Rehabilitation after suturing the Achilles tendon for its rupture

Why does the Achilles tendon rupture?

Such gaps are often observed in people involved in sports, especially beginners. In an effort to stand out, athletes sometimes neglect precautions.

For this reason, complete rupture of the ligaments is possible. The most common injuries are:

1. For runners. A sharp push at a low start can easily provoke such an injury. In this position, the tendon is exposed to exceptional danger, so you should be more careful and distribute the load correctly.
2. At the jumpers. The moment the foot lifts off the support surface is also a significant risk. In the present situation, the Achilles tendon is a “spring”, which, having pushed the body out, ruptures due to unbearable gravity.
3. When there is a sudden strong bending of the foot, for example, when falling on the heels. This often happens when diving into water. Therefore, it is necessary to be able to group correctly and visually assess the depth.

There is also the concept of partial rupture of the Achilles tendon. Real injury is possible when the ligaments are directly impacted by a piercing or cutting object.

Tensile Testing

The Achilles tendon does a great job of ensuring foot mobility. It connects to the calf muscle and is designed to absorb possible traumatic effects. Such impacts often occur when running or jumping, especially if a person is overweight.

Unable to withstand the load, the tendon may rupture completely or partially. The rupture is not only painful in itself, but also requires orthopedic treatment, as well as long rehabilitation after an Achilles tendon rupture to restore normal function of the foot.

If the gap is not visible to the eye, but there are suspicions, you should try to stand on your toes. Such an injury will not allow this to be done.

You can do the Achilles tendon rupture test yourself:

More clear image:

The rupture is also accompanied by swelling at the site of the ligaments, and sometimes there is hemorrhage.

Prevention of pain in the Achilles

Any Achilles injury requires treatment and a long recovery. Even with mild inflammation, doctors recommend not exercising and giving your leg a rest. To avoid a frustrating Achilles injury, follow these guidelines:

• Increase your running volumes gradually. It is widely believed that you can increase your mileage by no more than 10% per week.
• Always start speed workouts, uphill intervals, and tempo workouts with a warm-up.
• Wear comfortable, soft, stable casual shoes, especially if you work on your feet a lot. The heel should not be higher than 2-3 cm. For flat feet and other arch deformities, use orthopedic insoles.
• For training and long walks, choose suitable sports shoes. All major running shoe brands have models that offer arch support, good cushioning, and Achilles protection.
• Don't overload your legs. If you work standing, be sure to take breaks, let your legs rest and change the load. After work, do self-massage, roll out your muscles with a roller .
• Do exercises to strengthen your feet . They will help avoid injuries, especially during serious sports activities.

We recommend that you refrain from treating Achilles with kinesio taping. Its effectiveness has not been proven and is comparable to placebo. There are no studies showing that kinesio tape prevents injury, relieves pain, or improves performance. Running with a sore Achilles and kinesio tape will only make the situation worse. Read more in our article: Kinesio tapes: effective remedy or deception?

Rehabilitation methods

An Achilles tendon rupture can be treated conservatively, but if the rupture is complete, surgery may be necessary.

During the operation, the tendon is sutured with special non-absorbable materials. The method is the most effective and minimizes the risk of re-rupture.

In addition to the operating procedure, there is also a conservative method of treatment. This method involves long-term rehabilitation, excluding surgical intervention. There is no exact data on how long this may take. The result depends largely on the individual characteristics of the patient, patience and performance of all exercises.

Indications for a conservative technique are diabetes mellitus, cardiovascular and neurological diseases during exacerbation, inflammation of peripheral vessels.

However, regardless of the treatment method, there is a single recovery complex. Thus, the following are mandatory for an Achilles tendon rupture:

• exercise therapy,
• physiotherapy,
• walking exercises with crutches.

If there is a tear, it is enough to immobilize the leg with a plaster splint. Naturally, a person loses the ability to walk normally and has to use crutches or a cane, but at the initial stage, immobilization of the foot is a necessary condition for the tendon to heal. Wearing a cast for this injury is quite long - up to 10 weeks.

The rehabilitation program after an Achilles tendon rupture takes place in several stages, depending on the degree of healing of the injury.

