Patient’s guide to Achilles tendon rupture rehabilitation
Emma Burns- MSc Physiotherapist
Frank Gilroy – Consultant Physiotherapist MSc MCSP
Robert Carter- Foot and Ankle Specialist
Contents
- What is the Achilles tendon?
- How do you injure your tendon?
- Risk factors
- How is it diagnosed
- Achilles tendon rupture treatment
- Non-surgical treatment
- Surgical
- Rehabilitation
- Phase 1
- Phase 2
- Phase 3
- Phase 4
- Phase 5
- Phase 6
- Phase 7
- Non-Surgical
Information on Achilles tendon rupture
What is the Achilles tendon?
Tendons are strong and flexible tissues that connect muscles to other parts of your body, usually bones. Your Achilles tendon is the strongest tendon in your body and according to the American Academy of Orthopaedic Surgeons (AAOS) it can withstand more than 1,000 pounds of force.
Your Achilles tendon can be felt running down the back of your calf onto the heel. The tendon is made up of many bundles of fibres called collagen which is one of the body’s main building blocks. Your Achilles tendon is attached to two large muscles that make up your calf complex, the gastrocnemius and soleus. When these muscle contract, the Achilles tendon pulls on the heel. This movement allows us to move up on to our toes when walking, running, or jumping.
How do you injure your Achilles tendon?
An Achilles tendon rupture is a complete tear that occurs when the Achilles tendon is stretched beyond its tissue capacity. It can occur through sport, being particularly common in racquet sports and also team sports. This is due to lunging type movements, jumping, sprinting and changing direction quickly. It doesn’t always happen in sport, it can just be ‘bad luck’.
People with specific medical conditions or patients who are on certain medications can also be more vulnerable to a rupture. Long-term tendinopathy, which is a condition where the tendon becomes swollen, painful and weak can also increase your risk of an Achilles tendon rupture.
When the rupture occurs, you might have a sudden, sharp and severe pain in the back of your leg and may hear a snapping or popping sound. It might feel like you’ve been kicked or hit in the back of your leg.
Other signs of injury include:
- Swelling in your calf
- A limp/unable to put your full weight on your ankle or stand on tiptoes
- Some bruising on your lower leg.
If you have any of these symptoms and think you’ve ruptured your Achilles tendon, you should see a doctor urgently.
Achilles tendon injuries are most common in people who are in their 30-50’s and who are only active intermittently (i.e. ‘Weekend warrior’ athletes) however, may occur in all individuals.
How is it diagnosed?
The British Medical Association (BMA) recommend examining a suspected Achilles tendon rupture using ‘Simmonds triad’. This consists of 3 different tests to exclude an Achilles tendon rupture:
1. Looking for an abnormal angle of declination- rupture of the Achilles tendon may lead to greater dorsiflexion of the injured ankle and foot compared to the uninjured side
2. Feeling for a gap in the tendon-however no gap may be felt because of localised swelling or bleeding and bruising may be seen.
3. Gently squeezing the calf muscles while the patient is lying on their stomach should indicate if the tendon is still connected- in an acute rupture of the Achilles tendon the injured foot will typically remain in the neutral position when the calf is squeezed
Initial assessment and diagnosis will normally occur in the emergency department or minor injuries unit of a hospital. In order to diagnose an Achilles tendon rupture your doctor will carry out a clinical examination of your calf and ankle. Ultrasound and MRI can be used to aid diagnosis but this is a decision that will be made by your doctor.
Achilles tendon rupture treatment
An Achilles tendon rupture can be treated conservatively or surgically. This will be the decision of the orthopaedic surgeon when reviewing each individual patient. Recent studies have shown fairly equal effectiveness of both surgical and nonsurgical management if diagnosed and managed as soon as the rupture has occurred. Regardless of conservative or surgical treatment initial assessment and diagnosis will occur in the emergency department or minor injuries unit.
Non- surgical treatment
Non-surgical treatment starts with a half knee plaster cast or back slab with your foot pointing downwards for two weeks following diagnosis. This is often followed by a brace for another 10 weeks however, this depends on the specialist’s opinion.
