Physical Therapy for Achilles Tendon Tear

Photo of a physical therapist examining a patient's Achilles tendon
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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 PT can assess your condition and provide you with treatments and exercises to help you fully recover. So what can you expect from physical therapy for an Achilles tendon tear?

Anatomy

Your Achilles tendon is the large tendon that runs down the back of your lower leg. It arises from two muscles in your calf called the gastrocnemius and the soleus. These muscles join at the midpoint of your lower leg to form the Achilles tendon. The tendon then attaches to the back of your heel bone.

Your calf muscles serve to point your ankle and foot away from you. When your foot is on the ground, it is your calf and Achilles tendon that help you rise up onto your toes. Since your calf muscle crosses the back of your knee joint, it also serves as a "force couple" with the hamstrings to help stabilize your knee.

How Tears Occur

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.

Your Achilles tendon usually ruptures about six centimeters up from its heel bone attachment. There is a zone of decreased circulation of the tendon causing it to be slightly weaker there. 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

If you suspect you have an Achilles tendon rupture, you must see your doctor 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 doctor to a diagnosis of Achilles tendon tear.

Thompson's test also can be helpful. To perform this test, your doctor 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. An MRI is usually done to confirm the diagnosis.

Your doctor 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 Achilles remain intact
  • Grade III: Your tendon is completely torn

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 doctor 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:

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.

Specific 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 Exercises

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:

At this early point in your rehab, motions should be slow and steady, and you may feel slight pain, ache, or pulling sensations in your Achilles and ankle as you exercise. Check in with your PT before starting exercise, and stop if you feel any worsening pain in your ankle.

Sub-acute Phase Exercises

After seven to ten days of healing, 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:

You can progress your strengthening exercises with more resistance using weights or resistance bands, and you may start using body weight exercises, like double-leg calf raises, to start to add a little more pressure to your healing Achilles tendon. Be sure to stop any exercise that causes lasting pain.

Chronic Phase Exercises

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:

The focus of these exercises is to help improve the loading tolerance of your Achilles tendon in a safe and progressive way. Your PT can be a guide so you know exactly how to progress with your rehab.

Modalities Used

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.
  • 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 what treatment you are getting and ask if the treatment is really necessary.

Timing

After an injury, normal tissue healing time is about six to eight weeks. Your tendon may heal more rapidly or more slowly depending on the nature of your injury and any co-morbidities you may have. Part of your rehab program should focus on determining when you can return to full function and learning to prevent future problems with your Achilles tendon. As a general rule, expect to be limited in some capacity for about eight weeks.

Surgery

Many people with a torn Achilles elect to have a surgical repair of the tendon. There is some question if it is absolutely necessary for the treatment of an Achilles rupture. Research indicates that the long-term outcomes of surgical versus non-surgical management of Achilles tendon tears are about the same. People who have surgery recover faster, but surgery also carries risk. Research also shows that the re-rupture rate is slightly higher in people who have not had surgical repair of the tendon. It is a good idea to discuss your options with your doctor to see which is best for you.

A Word From Verywell

If you have suffered an Achilles tendon tear, you may benefit from PT to help improve function and mobility. Your PT can show you what to do—and what to avoid—to help you quickly and safely get back to your normal activities.

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