The first stage, while the leg is still in a cast, does not involve active physical exercise and is aimed at improving blood circulation in the injured limb and preventing swelling. During this period, light exercise and massage are indicated.

After removing the cast, careful restoration of joint mobility begins. If you are overweight, it is extremely important to lose at least a little to reduce the load on your leg.

During this period, you need to start walking, about 20-25 minutes a day, and continue to massage to prevent swelling. You can contact a qualified chiropractor.

When the walking speed is already about six kilometers per hour, you can move on to slow running and exercises for multi-plane movement of the foot.

Achilles injuries and diseases

A sick Achilles has several conditions: tendonitis, tendinosis, partial or complete rupture, separation from the heel bone.

Tendonitis is inflammation of a tendon resulting from overuse. It is important not to start this problem, but to immediately reduce the load and wait for recovery. Advanced tendonitis is much more difficult to cure, and you will have to give up training for a couple of months.

Tendinosis is a wasting of the tendon that occurs due to frequent inflammation without repair. Recurrent tendonitis progresses to chronic tendinosis. The tendon fibers become depleted and tear. Thick, inelastic fibers form at the site of microtrauma. Therefore, the tendon with tendinosis thickens and becomes less strong. Most often, tendinosis requires surgery.

ruptures and avulsions are accompanied by sharp sharp pain and a clicking sound, followed by swelling and redness. After such an injury it is impossible to step on your foot. Contact your doctor right away - you will most likely need surgery. Achilles recovery can take 6-12 months.

The treatment for all problems is different, so first you should consult a doctor and make a correct diagnosis - this, as you know, is half the treatment. For tendinitis, it is necessary to relieve inflammation, for example, with diclofenac, and apply cold. Tendinosis is often treated with surgery. Recent research has shown that tendinosis can be treated without surgery using Achilles stretching exercises.

Read: Why the Achilles hurts: diagnoses, causes, treatment .

Photo: healthdirect.gov.au

What are the consequences of refusing rehabilitation?

Failure to rehabilitate after Achilles tendon surgery can lead to a number of serious consequences.

This may be a contracture of the joint, that is, a significant restriction of the mobility of the foot, which will lead to a change in gait.

Many people who hoped that the injury would “heal on its own” cannot restore the mobility of the injured joint for the rest of their lives. Complications are possible in the form of muscle atrophy, the occurrence of adhesions at the site of rupture.

One of the most serious consequences can be deep vein thrombosis, the complications of which are life-threatening.

Exercise therapy for tendon rupture

Exercises in the exercise therapy room should begin immediately after the cast is removed from the injured leg.

Important

! It is necessary to be extremely careful about the complex, and not to do excessive exercises! This may lead to injury or re-rupture. For the first 2 weeks, you should exercise exclusively while sitting or lying down, avoiding direct pressure on the sore leg.

The main thing is to perform the exercises gradually, under the supervision of medical personnel. The attending physician himself prescribes the sequence of classes.

So, in the first two weeks the load is aimed at flexion/extension of the foot, in the third week it is recommended to start walking with the help of crutches, then exercises in the pool, squats. With an operative treatment method, after 2-2.5 months the patient will be able to move freely without support for a long time.

Exercise sets

The physical therapy complex serves for the speedy restoration of damaged ligaments. The required load depends solely on the location of the injury. Thus, if the Achilles tendon ruptures, at the initial stage of rehabilitation it is recommended to perform the following exercises in the exercise therapy room:

Sets of exercises during rehabilitation after an Achilles tendon rupture can be different, depending on the period of time that has passed since the operation.

Complex No. 1

The first complex is the most gentle and is used in the first month and a half after injury.

You can start doing exercises one week after surgery or plaster casting. Since the plaster seriously restricts movement, this complex is aimed primarily at increasing blood circulation in the affected limb.

All exercises are done sitting or lying down, without much strain and without causing pain.

1. Flexion and extension of the toes in a sitting position.
2. Lie on your back, legs raised and knees bent, imitating riding a bicycle.
3. Lie on your stomach, bend your knees, as if throwing them back, alternately.
4. Lie on your back, legs straight, try to raise your pelvis, resting on your shoulder blades and heels.
5. Sitting on a chair, press the sole onto the cast without much strain.

