two to four weeks of immobilization, your healthcare provider may prescribe physical therapy to help you regain normal function and mobility.

Physical Therapy

Your first appointment with an outpatient physical therapist for your Achilles tendon tear is called an initial evaluation. During this appointment, your PT will ask you questions about the nature of your injury, how your injury affects your normal activity, and how your symptoms are behaving and changing.

Your past medical history will also be reviewed. Your PT will then collect information about your condition by performing various tests and measures. Measurements taken during the initial evaluation for Achilles tendon rupture may include:

• Palpation
• Range of motion
• Strength
• Gait analysis
• Functional analysis
• Swelling measurements
• Balance and proprioception

When your PT has gathered data about your current condition, he or she can then put together a comprehensive treatment plan. This may include a variety of treatments or modalities and exercises.

Exercises

Exercises for an Achilles tendon tear should be one of the main things you do to rehab the injury. Various types of exercises may be used at different points in the healing process. Exercises are designed to restore normal range of motion, strength, and function around your ankle and leg.

Exercises may also be used to help you return to normal activity and to prevent future problems with your Achilles tendon.

Acute Phase

During the initial, or acute phase of healing after an Achilles tendon tear, your exercises should focus on restoring normal active and passive range of motion to your ankle. Exercises may include:

• Ankle pumps
• Ankle active range of motion
• Gentle resistance exercises with a light resistance band

Sub-Acute Phase

The number of days it will take to heal depends upon the degree of your tear; once healing has reached a certain point, you can start performing sub-acute phase exercises for your Achilles tendon. These exercises are slightly more aggressive while still protecting your healing tendon. Exercises may include:

• Achilles tendon stretching (such as a towel calf stretch)
• Ankle and lower extremity strengthening exercises
• Beginner balance and proprioception exercises
• Endurance and aerobic exercise

You can progressively include resistance training exercises, incorporating weights or resistance bands.

Chronic Phase

After three to four weeks of healing, your rehab progress will move into the chronic phase. This means you can start placing more and more stress on your healing tendon, and you can start thinking about incorporating injury prevention exercises into your routine. Exercises during the next four weeks should include:

• Dynamic balance and proprioception exercises
• Plyometric progression (including single-leg hopping)
• Alfredson protocol calf strengthening

Surgery

Many people with a torn Achilles tendon will elect to undergo surgery to repair the tear. It can involve one large incision (open surgery) or numerous smaller incisions (percutaneous surgery). The surgery itself only takes 30 minutes to an hour, after which you will be placed in a knee-to-toe cast with to keep your foot in a pointed position.

As beneficial an Achilles surgery may be, there is some question as to whether surgery is absolutely necessary in all cases.

In the end, both immobilization and surgery are often successful in healing a ruptured tendon. To make the appropriate choice, work with your orthopedic surgeon to weigh the benefits and risks of surgery base on your individual needs and goals.

Adjuvant Therapies

Some physical therapists use physical modalities to augment a rehab program for Achilles tendon tears. These modalities may include:

• Ultrasound: Ultrasound is a deep heating treatment that helps to improve circulation. Some PTs feel this can help improve tissue extensibility and healing.
• Electrical stimulation: E-stim may be used to help control pain and improve muscular function.
• Heat: Superficial heat may be applied to your Achilles tendon or calf to ease pain and spasm or to improve tissue extensibility prior to stretching.
• Ice: Cold packs and ice are used to control inflammation and decrease pain.
• Low-level laser: Laser therapy has been purported to speed the inflammatory process and improve healing time.
• Assisted massage: Massage is used to improve tissue mobility and extensibility prior to stretching.
• Kinesiology taping: Kinesiology tape is sometimes applied to your calf or Achilles to improve muscle function or decrease pain and spasm.

Keep in mind that the application of modalities is passive; you do nothing while your PT applies the treatment. Also, there is a significant body of research that indicates that some physical modalities—like electrical stimulation and ultrasound—add very little to your Achilles rehab.

So, it is important to understand the treatment recommendations and to ask if they if (and why) they are absolutely necessary.