Three trials compared the combination of full weight bearing and early ankle mobilization to immobilization. Goals: Achilles Tendon Repair Rehabilitation Protocol, North Fork Orthopaedic and Sports Medicine, Lower Extremity Fracture Care Post-Op Instructions. plantar grade only. Post-op weeks 3-4: boot at 10 degrees, sleep in boot, TTWB with crutches. and transmitted securely. Zhang Z, Li Y, Zhang T, Shi M, Song X, Yang S, Liu H, Zhang M, Cui Q, Li Z. 2014. % <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 594.96 842.04] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Squat and lunge to 70 degrees knee flexion without weight shift. Achilles tendon rupture is a clinical diagnosis. Effect of Transdermal Fentanyl Patch Combined with Enhanced Recovery after Surgery on the Curative Effect and Analgesic Effect of Liver Cancer. Open navigation menu. Splint/Boot: Locked 20-30 degree plantarflexion for two weeks movements (not past plantar grade). Everything went well, had the staples removed yesterday. 2016 Jun;24(6):1852-9. doi: 10.1007/s00167-014-3180-5. weight high load ankle, knee, hip s% i5iYd}mYSz;0Wj|*:2aO5ZmJeNWhqLx* EUgm"5l94`0;C1B]@-yH?0{2ER'fL-j6U,@tyS]?sZn|(E31-*=} The Alfredson Protocol is an exercise program for people with Achilles tendonitis ( tendinopathy ). Accessibility Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. ':IU""e"E/JT?|OW:_Yn]n7buq}].moS_7xbU]}\o/|`ND^QTK/EnTYJ=U6~U1 228 0 obj <>stream 2022 Oct 26;7(10):680-691. doi: 10.1530/EOR-22-0072. bearing Level of evidence: Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. Ankle range of motion (ROM) respecting precautions. eCollection 2022. Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? independently). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair. . Cardiovascular: stationary bike, StairMaster, swimming. Close suggestions Search Search. Non-Operative Treatment of Achilles Tendon Rupture Post-Operative Protocol Accelerated Rehabilitation Program: Weeks 1-2: Short leg fiberglass cast with ankle in plantarflexion of ~20 degrees Non-weight bearing with crutches for ambulation assistance Weeks 2-6: Transition to CAM walking boot with 6 heel lifts endobj 1,2 These reviews and other systematic reviews consistently show a slightly lower incidence of re-rupture with operative treatment, which is . stream We performed a systematic literature search in Medline, Embase and Cochrane library. This combination was most beneficial. basketball, tennis shots from standing start, contralateral Touch weight Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. We performed a systematic literature search in Medline, Embase and Cochrane library. Surgical and non-surgical treatment of Achilles Tendon rupture. [PubMed: 25059505]. Cardiovascular: replicate sport/work-specific energy demands. Biomed Res Int. No tackling, sudden unexpected change Wr5)Z nK!e*~[~[)$WoU]sMHUoUbmJ9yOJ}` The mean changes in the Achilles' tendon Total Rupture Score were 17.0 points in the nonoperative group, 16.0 points in the open-repair group, and 14.7 points in the minimally invasive . Unable to load your collection due to an error, Unable to load your delegates due to an error. We mostly see ruptures of the Achilles tendon in high-impact sports predominantly in the male athlete. endobj A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles ACHILLES TENDON RUPTURE ACCELERATED REHAB PROTOCOL - Fowler Kennedy Sport Medicine. Epub 2017 Jan 17. 8600 Rockville Pike Normalize gait on level surfaces without boot or heel lift. ,8vue6Tq]6u06glk+zBE)wY4DNmJM4Y >I>UB5|g`dd?#ap_N#r*cCQm5&tcH_~vw~DXOI)J,!u The Thompson Test should be applied in all suspected cases Remember to brace or splint a rupture, even if suspected, in the resting equinus position for optimal healing and prevention of further injury Careers. -, Am J Sports Med. For best outcomes, the Achilles tendon repair is typically performed within 2 weeks of the injury and recovery is expected to take between 6 to 9 months. This was the standard procedure (long back of the leg incision vs newer technique with a shorter cut and a heel incision). 