Each exercise is performed no longer than 3 minutes .

Complex No. 2

The second complex is designed for a period of one and a half to three and a half months after surgery. It should be started after the plaster has been removed.

During this period, the best exercise is careful walking. To protect the injured leg from repeated damage, you can make a heel pad in shoes made of soft materials - felt or felt.

The thickness of the lining can be varied, but not less than one and not more than four centimeters. You need to walk slowly and carefully, especially in winter. The length of the step should initially be no more than the length of the foot; subsequently, the length of the step can be gradually increased.

At home, you can build yourself a kind of exercise machine from objects that resemble a paperweight or a foot-operated sewing machine pedal. Rocking the foot with support on such objects stretches the tendon well without injuring it. Naturally, this exercise is performed in a sitting position. To the exercises from the first complex we add the following:

1. Sit on a chair, feet on the floor. First, carefully raise your heels with support on your toes, then rest your entire foot on the floor. Raise your toes with support on your heels and return to the starting position again.
2. When the previous exercise is easy, introduce a load. Sit on a chair, feet flat on the floor, place dumbbells weighing up to 5 kg on your hips. Raise your heels, overcoming the weight.
3. Sit on a chair placed in front of a wall, raise your leg and rest against the wall, with a little tension. Perform alternately with the healthy and injured leg.
4. Gradually begin to stand on your toes, raising your heels.

Examples of possible exercises

Complex No. 3

The third complex is performed in the pool when at least two months have passed since the operation. In water, body weight decreases, so movements can be performed with greater amplitude. The main exercises of this complex:

1. Perform side lunges in the water while holding the handrail.
2. While standing in the water, perform calf raises.
3. Walking in water on toes.
4. Walking with a roll from toe to heel and vice versa.
5. Swimming.

Complex No. 4

The fourth complex can be described as restorative; it is performed 3.5-4 months after the injury and is aimed at normalizing the mobility of the foot to the same extent as before the injury.

During this period, the loads are close to sports, so you should switch to it only when the previous sets of exercises are given without difficulty.

The complex includes:

1. Walking on a treadmill, normal and backwards.
2. Lifting onto a stepper (initially holding onto a support when lifting onto the injured leg).
3. Jumping rope with support alternately on the healthy and injured leg.
4. Squats, holding a support, foot completely on the floor.

Additional exercises

Sitting:

• strain your toes, forming a “fist”;
• lift your toes first, then your heels;
• roll the load from heel to toe and back;
• perform rotational movements with the foot.

standing:

• without lifting your fingers from the surface, walking in place;
• holding onto the support, roll from heel to toe;
• squats on toes;
• full foot squats.

Possible exercises:

Later, the complex is supplemented with an exercise bike, exercises with weights, a treadmill with walking backwards, and exercises on a stepper. On our website in the near future you will be able to watch a video of exercise therapy after an Achilles tendon rupture. After consulting with your doctor, you can independently build an individual program based on these videos.

The impossible is possible. Or how to come back after an Achilles tendon rupture

This article was written by someone who knows everything about sports injuries. Will Carroll, a columnist for SI.com, ESPN, has been writing about sports injuries for 12 years. He is not a doctor or TV presenter. He's just a columnist who spends a lot of time around sports injury specialists. And in this article he describes all the stages of Kobe Bryant’s recovery.

Kobe Bryant tore the Achilles tendon in his left leg Friday night and immediately found himself on the surgeon's table a day later. It is very good that measures were taken immediately. However, surgery is only the beginning.

Many NBA fans are questioning Bryant's return to the floor. They wonder if he can recover in 6-12 months. They doubt whether he can return to his previous level. Bryant himself clearly explained to all doubters.

While the media and fans chatter about whether he will return or not, surgery and medicine take a backseat. But in vain. All medical aspects are carefully hidden from prying eyes. And few people know about real restoration. However, this stage is the most important. It all depends on three factors: the athlete, the progress of rehabilitation and luck.