Casting Week 0-2 (Dependant on specialist opinion)
The cast is usually from your knee downwards and is put on with your foot in a fully bent downwards position. Usually you’ll be asked to put very little weight through your leg while the cast is on, but once the brace is on you may be able to put weight through it. You’ll need to walk with crutches. The decision if in cast or brace will be made by your surgeon.
This can be up to a couple of weeks but is usually dependant on the consultant, who will advise based on each individual case.
Functional brace Week 2-12 (Dependant on specialist opinion)
The brace is a rigid type of boot with straps to adjust it that usually goes from your knee downwards. Once the brace is put on, it will be adjusted several times over a few weeks to bring your foot up. You will probably be asked to wear the brace all the time, including when you’re asleep.
While the brace is on, and when it comes off, a physiotherapist may give you specific exercises to do. These might include keeping your toes moving along with exercises for your knee and hip to stop them getting stiff.
Strength & conditioning Week 12-16+ (Dependant on specialist opinion)
Conditioning & return to sport preparation Week 16-24+ (Dependant on specialist opinion)
Surgical Treatment
A surgeon will discuss plan of care with you and decide if surgery is the best option taking into account your specific injury. Surgery is often the option for the following and would take into account:
- Delayed presentation / treatment
- Re-ruptures of Achilles tendon
- Avulsion injuries
The procedure lasts about 45-60 minutes and involves making an incision over the Achilles tendon and repairing the tendon with sutures. After the procedure you will have a below knee back slab applied. Most patients should be able to go home the same day as their surgery.
Casting Week 0-2 (Surgeon dependant)
The cast is usually from your knee downwards and is put on with your foot in a fully bent downwards position. This allows the repair to heal without being stretched or stressed. Usually you’ll be asked to put very little weight through your leg while the cast is on, but once the brace is on you may be able to put weight through it. You’ll need to walk with crutches. The cast will be removed for wound assessment and removal of sutures.
Functional Bracing Week 2-7 (Dependant on specialist opinion)
The brace/cam boot is a rigid type of boot with straps to adjust it that usually goes from your knee downwards. Once the brace is put on, it will be adjusted several times over a few weeks to bring your foot up. You will probably be asked to wear the brace all the time, including when you’re asleep.
While the brace is on, and when it comes off, a physiotherapist may give you specific exercises to do. These might include keeping your toes moving along with exercises for your knee and hip to stop them getting stiff.
Strength & conditioning Week 8-16+ (Dependant on specialist opinion)
Return to sport preparation Week 16-20+ (Dependant on specialist opinion)
Rehabilitation
For both surgical and non-surgical intervention you will need to commit to Physiotherapy for 6-12 months.
Returning to work will depend on the level of activity your job requires. Below is a guideline indicating when you can expect to return to specific activities. But this will depend on your consultant’s opinion and advice.
The above and following advice are only guidelines. Progression may vary depending on the individual. Your rehabilitation should be monitored by a physiotherapist and surgeon. You are advised not to return to full activity too early as this may risk a re-rupture. *In some cases it can take 12-24 months to restore maximal function.
Surgical rehabilitation
PHASE 1: Surgical Week 0-2
Remember this programme is just a guideline. You may progress more rapidly or slowly through the programme as guided by your surgeon and physiotherapist. You should always check with them first before progressing onto the next rehabilitation stage.
Goals:
- Rest/recover
- Protect tendon
- Walk non-weight bearing safely on crutches
Intervention:
- Elevate limb as much as possible
- Pain control
- Maintain hip/knee/toe movement as cast allows
Precautions:
- Plaster cast with ankle plantar flexed to approx. 20 degrees
- Non weight bearing with crutches
Joint range of movements
- Hip range of movements: perform each of these activities 10 times ensuring you do not put any weight on the effected side
- Extension: Standing in front of a support take your hip backwards keeping your knee straight and your body upright.
- Flexion: Lift your knee up, flexing your hip and then lower.