24 staples. 1 This is called "eccentric loading." If you have Achilles tendonitis, walking and running can be painful. J Bone Joint Surg Am. Procedure: Conservative Management of Tendo-Achilles Rupture - Accelerated 8-week protocol Indications for Procedure: Tendo-Achilles Rupture Expected Length of Stay: n/a Surgeons: All orthopaedic trauma surgeons Scope of Practice These guidelines are designed to guide physiotherapists when treating patients following conservative management . Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. <> Consequently, physicians may have reservations about adopting functional rehabilitation. Detailed Description: In addition, surgical repair involves, but is not limited to, an increased risk of infection, adhesions and disturbed skin sensibility with a pooled relative risk of 10.6 (95% CI; 4.8;23.3) as . This article describes a high-quality accelerated functional rehabilitation program that begins with early diagnosis and appropriate patient selection to allow initiation of the nonoperative protocol. Dynamic neuromuscular control with multi-plane activities, without pain or swelling. Achilles Rupture Non-operative Protocol Page 3 of 3 Last Updated September 3, 2020 REFERENCES: 1. The site is secure. %PDF-1.5 Surgery is only the beginning of a long rehabilitation period. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. 1 0 obj <>>> Active ankle eversion/inversion. 3 0 obj 1995 Jan;98 (1):21-32 -, Am J Sports Med. HHS Vulnerability Disclosure, Help The American journal of sports medicine. The Achilles Tendon is the strong fibrous band that attaches the calf muscles to the calcaneus bone. After the Achilles tendon rupture repaired , patients were randomly divided into 2 groups, and the rehabilitation protocol was traditional rehabilitation protocol and accelerated rehabilitation protocol under ultrasonic monitoring , respectively, to study the difference in efficacy between the groups. He was able to ambulate without assistive devices at the 5-week follow-up examination. % ACHILLES RUPTURE: OPERATIVE PROTOCOL In this surgery, the torn ends of the tendon are sewn together with strong suture. An objective assessment of surgical and non-surgical treatment. A LOCATION OF STONY BROOK ORTHOPAEDIC ASSOCIATES. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0 should be applied. Achilles tendon rupture; Ankle mobilization; Evidence-based; Functional treatment; Immobilization; Rehabilitation; Surgical repair; Treatment protocol; Weight bearing. Achilles tendon repair is performed after injury occurs to the Achilles tendon. -. Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. 2017 Mar;137(3):333-340. doi: 10.1007/s00402-017-2627-9. FOIA The best approach varies for each individual. MeSH <> without in air contact Achilles Tendon Rupture - Non-operative treatment rehabilitation guidelines 0-2 WEEKS REST (PHASE 1) Goals Rest, recovery and mobilise non-weight bearing safely on crutches Immobilisation Plaster cast/Rigid boot with foot pointing downwards 20 (with 3 wedges inside - 22/16/10, more if needed) Tripping, falling or twisting your ankle can also cause an Achilles tear. Brumann M, Baumbach SF, Mutschler W, Polzer H. Accelerated rehabilitation following Achilles tendon repair after acute rupture-development of an evidence-based treatment protocol. Rehabilitation following operative treatment of acute Achilles tendon ruptures: a systematic review and meta-analysis. Independent gait. 4 0 obj The Achilles tendon gives your leg strength to walk, run and jump. In chronic and neglected rupture, surgical treatment is preferred over non-surgical treatment . Sports massage techniques and ultrasound can aid torn Achilles rehabilitation by helping to realign the new fibres in line with the tendon. The goal of surgery is to reapproximate the ruptured tendon ends in order to promote healing and restore overall strength. National Library of Medicine Rehabilitation following operative treatment of acute Achilles tendon ruptures: a systematic