For once, professional athletes are having an easier time recovering from injuries. They are in excellent physical shape, have good muscle tone and an unquestioned work ethic. A player like Bryant is undoubtedly the most disciplined player in terms of physical conditioning. He works hard. He always had to keep his knees normal and not let them slide. After all, if you stop following them, you can immediately pay for it. This is a big plus.

All information regarding repair is taken from the standard post-surgical protocol for Achilles tendon rupture created at the University of Missouri. Of course, there is no absolute guarantee that Bryant will participate in this particular program, but it will give you a general idea of ​​​​how the rehabilitation process will go.

I also spoke with several doctors and athletic trainers, including Dr. Bob Baraverian of St. John's Health in Santa Monica, California, who explained the recovery process.

Surgery.

There are three scenarios for how the Achilles tendon was repaired. We don't know exactly what "type of repair" Dr. Neil Elattritch and Dr. Steve Lombardo performed on Kobe Bryant on Saturday, but the recovery process will still be roughly the same.

The essence of the operation is to return the Achilles tendon to its proper shape. The ideal thing is to return it to the same length it was before the injury. But often there is some damage that needs to be removed.

The first type, and the most common, is the “medium gap.” In this type of rupture, the tendon is separated in half. The surgeon must be able to prepare the tendon by removing any fray or other damage from the wound itself and then suturing the two ends together. A special type of seam is used. The suture itself will dissolve into the body in about six weeks, allowing the body to repair the tendon itself.

(To watch how this happens, click here. Warning: The video will contain the operation process)

The second type is a tear far from the muscle. When this occurs, the tendon remains largely intact, but the tear is located far from the calf muscle. The surgery itself is difficult due to the high pressure on the area and the difficulty in connecting the tendon to the muscle. If you're curious why this is so difficult, try cutting a raw steak and then sewing it together.

And the last type - the gap is located far from the heel. This is a simple operation because the tendon is not damaged. The surgeon simply needs to reattach the tendon using a pin or screw. And make sure that everything is holding well and is again of normal length.

Dr. Bob Baraverian, a leading foot and ankle injury doctor who has written a book on surgery for sports-related foot and tendon injuries, called this procedure one of the simplest. “The tendon is huge compared to other parts. There is a large “springboard” for work. “Lots of material,” he told me. “There are some tricks to suturing, but it’s all simple.”

Dr. Baraverian explained that there are new techniques that are being used in modern medicine. He didn't know if they were used on Bryant, but there was a possibility they were.

The first is the increasingly popular use of PRP (platelet-rich plasma). PRP could be injected into and around the tendon to reduce scarring and speed up the healing process. (Dr. Elattreich said that they have already used this technology. Zack Greink injured his elbow in the spring.)

Another technique is to use a membrane around the tendon. A product such as Graftjacket could be placed around the tendon to lengthen it. Another similar product is called AmnioFix, which has some interesting healing properties due to its unique structure.

In general, this is a simple and general surgery that bears fruit.

Stage 1: Healing

It is often said that “successful surgery” is defined by two things: 1) the surgeon did what he wanted to do when he walked into the operating room, and 2) the patient woke up from the anesthesia. As with most cases, Bryant's surgery was successful and the hard work of recovery begins immediately.

You cannot perform active activities for 4-6 weeks. The scars from the operation should tighten and heal

As I said, the body itself will absorb the special stitches and the Achilles will fall into place.

The tendon is protected by a special clamp. Which prevents the leg from “falling off” and fixes the ankle. During this stage of recovery, it is very important to move as little as possible. Because there is a possibility that the entire operation will be ruined. That is, a rupture may occur again.

The main problem is that the tendon itself will not lengthen to the place where the sutures were placed.

If the tendon lengthens during recovery, it will act like old sweatpants, stretching but not producing results. In this case, Bryant's athletic performance such as jumping and acceleration will be completely lost.

Exercises at this stage will need to be given great attention. The frequency of repetitions should be increased, as a result of which you will make a “pump” from your body that will pump blood to the place where the operation was performed. After a week, Bryant will be able to begin cardio-only exercises, such as cycling, and may begin to slowly do step-by-step exercises.