- Abduction: Lift your affected leg out to the side
2. Knee range of movements
- Put a plastic bag or board under your heel and gently slide your heel up towards your bottom, bending your knee and straightening. Repeat 10 times.
General mobility with crutches
- Walking with crutches: place the crutches forward with the injured leg and then step through with the good leg by itself.
- Sit to stand with crutches: to sit down remove arms out of the crutches and
hold both on one side and sit. To stand up hold crutches on one side and rise up placing your arms through the crutches to hold.
- Stairs with crutches: going up stairs first take a step up with your good leg and then take a step up with your injured leg. Then bring your crutches up onto the step. Going down stairs first put your crutches down one step and then take a step down with your injured leg. Then take a step down onto the same level with your good leg.
PHASE 2 Surgical Week 2-4
Remember this programme is just a guideline. You may progress more rapidly or slowly through the programme as guided by your surgeon and physiotherapist. They may advise you to remove your boot for certain exercises, so only do the ones as advised. You should always check with them first before progressing onto the next rehabilitation stage.
Goals:
- Protect tendon
- Regain range of movement
- Manage swelling
- Confidently weight bearing using crutches as pain allows
- Maintain core, hip and knee strength
Intervention:
- Rigid walking boot pointing downwards with wedges inside boot*
- Wear boot 24 hours a day
- Weight-bear with crutches as discomfort allows in boot
- Gentle active plantar flexion full range
- Gentle dorsi flexion to position in boot but no further
- Inversion/eversion below plantigrade
- Swelling control
Precautions:
- Avoid moving ankle beyond plantargrade dorsiflexion when performing any exercise.
- Use boot with a 2-4cm heel lift *
- Tubigrip to be worn under boot to help control swelling.
- Protective weight-bearing with crutches and boot:
- Patient to use pain as a guideline; if increased pain, decrease activity and/or weight-bearing level.
*This will depend on the type of boot worn. Please follow the advice as guided by your surgeon and physiotherapist.
Knee straightening in sitting
Sitting on a chair pull your toes up ONLY BACK TO THE POSITION IN BOOT- NO FURTHER. Tighten your thigh muscle and straighten your leg. Hold for approximately 3-5 seconds and repeat until leg is tired.
Quads set and straight leg raise
With a raise under your heel, tighten your thigh muscle until your leg is straight. If you achieve full extension of the knee then slowly lift the leg up six inches (without letting it roll in) and hold for 5 seconds. Lower the leg, relax and repeat.
Repeat 10 times.
PHASE 3 Surgical Week 4-8
Remember this programme is just a guideline. You may progress more rapidly or slowly through the programme as guided by your surgeon and physiotherapist. They may advise you to remove your boot for certain exercises, so only do the ones as advised. You should always check with them first before progressing onto the next rehabilitation stage.
Goals:
- Progress to fully weight bearing but using crutches for balance if needed.
- Active ankle movement through available range of plantarflexion from position held in boot.
- Regain full inversion and eversion in available plantar flexion range
- Confidently weight bearing using crutches as pain allows
- Aim for ankle plantigrade (foot flat)
- Wean out of boot and place heel raise in shoe
Intervention:
- Wedges within rigid walking boot to be removed weekly to plantigrade position
- Wear boot 24 hours a day
- Continue with previous exercises (as advised by specialist)
- Perform active resisted plantarflexion, eversion and inversion with theraband (as advised by specialist)
- Seated heel raises (as advised by specialist)
- Hydrotherapy (as advised by specialist)
- Gait re-education. No knee hyperextension to compensate for lack of ankle dorsiflexion
Precautions:
- Avoid moving ankle beyond plantargrade when performing any exercise.
- Use crutches as needed
- Gradually remove heel lifts from boot
- Can shower out of boot as long as very careful not to stand/stumble, otherwise use waterproof covering.
Active ankle movements– as advised by your specialist
- Plantar flexion
Sit on the floor and hold both ends of the theraband. Loop the band around the base of your foot and try to keep your knee straight. Point your toes away from yourself resisting this with the band. Slowly return to the starting position. Avoid moving beyond plantargrade. Repeat 10 times aiming to complete 2 – 3 sets each day as comfortable.