review and meta-analysis. CAMBOOT with 20mm heel lift or VACOPED (2) and wedge sole for 3rd week. Walking). York (UK): Centre for Reviews and Dissemination (UK); 1995-. stream -, Unfallchirurg. Static balance exercises (begin in two-foot stance, then two-foot stance on balance board and gradually progress to single-leg stance). Plaster Cast or CAMBOOT with 30mm heel lift or VACOPED (3) plus wedge sole for 1st week. close menu Achilles Tendon Ruptures are common tendon injuries that occur due to sudden dorsiflexion of a plantarflexed foot, most commonly associated with sporting events. Online Physical Therapy Protocol Quality, Variability, and Availability in Achilles Tendon Repair. %PDF-1.5 % The clinical outcomes are similar regardless of the surgical treatment, but an accelerated rehabilitation program should be accompanied by good results. < Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. `p19~%t?JGw]Sv+[ ]RDir)A) '$M*0 eC5 7<81$^;c! Brumann, M., Baumbach, S. F., Mutschler, W., & Polzer, H. Accelerated rehabilitation following Achilles tendon repair after acute rupture-Development of an evidence-based treatment protocol. The tendons twist from proximal to distal as they insert into the calcaneous, creating a shearing force. Injury2014;45(11):1782-1790. Achilles Tendon Repair; ACL Reconstruction: Quadriceps Tendon Autograft; Achilles tendinopathy can be described as an insertional or mid-portion, the difference . The only randomized controlled trial performed the most accelerated protocol demonstrating a superior functional outcome and fewer complications after immediate full weight bearing combined with free ankle mobilization. As a result, an effective rehabilitation protocol for Achilles tendon rupture appears to be more important than the surgical treatment method itself. Acute Achilles Tendon Rupture Repair Rehab The Achilles tendon is the biggest and strongest tendon in the human body and is formed by the tendons of the soleus and gastrocnemius muscles which both insert at the calcaneus. Please enable it to take advantage of the complete set of features! Literature Search We searched the MEDLINE, Embase, CINAHL, Cochrane Library, and Physiotherapy Evidence Database (PEDro) databases. Morimoto S, Iseki T, Nakayama H, Shimomura K, Nishikawa T, Nakamura N, Tachibana T. Regen Ther. etc until cleared by Active ROM between 15 degrees of dorsiflexion and 50 degrees of plantarflexion. <> Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. J Bone Joint Surg Am. group 2-4 weeks Aircast walking boot with 2-cm heel lift* Protected weight-bearing with crutches % Frankewycz B, Krutsch W, Weber J, Ernstberger A, Nerlich M, Pfeifer CG. 1 0 obj II. Five trials compared full to non weight bearing, all applying immobilization in equinus. Keep incision/splint clean and dry. Knee Surg Sports Traumatol Arthrosc. One study allowed early mobilization leading to excellent subjective and objective results. endobj PMC The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Fibrin biopolymer sealant and aquatic exercise association for calcaneal tendon repair. (50% BW) by 8600 Rockville Pike The acute rupture of the Achilles tendon is a protracted injury. Light concentric and eccentric calf raises with heel lift and progression to resisted ankle 2 0 obj Epub 2015 Sep 26. Metz R, Kerkhoffs GM, Verleisdonk EJ, van der Heijden GJ. Rehabilitation following Achilles tendon repair is vital in regaining motion, strength and function. PMC sharing sensitive information, make sure youre on a federal Patient 2 was a 38-year-old male soldier who experienced a complete left Achilles tendon rupture while exercising. <>/Metadata 358 0 R/ViewerPreferences 359 0 R>> In revision cases or when the tendon was damaged before the rupture, the tendon may need to be reconstructed using a graft from another tendon in your body. Sport/work-specific balance and proprioceptive drills. This combination was most beneficial. necessary. National Library of Medicine Epub 2020 Dec 17. . 2023 Feb 10;11(2):23259671221145199. doi: 10.1177/23259671221145199. 