Of course, specialists will monitor him. And check the strength of his leg every week. Check the condition of the tendon after 1, 2, 6 weeks. And the final phase of testing can be postponed to a later date if any complications occur: there will not be sufficient strength, the wound healing process will be delayed.

Dr. Baraverian explained that at this early stage, Bryant needs to stay in shape. There are many exercises where you don't need to use your legs, such as a special exercise bike for your arms. In addition, he will be able to watch the matches of both his team and someone else’s from the outside.

Another key point in the early stages of rehabilitation is monitoring the site where the operation was performed. That is, protect from infection. College football fans will attest to what happened to Rob Gronowski. Infection can delay recovery processes for months and can even be life-threatening.

Stage 2: Movement.

The wound healing progress is complete. The tendon is back in place and now we need to give it strength. This must be done slowly, carefully, according to Missouri protocol.

Bryant's "boot" will be removed, but a special platform will be inserted into his shoe to prevent him from flexing the tendon. The main thing at this stage is not to bend the tendon, as it is still too weak for this.

At this stage, Bryant will be doing leg exercises. Will strengthen the calf muscles and muscles of the lower leg, ankle and leg.

He will also be able to work hard on cardio equipment, focusing on the "elliptical trainer" or stationary bike. (The bicycle must be such that it is impossible to bend)

Bryant will not be able to participate in any basketball practices, but will be able to watch tapes of games with the team. The downside is that it will be the summer when the team gets time off. And Bryant will have to test his moral fortitude, because he will have to work alone.

This stage usually lasts 10 weeks. It is during this period of time that it will be possible to say approximately when Bryant will return to the floor. Due to this news, the team will select free agents and players in the draft. If Bryant stays ahead of schedule, that's a good sign.

At this point, the main milestone for Bryant will be...

. If he can do that before the NBA Draft, that would be great.

Stage 3: Full Range of Motion

After the 10-week mark, Bryant is scheduled to begin flexion, according to protocol. This final phase of movement recovery exercises is one of the most dangerous parts of rehabilitation. The problem is that the tendon will be greatly elongated.

An overextended tendon does not have the same strength as the tendon before the injury or the tendon on the other leg. This leads to an imbalance that causes many problems. Kobe's every step will be checked regularly, as any type of limp may be overextended.

This stage of recovery is long, but also the most important. Since the tendon is holding up well, you need to focus on its complete recovery, strength, and maximum similarity to the tendon on the other leg.

Bryant still won't be able to do any physical activity. But he will work hard on his cardio. Will perform specific exercises such as using an Alter-G treadmill or Swimex that will help restore that sense of movement that was lost during the injury

This stage is very difficult for an athlete. He feels fine, but still cannot perform basketball activities.

Typically, this phase takes approximately 4 months. It is the longest and most important. But the time frame could be shortened because the patient is Kobe Bryant, a man who knows his body better than anyone. An athlete who is always in excellent physical shape. There is no milestone at the end of this stage. Bryant is simply placed on isokinetic testing, which should show that the injured leg is identical to the healthy one.

Once Bryant gets through this phase, he will be able to start running and will be very close to his return.

Stage 4: Strength and Skill Development

The final phase of therapeutic recovery focuses on strength. The previous phases were to return the tendon to its normal state. This stage is about getting him back to the strength he needs to play basketball.

Doctors will already begin to strengthen the muscles around the “surgical area”. He will also start lifting weights.

At this stage he will do some running exercises. Transverse movements are one of the biggest aggressors to tendon repair. It is by performing these exercises that the tendon is tested to see whether it can withstand the load. And will it be able to act as a “brake” when moving?

This is a very joyful period for an athlete. After all, you can finally go out on the floor and start “throwing” training. It is during this period, when heavy loads cannot yet be given, that players improve their throwing skills, but this is also a dangerous period. Once on the floor, an athlete can forget about everything and get injured. Therefore, he must take care of himself. Plus, to all this, it will have a special fixing mount.

This phase may pass faster because Bryant is the patient. The milestone is the “jumpshot”. Once Bryant can easily perform this move, he is ready to move on.