2. Inversion
Sit on the floor and tie the theraband onto the end of a sturdy structure (i.e. table/chair). Loop the band around the base of the inside of your foot. Turn your foot in against the resistance of the band. Perform movement in plantargrade position. You should feel a resistance when doing this movement Repeat 10 times aiming to complete 2-3 sets each day as comfortable
3. Eversion
Sit on the floor and tie the theraband onto the end of a sturdy structure (I.e. table/chair). Loop the band round the base of the outside of the foot. Turn your foot away against the resistance of the band. Perform movement in plantargrade position. You should feel a resistance when doing this movement. Repeat 10 times aiming to complete 2-3 sets each day as comfortable.
You can actively dorsiflex foot (bringing toes/ankle toward you) ONLY to position allowed by wedges in boot not beyond plantigrade (flat foot)
Seated heel raises
Sit on a chair with your knees and feet hip-width distance apart with your feet flat on the floor parallel to one another. Sit tall with upright posture. Lift the heels to rise up onto your toes.
Repeat 10 times aiming to complete 2 to 3 times each day as is comfortable
Gait re-ed
Heel / toe gait & good pelvic alignment
Aqua jogging- advised
This should ideally be carried out in a hydrotherapy pool.
Use an aqua jogger belt in the deep end of the pool. Your feet should not hit the bottom. Mimic the jogging motion using your arms and legs, keeping your back upright and straight. As there is no weighted resistance in the pool it allows you to work at strengthening your legs and cardiovascular system without risk of injury reoccurrence from impact. The heat from the pool also has a therapeutic effect through loosening off tight tissues and encouraging the muscles to relax.
15 – 20 minutes once a week.
PHASE 4 Surgical Week 8-14
Remember this programme is just a guideline. You may progress more rapidly or slowly through the programme as guided by your surgeon and physiotherapist. They may advise you to remove your boot for certain exercises, so only do the ones as advised. You should always check with them first before progressing onto the next rehabilitation stage.
Goals:
- Normal walking- careful not to push into too much dorsiflexion
- Increase ankle and lower limb strength specifically calf strength
- Continue to progress range of movement and proprioception exercises
Intervention:
- Continue active resisted theraband exercises- dorsiflexion to plantargrade, no further
- Allow dosiflexion to return naturally
- Heel raises in standing
- Exercise bike with boot
- Continue hydrotherapy
- Proprioception rehabilitation- double leg stance out of boot, single leg stance in boot, progressing to out of boot as balance improves
Precautions:
- Remember to wear your boot until advised by your clinician that you can gradually walk without it
- Shower carefully so not to forcefully dorsiflex ankle
- Any stretches in dorsiflexion should not be forceful
- Do not allow ankle to go past neutral position during strengthening
- Tendon remains vulnerable to sudden loading (i.e. tripping) so be diligent with daily activities and exercises to avoid re-rupture
Proprioception and balance exercises- Weeks 8-12
Try to do 5 mins of balance work three times a day, every day
Progression for each:
- 60 secs standing
- 60 secs standing arms crossed over chest
- 60 secs eyes closed
Once you can do the above, move onto the next stage.
Stage 1: Double leg stance out of boot
Stage 2: Single leg stance in boot
Stage 3: Single leg stance out of boot
Stage 4: Tandem walking- Walking slowly along a line, placing one foot heel to toe in front of the other, as if on a tightrope, try to keep to the line.
Variations:
1. High knees
2. Close one or two eyes.
3. Walk backwards.
4. Walk sideways.
Stage 4: Single leg stance on cushion
Stage 5: Balancing on wobble board
Weeks 12-14
Double heel raises in standing
Standing by a counter or chair for support, rise up on your toes with your knees straight and your body tall. Slowly lower down onto your heels and repeat ensuring foot does not go into dorsiflexion Repeat for 15 times. Aim to complete 3 sets
If you can manage 3 sets of 10 reps with relative ease a light weight (such as a dumbbell, water bottle or loaded rucksack) could be added. This should be done with caution and only if the non-weighted exercises have been completed with no reaction. The weight should be increased in 2kg increments.
