Early Functional Loading Post Achilles Rupture: A Step Towards Faster Recovery
Achilles tendon rupture is a common injury that can be debilitating and historically, it often required surgical intervention for proper healing. In the past, the recovery process for Achilles tendon ruptures involved prolonged immobilization in a cast or brace, followed by gradual return to weight-bearing activities. However, recent advancements in the field of orthopedic rehabilitation have led to a paradigm shift towards early functional loading, which has shown promising results in expediting recovery and improving patient outcomes. In this blog, we will explore the concept of early functional loading post Achilles rupture and its potential benefits.
Understanding Achilles Tendon Rupture
The Achilles tendon is the largest tendon in the human body, connecting the calf muscles to the heel bone. It plays a crucial role in walking, running and jumping. A rupture typically occurs as a result of a sudden forceful overstretch of the Achilles tendon, leading to a partial or complete tear of the tendon. It commonly occurs during a stepback motion in basketball and tennis or changing directions in soccer.
Historical Approach: Immobilization
Traditionally, the treatment approach for Achilles tendon rupture involved immobilization of the ankle in a cast or brace for an extended period, often up to 8-12 weeks. This method aimed to protect the injured tendon and allow it to heal gradually. However, it had several disadvantages:
Muscle Atrophy: Extended immobilization leads to significant muscle atrophy in the calf and thigh resulting in weakness and loss of function
Stiffness and Reduced Range of Motion: Immobilization could lead to joint stiffness and a decreased range of motion in the ankle and foot, making it challenging to regain normal function.
Delayed Rehabilitation: Prolonged immobilization delayed the start of rehabilitation, leading to slower recovery, a higher rate of re-ruptures and a higher risk of complications like blood clots.
The Emergence of Early Functional Loading
In recent years, orthopedic research has focused on finding more efficient and effective ways to treat Achilles tendon ruptures. Early functional loading, also known as accelerated rehabilitation, has gained popularity as a treatment approach. This method involves initiating controlled weight-bearing and early mobilization of the ankle within 3 weeks of the Achilles rupture or surgical repair.
Early functional loading following an Achilles rupture using a VACOped boot
Benefits of Early Functional Loading
Faster Recovery: Early functional loading promotes faster healing of the tendon and surrounding tissues. It stimulates blood flow to the injured area, which accelerates the natural healing process.
Reduced Muscle Atrophy: Weight-bearing activities and range of motion exercises help maintain muscle strength and reduce muscle atrophy during the recovery period.
Improved Range of Motion: Early mobilization helps preserve and improve the range of motion in the ankle joint, which is essential for normal function.
Lower Risk of Complications: Studies have shown that early functional loading may reduce the risk of complications such as deep vein thrombosis and joint stiffness.
Earlier Return to Normal Activities: Patients undergoing early functional loading often return to daily activities and sports sooner than those following traditional immobilization methods.
The Rehabilitation Process
Early functional loading post Achilles rupture involves a well-structured rehabilitation program under the guidance of a physical therapist and an orthopedic specialist. The process typically includes:
Controlled Weight-Bearing: Patients start with partial weight-bearing using crutches and a walking boot. Over time, they gradually increase the amount of weight they put on the injured leg.
Range of Motion Exercises: Gentle ankle exercises help improve flexibility and reduce stiffness. Initially, it is all performed with the foot pointed down to protect the Achilles tendon and avoid excessive stretch in the early stages.
Strength Training: Progressive strengthening exercises for the calf muscles and surrounding muscles are essential to regain full function.
Gait Training: Learning to walk properly again is a crucial part of rehabilitation.
Functional Activities: As the patient progresses, they will incorporate more functional activities and sports-specific exercises to prepare for a return to normal activities.
Are you curious about 416 Physio’s very own rehab protocol? Visit our Achilles Care page and download it for free!
Conclusion
Early functional loading post Achilles rupture represents a significant advancement in the treatment of this challenging injury. It offers patients the opportunity for faster recovery, reduced muscle atrophy, improved range of motion and a lower risk of complications. However, it's essential to consult with a healthcare professional to determine the most suitable treatment approach for each individual case. With the right guidance and rehabilitation plan, many patients can look forward to a full recovery and a return to their active lifestyles.
At 416 Physio, we have treated over 120 patients with Achilles ruptures in the past 2 years. Our team of physios, chiros and massage therapists are passionate about promoting and helping people recover from Achilles-related injuries. If you are interested in in-person or virtual care, even if it is just a one-off consultation, reach out to us.
Interesting readings on this topic:
Aufwerber S, Heijne A, Edman G, Silbernagel KG, Ackermann PW. Does Early Functional Mobilization Affect Long-Term Outcomes After an Achilles Tendon Rupture? A Randomized Clinical Trial. Orthop J Sports Med. 2020;8(3):2325967120906522. Published 2020 Mar 16. doi:10.1177/2325967120906522
Zellers JA, Christensen M, Kjær IL, Rathleff MS, Silbernagel KG. Defining Components of Early Functional Rehabilitation for Acute Achilles Tendon Rupture: A Systematic Review. Orthop J Sports Med. 2019;7(11):2325967119884071. Published 2019 Nov 25. doi:10.1177/2325967119884071
