Achilles tendonisis and Achilles rupture are frequent problems associated with Achilles tendon. Exercises for Achilles tendon are designed for rehabilitation of these conditions.
Exercises for Achilles Tendon Rehabilitation after Achilles Tendinosis
There are three phases of rehabilitation in Achilles tendinosis
- In first and earlier half of second phase of physical therapy active active ankle dorsiflexion with gentle calf stretching is performed. Pain is used to guide the intensity of exercise.
- In the late half of second phase strengthening exercises are initiated along with neuromuscular control programs are initiated
- In last and third phase of rehabilitation, progressive stress is applied. After pain is resolved, aggressive stretching and active exercises against resistant are performed. [Eccentric exercises]
The cornerstone of strengthening is the use of eccentric exercises, with most patients achieving 60-90% pain relief. As with stretching, strengthening should be done with the knee in both extension and flexion. Cross training with low-impact exercises can begin during this phase. If pain develops, the athlete should decrease the amount of activity to alleviate the pain.
Sidenote – Eccentric muscle contraction occurs when the force generated by muscle is not able to overcome the external load applied. Lowering a load gently is an eccentric muscle contraction.
Benefits of eccentric training are thought to be due to
- Effect of stretching
- Lengthening of the muscle-tendon unit
- Hypertrophy and increased tensile strength in the tendon
- Eccentric training also causes remodeling of the tendon.
The treatment aims at preserving good range of motion and strength in the tendon. Application of moist heat or compresses before workouts and at night is beneficial.
After strenuous activity, cold application is used for pain relief and inflammation reduction.
If the individual is pain free with low-impact activity, the athlete can begin sport-specific training. If pain develops as activity is escalated, the patient should decrease the level of activity to one that does not cause pain.
Care must be taken to not commit another training error if that is what initially caused the tendinosis. The patient should warm up the muscle-tendon unit well before engaging in vigorous activity, such as sprinting and jumping.
For Achilles tendinosis, towel stretches are initial exercises to begin with after acute phase has subsided. When towel stretches become easy, patient should move to other stretch exercise like standing calf stretch, soleus stretch, and plantar fascia stretch.
As the name indicates, towel stretches are done with help of towel and are generally done first before getting out of bed. With your injured leg stretched out in front of you, loop a towel around the ball of your foot and pull the towel toward your body, keeping your knee straight. The position is held for 30 seconds and the stretch is repeated repeat 3 times.
Standing Calf Stretch
Stand about 40 cm away from a wall and put your hands against the wall keeping them at the eye level. Bring the unaffected legin the front and keep the afffected one at the back with foot and heel firmly on the floor. The foot behind [affected leg] should be turned inward. Lean on the wall to stretch the calf muscles and hold for 30 seconds.
This should be repeated several times a day.
Standing Soleus Stretch
The positioning is similar to above but hands are kept at the chest level. Bend both the knees slightly [ affected limb is at the back and intoed and heel on floor]. Lean on to the wall to stretch the lower calf the wall until you feel a stretch in your lower calf and hold for 30 seconds
Repeat three times.
Plantar Fascia Stretch
With foot slightly toes out, stand on balls of affected foot with rest of the foot beyond the edge of step. Lower yourself so as to touch the bottom of step[foot goes into dorsflexion] with your heel to stretch in the arches and plantar fascia of foot. Hold for 30 seconds.
Standing in normal weight-bearing position lift up your toes off the ground while rocking back on your heels. Hold for 5 seconds and Repeat 10 times. Do three sets of 10.
In other method tha person sits on chair with knees bent at right angles and feet and heels flat on the floor. Keep the heel on the floor and lift the foot Lift your foot upwards, keeping your heel on the floor. Hold the position for a few seconds and then relax.
Stand behind a chair while holding the chair for balance and raise your toes. Hold for five seconds and then lower yourself down. Repeat 10 times and perform three sets.
Single Leg Balance
In this exercise, the person stands without any support and attempts to balance on injured leg. The exercise is first done with eyes open and then close. Hold the single-leg position for 30 seconds. Repeat 3 times.
Eccentric Exercise for Achilles Tendinosis
Stand on edge of 4-6 inch box [See video below]. The box can be slanted or with horizontal surface. Standing on both feet, raise up on to tiptoes. At this moement, transfer your weight across to your affected leg and lower yourself down. Perform 3 sets of 15 repetitions. The standing on tiptoe exercise can be performed with your knees straight and with your knees bent. Increase the speed, number of sets, and amount of weight as tolerated.
Eccentric training can also be done initially with thera-band exercises, This loops around the foot and active plantar flexion is done against resistance.
Here is a video that covers most of the discussed exercises and teaches how to use a band
Achilles Tendon Repair Rehabilitation
The exercise should be performed under supervision of expert and a continued assessment by the treating therapist which should guide the progress.
Following is a rough working protocol only and should be individualized from case to case
For first three weeks the foot is kept in plaster or adjustable boot locked out at 30° of plantar flexion non –weight bearing
Well-leg cycling and weight training may be done for cardiovascular conditioning
In next 3-8 weeks patient is allowed to bear weight gradually beginning with toe touch and progressing to full weigh bearing towards the end.
Walking orthosis is adjusted by reducing 5 degrees every week till 10 degrees of plantar flexion is left.
After 8 weeks shoe with with a lift in shoes may be worn. Pasisive stretch and range of motion exercises are begun.
The patient should wean into regular shoe over a period of 2-4 weeks.
Begin and gradually increase active/resistive exercises of the Achilles. Range of motion exercises should now cover almost full range of motion.
At 3 months heel lifts should be weaned off and exercises like controlled squats, bilateral calf raise, toe raises and eccentric exercises should begin. Cycling should be done.
Patient can progress to training jogging, jumping, and eccentric loading and sports specific exercises.
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