Toe walking
Stand with the kitchen counter by your side for support if required. Rise up onto your toes and walk slowly on your toes for the length of your kitchen counter and back.
Repeat 10 times aiming to complete 2 – 3 sets each day.
Half double leg squats
Stand with your back leaning against a wall and your feet about 30cm from it. Keeping your quads and hamstrings tight, slowly slide down the wall until both knees are bent to about 45 degrees or halfway down into a squat. Slowly straighten your knees and return to the starting position.
Hold for approximately 3 – 5 seconds and repeat 10 times aiming to complete 2 – 3 sets each day as comfortable.
PHASE 5 Surgical Week 14-20
Remember this programme is just a guideline. You may progress more rapidly or slowly through the programme as guided by your surgeon and physiotherapist. They may advise you to remove your boot for certain exercises, so only do the ones as advised. You should always check with them first before progressing onto the next rehabilitation stage.
Goals:
- Mastering proprioception and balance in normal footwear
- Normal dorsiflexion range
- Increase exercise intensity
- Sport specific drills
Intervention:
- Theraband exercises with dorsiflexion as tolerated
- Progress muscle strengthening
- Progress proprioception/balance exercises
- Concentric/eccentric work
- Plyometric exercises
Precautions:
- Normal shoes with good heel support
Range of movement and flexibility- weeks 14-16
- Standing calf stretch
Stand with your feet hip width apart and take a step back into a lunge position. With most of your weight on your front foot gently and gradually take your weight onto your back foot stretching your heel to the floor. Keep your hips and back foot facing forwards.
Do not overstretch into pain
Hold for approximately 20 – 30 seconds and repeat 10 times aiming to complete 2 – 3 sets each day as comfortable.
2. Standing soleus stretch
Stand with your feet hip width apart and take a step back with one foot. Gently take stretch your heel down to the floor while bending your knee. You will start to feel a stretch along your Achilles tendon.
Do not over stretch into pain. Hold for approximately 20 – 30 seconds and repeat 10 times aiming to complete 2 – 3 sets each day as comfortable.
3. Theraband dorsiflexion
Sit on the floor and tie the Theraband to a nearby table leg or pole making sure it is secure. Put the Theraband around your foot and pull your toes back towards your body trying to keep your knee straight. Slowly return to the starting position.
Repeat 10 times aiming to complete 2 – 3 sets each day as comfortable.
Step ups
Using a step-up block place one foot onto the step and stand up onto this following with your other foot. Step down with your first foot and follow with your other foot to return to a standing position. Start of gently and gradually increase the pace as comfortable
Repeat 2 – 3 minutes aiming to complete 1 – 2 times each day.
If you can manage 3 sets of 10 reps with relative ease a light weight (such as a dumbbell, water bottle or loaded rucksack) could be added. This should be done with caution and only if the non-weighted exercises have been completed with no reaction. The weight should be increased in 2kg increments.
Weeks 16-20
Wall squat with heel raise
Stand with your back leaning against a wall and your feet wide apart. Bend your knees and put your hands on your thighs. Lift both heels off the floor.
Hold for approximately 3 – 5 seconds and repeat 10 times aiming to complete 2 – 3 sets each day as comfortable.
Lunges
Stand with an upright posture and your legs hip width apart. Take a step forward with your one leg and squat down slowly. Push down through the foot in front to return to the starting position.
Repeat 10 times aiming to complete 2 – 3 sets each day as comfortable
Single leg heel raises
Stand holding onto a chair in front of yourself. Stand on one leg and rise up onto your toes then slowly lower yourself back down again.
Hold for approximately 3 – 5 seconds and repeat 10 times aiming to complete 2 – 3 sets each day as comfortable.