Stage 5: Return to full training

This is the final part of the Missouri rehabilitation protocol. At this stage, concepts such as “return to basketball activity” are introduced. Bryant will be able to lift weights using his tendon. But it still cannot be said that he is “normal.”

At this stage he will become accustomed to the way the leg now functions. It would be ideal if the athlete did not feel any difference, or the leg would function approximately the same as a healthy one.

Instead of just throwing training, he will be able to take part in games, train, and do full running and jumping drills. The jump is “introduced” gradually, at this stage Bryant is still being monitored by specialists.

He is close to true functional activity, but he will not be allowed to "get into the game" until he passes all medical and physical tests.

Key Milestone - Bryant can easily take jump shots and is ready for contact. For example, he will have to balance under strong shocks. At this stage, the tendon may begin to swell, but as the athlete increases the load, this, on the contrary, makes it clear that rehabilitation is going well.

Stage 6: Return to the Game

While typical rehab calls for recovery within 8-10 months, the Lakers believe Bryant will recover in 6-9 months. Dr. Baraverian believes Bryant can return even sooner.

“Five months,” he told me. “I wouldn’t be surprised to see him early in the season, although his minutes will be limited.”

Bryant will have to adjust his footwork. Dr. Baravarian believes Bryant may need to make changes to his deflection throw.

“Just think about that throw,” he said. - He turns around and takes off. He has to have crazy body control to throw with a deflection and then land cleanly. As a result of this injury, Kobe will have to change his game a bit. Adapt to the “new body”.

HIS deflection throw could be the final milestone in the recovery phase. If he does it, then the “old” Kobe is back.

Bottom line.

The rehabilitation program will obviously be different. It will be observed by the best specialists in the country. Who will take care of returning it to its previous state.

If Kobe returns early, I wouldn't be surprised. Dr. Baraverian agreed, stating that returning after 5 months would not be a shock. “I assume he will be back by the start of the season. Naturally, his minutes will be reduced, but he will still be ready by the start of the season...” he said.

Bryant is ready for recovery procedures. And he put all the doubters in their place.

Kobe Bryant ‏@kobebryant

This is what my friend/agent sends me this am. Shiesh! #kobe #motivationsunday I'm keeping track of…https://instagram.com/p/YF9wLsxNua/

I'm not one to doubt Kobe. On the contrary, I think that he will return to the beginning of the season in excellent shape. This is a situation very similar to what we saw with Mariano Rivera. Bryant wants to come back, he still has something to prove. The surgery and recovery will be long and difficult, but it will give him another chance. A chance to return.

Source Here

Rules for massage

Physical therapy exercises after an Achilles tendon rupture must be accompanied by either self-massage or seeking help from specialists. For self-massage, you will need to slowly rub your shin with your hands using smooth movements. Next, you need to place the ball under your foot and roll it with light circular movements until warmth appears.

The first weeks of rehabilitation are especially difficult. Patients often complain of swelling. To get rid of it, a professional massage is prescribed. It helps disperse blood and lymph, helps cope with tumors. Massage is performed using several methods:

• soft bilateral kneading with two hands;
• light stroking;
• circular impact with the pad of the thumb;
• by mechanical vibration.

Important

! The procedure must be carried out from the bottom up. Movements should be smooth and not cause sharp pain or discomfort. If necessary, it is recommended to use special massage oil.

Complications after surgery

Following surgery for an Achilles tendon rupture, the following complications may occur:

• Rough painful scars as a result of insufficiently good surgical technique or a poorly conducted postoperative period. They can also occur when the tendon ruptures again. This can lead to limited joint movements, constant pain, and disruption of the normal walking process.
• Recurrent rupture can occur due to a violation of the postoperative regimen or due to excessive stress on the injured leg. This complication requires a repeat operation, the rehabilitation process after which is more complex and lengthy.
• Damage to the sural nerve, manifested by numbness along the edge of the foot. This complication does not cause much discomfort or pain.
• Neuroma of the foot is a benign neoplasm that can be treated quite well with medication. The discomfort that this disease causes can be eliminated with comfortable shoes and special pads.

If you follow your doctor’s recommendations in the postoperative and rehabilitation periods, you can avoid complications after an Achilles tendon rupture and return to your normal active lifestyle.