1.Introduction. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0 should be applied. Clinical, Ultrasonographic, and Elastographic Comparison. xwn $8sxkL=. *MoaoLzhN:fOad)t-h96.&JxEys4JUy-nEu  Accelerated rehabilitation following Achilles tendon repair after acute rupture development of an evidence-based treatment protocol. Low level calf plyometric exercises (fast CRs, tip toe 2019 Feb;12(1):16-24. doi: 10.1177/1938640017751185. Jogging, increase exercise intensity, Sports specific drills, Full active ankle range of movement with dorsiflexion as tolerated, Progress muscle strengthening from open chain to closed chain during this period, Single leg stance, eyes closed, wobble board/ BOSU, Double heel raise progress to single heel raise, Dorsiflexion equal to contralateral side, no need to push to extreme, Hopping, Mini hurdle jumps, Straight line running, Introduce cutting/side to side/ carioca/ figure of 8 runs, Normal activity, explosive actions and return to sport. Keywords: Bethesda, MD 20894, Web Policies eCollection 2021. Keywords: A systematic review of early rehabilitation methods following a rupture of the Achilles tendon. Movement control exercises beginning with low velocity, single plane activities and progressing to higher velocity, multi-plane activities. Active ROM between 5 degrees of DF and 40 degrees of PF. 2017 Mar;137(3):333-340. doi: 10.1007/s00402-017-2627-9. 204 0 obj <>/Filter/FlateDecode/ID[<5F38DF44F3FF7641895593BD7106A5BB>]/Index[179 50]/Info 178 0 R/Length 115/Prev 119698/Root 180 0 R/Size 229/Type/XRef/W[1 3 1]>>stream weight) Results: Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. Before Factors That Affect Return to Sports After an Achilles Tendon Rupture: A Qualitative Content Analysis. Scribd is the world's largest social reading and publishing site. Passive dorsiflexion both with knee in extension and flexed to 35 - 400 until gentle stretch on achilles. nb^t~luNS zRBR}mHbKz!MKCZ?/ibO'"qwDG&lQz=>4 QG`7]qvZ;{t;-rq@ .iij1QB\:Lw;hxAMOPNw(v9`K-{ig@@HymirxF> health, rehab compliance and injury severity, our team has established time frames, precautions and progression criteria that help ensure a safe return to sport. A systematic literature search in Embase, MEDLINE and Cochrane Library for prospective trials reporting on early functional rehabilitation after minimal invasive repair was performed. Objectives To (1) describe which resistance exercises are used in the first 8 weeks of treatment for acute Achilles tendon rupture and (2) assess the completeness of reporting of the exercise descriptions. Using Long-Duration Static Stretch Training to Counteract Strength and Flexibility Deficits in Moderately Trained Participants. The non-comparative study reported high satisfaction, good functional results and an early return to work/sports following combined treatment. Avoid forceful active and passive range of motion of the Achilles for 10 - 12 weeks. endobj endobj Begin gait and ankle proprioception retraining. <>/Metadata 1559 0 R/ViewerPreferences 1560 0 R>> Squat to 30 degrees knee flexion without weight shift. Transitioning towards plantargrade until boot is completely removed. #WDA Braunstein M, Baumbach SF, Boecker W, Carmont MR, Polzer H. Knee Surg Sports Traumatol Arthrosc. David Gordon, Consultant Orthopaedic Surgeon - Achilles Tendon Repair Post Operative Accelerated Rehabilitation Protocol: A Patient Guide Nov 2016 Achilles Tendon Repair: Rehabilitation Protocol Reference List Cetti, R., L. O. Henriksen, and K. S. Jacobsen. 4 0 obj . 8]z].U3wKI2 Ruptures of the tendo achillis. We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. Bookshelf Rehabilitation regimen for non-surgical treatment of Achilles tendon rupture: A systematic review and meta-analysis of randomised controlled trials. 2014 Nov;45(11):1782-90. doi: 10.1016/j.injury.2014.06.022. building to We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. Kangas J, Pajala A, Siira P, Hmlinen M, Leppilahti J. J Trauma. View a complete list of our locations and hours. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. It's the largest tendon in your body. x][~|.T%c<8A+qwX+)#`T];% t4!^}I? 4 However, this . Orthop J Sports Med. It is found at the back of the lower leg, just above the heel bone. Arch Orthop Trauma Surg. -, Injury. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. V.&!Na 1"}2C1[irXd8`<9f4X|(iTerx_&>uQMAv/>My]Zg}?;fl|Hpt. 1. bearing Frankewycz B, Krutsch W, Weber J, Ernstberger A, Nerlich M, Pfeifer CG. surgeon and physio. MRI studies may be indicated for surgical management of chronic injuries. !.XyR-Kd-+"v+l3,~l|LR {Z^R}TTKS`p*9szqAdJAs2QGE6pzHf)'a n7=pMi-Sn3r7$5B"yUMQy^&hkj)V&a55JZp5JSb^]"37H919=N]?&h6.M{Af[Uf`0R;DW x^Q^5fu;%)Ptu$DtqEHg Early functional rehabilitation protocol for Achilles tendon rupture improved patient satisfaction, compared with standard immobilisation regimens, with reductions in minor complications and no difference in re-rupture rates. The Achilles tendon is a strong, fibrous cord in the lower leg. Disclaimer. Muscle strength and balance. A potentially more accelerated rehabilitation and return to activity; Tendon healing with optimal end to end re-attachment, hence restoring Calf muscle-Achilles anatomy with minimal scar tissue bridging. IRh3J@+ZR*RNE+Ni$Gg3) x):+!#$SEL*u:Jd4r Initially a walking boot is used for the first 4-5 weeks. endobj 2 0 obj SWE is a convenient noninvasive method to determine the progress of the healing process after tendon injury. Surgery is only the beginning of a long rehabilitation period. Review Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence . Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. Closed chain weight bearing quads, hamstrings, glutes, calf strengthening with physio guidance. The Achilles tendon is the biggest and strongest tendon in the human body and is formed by the tendons of the soleus and gastrocnemius muscles which both insert at the calcaneus. Injury. Tendon is a specialized tissue mainly composed of collagen extracellular matrix (ECM), transmitting forces from muscle to bone [1].Tendon injury accounts for a large proportion of musculoskeletal system disorders and poses a substantial burden on human health [2].Therapeutic interventions including surgery, drug, physical therapy and rehabilitation are used for tendon repair [3]. Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? eCollection 2021 Dec. Hidd SMCM, Tim CR, Dutra EF Jr, Maia Filho ALM, Assis L, Ferreira RS Jr, Barraviera B, Silva JF, Amaral MM. x\*"S&Rd9l)+%\hwMROw3$\Z1~v/^x|m],^}3fdY7iTe*)XU6ugshO_KQ`F5vYU? 3 0 obj bearing transitioning towards full weightbearing. Several common injuries can make your Achilles tendon painful or prevent it from working well. Federal government websites often end in .gov or .mil. kicking small. and transmitted securely. 2 0 obj It arises near the middle of the calf and rotates approximately 90 degrees laterally during its course to insert on the posterior aspect of the calcaneal tuberosity [ 1, 2 ]. Massen FK, Shoap S, Vosseller JT, Fan W, Usseglio J, Boecker W, Baumbach SF, Polzer H. EFORT Open Rev. 2022 Jul 25;2022:9722458. doi: 10.1155/2022/9722458. Immediate full weightbearing and ankle motion exercise after repair of acute Achilles tendon rupture can provide a good rehabilitation option with a low re-rupture rate and satisfactory functional results. It happens most frequently while playing sports. 2010 Dec 1;92(17):2767-75. doi: 10.2106/JBJS.I.01401. 0_'|,t0:!: . ^Fz,l6N}{D6Y?TP),#uz/i3F~bHG(BQ" If you have a concern, please consult with Dr. Roe. ?ynKdl?