If you can manage 3 sets of 10 reps with relative ease a light weight (such as a dumbbell, water bottle or loaded rucksack) could be added. This should be done with caution and only if the non-weighted exercises have been completed with no reaction. The weight should be increased in 2kg increments.
Double leg heel raises off a step
Standing on a step rise up on your toes with your knees straight and your body tall. Slowly lower down onto your heels so they go past plantargrade and dip your heels below the step, rise up onto your toes and repeat.
Hold for approximately 3 – 5 seconds and repeat 10 times aiming to complete 2 – 3 sets each day as comfortable.
If you can manage 3 sets of 10 reps with relative ease a light weight (such as a dumbbell, water bottle or loaded rucksack) could be added. This should be done with caution and only if the non-weighted exercises have been completed with no reaction. The weight should be increased in 2kg increments.
Cardio/fitness
Static bike increased resistance Start with minimal resistance, 60 -80 rpm. Increase the resistance as tolerated.
30 minutes aiming to complete 1 set each day.
Swimming
Ease into swimming building up leg kicking work. Don’t start off too vigorously, begin with gently kicking legs before increasing pace.
20 minutes aiming to complete 2 – 3 sets each week.
PHASE 6 Surgical week 20-24
Remember this programme is just a guideline. You may progress more rapidly or slowly through the programme as guided by your surgeon and physiotherapist. They may advise you to remove your boot for certain exercises, so only do the ones as advised. You should always check with them first before progressing onto the next rehabilitation stage.
Goals:
- Start running programme as able
- Mastering proprioception and balance in normal footwear
- Normal dorsiflexion range
- Increase exercise intensity
Intervention:
- Continue with phase 5 and progress reps/sets as able
- Progressive running programme
Once it has been established that you have adequate muscle strength, endurance and control a running program as the example set out below can be established in agreement with your physiotherapist and your surgeon. Progress by building up your pace from ½ to ¾ to full.
Starting position should be different for each run. Remember your running program must not be progressed if you are experiencing pain, swelling or other symptoms at any level. Remember the program is just a guideline and not everybody is expected to be at this level.
Trampoline jogging
Jog on a trampoline trying to keep raising your knees high. Start of gentle and increase this gradually to your regular jogging pace.
5 – 10 minutes aiming to complete 1 – 2 times a day.
Trampoline single leg standing/ hopping
Stand on one leg on a trampoline keeping your balance with your knee and toe in line. Progress this to gently hopping on one leg building up the height of the hop gradually.
Repeat 10 times aiming to complete 2 – 3 sets each day.
PHASE 7 Surgical week 24+
Remember this programme is just a guideline. You may progress more rapidly or slowly through the programme as guided by your surgeon and physiotherapist. Your specialist may advise you to start certain exercises at different times at this stage of rehab so you should always check with them first before progressing onto the next rehabilitation stage.
Goals:
- Running
- Increase exercise intensity
- Sport specific drills
Intervention:
- Progress muscle strengthening
- Progress proprioception/balance exercises
- Concentric/eccentric work
- Plyometric exercises
- Progressive running programme
- Sprinting and agility drills
Sprinting drills
Once you are able to run for 30 minutes without pain and can manage 2km’s in under 12 minutes, the following sprint drills can be commenced, if your sport/activity or lifestyle requires it.
- Grade one sprint: Slow accelerate (6x15M) x2- slow stop (10x15M) x2- slow stop
- Grade two sprint: Slow accelerate (3x50M) x2- fast stop (3x100M) x2- fast stop
- Grade three sprint: Fast accelerate (8x15M) x3- fast stop (3x50M) x2- fast stop
Starting position should be different for each run. Remember your running program must not be progressed if you are experiencing pain, swelling or other symptoms at any level. Remember the program is just a guideline and not everybody is expected to be at this level.
Plyometric drills
Ski jumps
Stand with a line marked on the floor to one side of you. Squat down and spring up jumping across the line and let your knees bend underneath you when you land. Progress this to jumping further from line on both sides.
Repeat 10 times aiming to complete 2 – 3 sets each day.
Leap frog
Stand with a long corridor or sufficient amount of space in front of yourself. Squat down and spring up jumping as far as you can in front of yourself. Land letting you knees bend underneath you to absorb the impact.
Repeat 10 times aiming to complete 2 – 3 sets each day
Box Jumps
Stand in front of a secured box or platform. Jump onto box and immediately back down to same position. Immediately repeat. Jump back and forth from floor and box as fast as possible, keeping landings short.
Exercise Variations
- Jump sideways down to side of box.
- Jump back onto box then jump down to the other side of the box.
- Jump back onto the box and repeat.
- Jump completely over the box from side to side as fast as possible.
Exercise Progressions:
- Build up to 2 sets of 30 reps.
- Increase speed.
- Use single leg.
- Repeat 5 – 10 times aiming for 2 – 3 sets each day.
Bounding
Stand in front of a short box or platform. Place one foot on edge of box. Jump up high and land with opposite foot on edge of box and other foot on floor. Immediately repeat.
Variations:
- Make the platform higher
- Repeat without a step (skipping on the spot)
- Repeat 5 – 10 times aiming for 2 – 3 sets each day.
Hurdles
Stand facing collapsible hurdles, barriers or cones (30-90cm). Squat down and jump over hurdle with feet together using a double arm swing. Upon landing immediately jump over next hurdle. Keep landings short. Hurdles should be collapsible in case it is not cleared.
Progressions:
- Increase height of barrier.
- Increase space between hurdles.
- One legged hopping
- Repeat 5 – 10 times aiming for 2 – 3 sets each day.
Depth Jumps:
Stand on top of a high box (platform), close to the front edge facing a second box. Jump from the platform, landing on both feet between the platform and the box. Jump of the ground as fast as possible onto the box.
Progressions:
- Increase height of platform as ability improves.
- Use only one leg.
- Repeat 5 – 10 times aiming for 2 – 3 sets each day
Gym Programme
Seated Hamstring Curl Machine
Start with the legs nearly fully extended. Move the heels toward the buttocks as far as possible and under control, maintaining this control, slowly extend the knee back to the starting position.
DON’T ALLOW THE KNEES TO HYPEREXTEND.
Exercise Progressions:
- Increase the resistance.
- Use just one leg.
- Repeat 15 – 20 times aiming for 2 – 3 sets each day at low resistance.
Leg Press Machine
Starting with the knee joints at 90 degrees, extend the legs until straight and then slowly return to the starting position.
Exercise Progressions:
- Increase the resistance.
- Use only one leg.
- Repeat 15 – 20 times aiming for 2 – 3 sets each day at low resistance.
Agility drills
Using cones, to mark out the circuits, perform the agility drills below.
Six cones are placed 5m apart in a straight line. The player completes a shuttle run at full pace, turning alternately to the left and to the right and sprinting backwards or forwards.
This should be repeated 10 times.
Set 4 cones in a square, each one 10m apart. Stand in the centre (0) and shuffle (side step) laterally to the cone on your right (1), shuffle back to the middle and then shuffle over to the cone on your left (2) and back to the middle, turn 90o clockwise and continue shuffling out to the 3rd cone and back in again to the middle and then onto the 4th, repeat this circuit 10 times.
Variations: Perform this exercise while doing cariocas (crossed sidestep running).
Phasing back to sport/activity 4
1. Kicking and ball work should be introduced specific to the requirement of the sport
2. Return to normal training with team/coach. Access reaction and response.
3. Begin low level match against and easy opposition/ teammates
4. Return to full competition
Non- surgical rehabilitation
Remember this programme is just a guideline. You may progress more rapidly or slowly through the programme as guided by your surgeon and physiotherapist. Your specialist may advise you to start certain exercises at different times at this stage of rehab so you should always check with them first before progressing onto the next rehabilitation stage. Your specialist will advise you on when you are able to take your boot off, when you can fully weight-bear and what exercises you can do at each stage of your rehabilitation.
The phases below correspond to the phases mentioned in the ‘surgical rehabilitation’ section.