~\X%__ =x18?O/Wo_I7j~tIdM)E:_QF'ljY*u=9PEF^},? ACCELERATED ACHILLES PROTOCOL Time Frame Activity . Copyright 2014 Elsevier Ltd. All rights reserved. All trials found mobilization to be superior as it shortens time to return to work and sports significantly. We mostly see ruptures of the Achilles tendon in high-impact sports predominantly in the male athlete. Surgery is only the beginning of a long rehabilitation period. One randomized controlled trail, one prospective comparative and five prospective non-comparative studies were identified. Our analysis using SWE has revealed the detailed chronologic changes in SWE values and related mechanical properties of a healing Achilles tendon rupture, which can be used for devising appropriate rehabilitation protocols. Progression of calf stretching past plantar grade. Continue active resisted theraband exercises; plantarflex through full range, dorsiflexion to a natural plantigrade position, push no further. An Achilles tendon rupture is a full or partial tear of the Achilles tendon. . PoT"u+: Clipboard, Search History, and several other advanced features are temporarily unavailable. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Your surgeon and you will determine what is best for you by discussing your specific injury and goals. The acute rupture of the Achilles tendon is a protracted injury. Wilkins R, Bisson Lj. Introduction Optimal postoperative rehabilitation regimen for acute Achilles tendon rupture (AATR) remains unclear. endobj Would you like email updates of new search results? Good control and no pain with functional movements, including step-up/down, squats and lunges. 2,14,20 This finding was believed to . 2022 Oct 14;19(20):13254. doi: 10.3390/ijerph192013254. Hydrotherapy, stationary cycling. Can begin upper limb sports specific training eg. Consider taking a more conservative approach to range of motion, weight bearing, and rehab progression with tendon augmentation, re-rupture after non-surgical management, revision, chronic tendinosis, and co-morbidities, for example, obesity, older age, and steroid use. Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. eCollection 2022. ^C< ^/PgN`r3~LV*m{ (3Nl(+J?~I 2003 Jun;54(6):1171-80; discussion 1180-1. doi: 10.1097/01.TA.0000047945.20863.A2. government site. Discussion. Achilles tendon ruptures (ATRs) mainly occur during sports activities . Begin standing calf stretch at 5 weeks (knee flexed and extended) Continue eversion, inversion and plantar flexion isometrics with resistance bands. Physical therapy appointments are once a week. Patients showed significantly higher satisfaction, less use of rehabilitation resources, earlier return to pre-injury activities and further demonstrated significantly increased calf muscle strength, reduced atrophy and tendon elongation. r 2020-2023 Mr Daniel Goldbloom | Privacy Policy | Disclaimer | Website design: Berwick - St John of God Consulting Suites. 2018 Mar;26(3):846-853. doi: 10.1007/s00167-015-3795-1. 3{pn04,NMi"]C@C!r-\8yJY cMylwJ nOVn:K"ldCsseC! Three trials compared the combination of full weight bearing and early ankle mobilization to immobilization. Accelerated rehabilitation following Achilles tendon repair after acute rupture development of an evidence-based treatment protocol, Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet], Centre for Reviews and Dissemination (UK). Immediate full weight bearing led to significant higher patient satisfaction, earlier ambulation and return to pre-injury activity. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 5 0 R/Group<>/Tabs/S/StructParents 1>> Patient must be willing to comply with the functional rehab protocol and strict guidelines. A prospective randomized study. 3. 1 0 obj Initiate balance exercises (double leg wide base narrow . endstream endobj 180 0 obj <>/Metadata 7 0 R/PageLayout/OneColumn/Pages 177 0 R/StructTreeRoot 11 0 R/Type/Catalog>> endobj 181 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 182 0 obj <>stream Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence-based treatment protocol. leg jumps, skipping). % Accessibility Rehabilitation phases after an Achilles tendon rupture The rehabilitation can be divided into four phases (1): The decision when a patient should proceed from one phase to the next is proposed to be based on both the recovery of the patient and the time since the injury. Active ROM between 15 degrees of DF and 50 degrees of PF. Accelerated rehabilitation; Achilles tendon rupture; Minimal invasive repair. Epub 2014 Jul 24. Download Accelerated Rehab Program Patient Information Sheet.