45 Responses to “ATR Rehab Protocols, Publications, Studies”

1. brendan, on March 8th, 2008 at 6:52 pm Said:

   Anyone know what ADL or AROM stand for in the workers comp post op guidelines document?

2. Ross, on March 8th, 2008 at 8:09 pm Said:

   Brendan..
   ADL= Activities of Daily Living
   AROM= Active range of motion

   just had surgery on my AT…I am chiropractor so I have dealt with the acronyms..let me know if you need anything else

   Ross

3. Stephanie, on March 16th, 2008 at 9:18 pm Said:

   one more thing before I go….I think I have saved so much money because I can only pick up things that I really need… No more shopping til I drop….LOL :O)

4. dennis, on March 16th, 2008 at 9:58 pm Said:

   Stephanie,

   I think I’ll have to add that one to: Bright Side of ATR

   Welcome to the ATR team. I wish you speedy recovery. How is the walking going for you?

5. Jim, on March 20th, 2008 at 9:14 pm Said:

   Dr. Ross, do you have chapter 6 from the article “About Tendons and Ligaments”? I would love to see that since it talks about the most effective rehab exercises.

   Thanks

   Jim

6. Doc ross, on March 24th, 2008 at 11:00 am Said:

   Dennis..

   Not sure if I sent this to you…but a good web of water rehab for ATR..
   http://www.hydroworx.com/rehab-and-performance-applications/sub-section.aspx?sectionId=1&subsectionId=5

   Doc Ross

7. dennis, on March 27th, 2008 at 1:00 pm Said:

   Good news!

   It’s taken a few weeks for me to get hold of this paper:
   Early Weightbearing and Ankle Mobilization after Open Repair of Acute Midsubstance Tears of the Achilles Tendon

   I was able to get it through a personal contact.. here it is:
   http://achillesblog.com/atr-rehab-protocols/

   It may be on this site temporaily as it’s an article you have to pay to access..

8. dennis, on March 27th, 2008 at 1:03 pm Said:

   If there are other articles that you wanted to read, but you could read only the abstract (requiring a fee or a subscription), please let me know, and I’ll see if I can also get those too.

   If there are issues with legality of this, then I’ll have to take it down at some point, and I may have to do my best to summarize the findings instead.

9. zurichfan, on May 30th, 2008 at 3:30 am Said:

   These were terrific! Thank you for sharing!

10. John Kelly, on May 30th, 2008 at 9:01 am Said:

    Dennis,

    As Doc Ross said donation time, keep up the good work !

    

11. Gonzalez, on July 10th, 2008 at 1:07 pm Said:

    Hi, I just had my op to repair my ATR 3 weeks ago I will be seeing my dic in a couple of days to remove the staples and replace the cast. Please advise what am I expecting to come when I see my doc for my first follow up? Thank you

12. catnboot, on September 4th, 2008 at 5:21 pm Said:

    Does anyone know if this injury, even after 1 or 2 years in recovery, means that the tendon is not as hardy as a tendon that has not had the injury?

13. lauran, on October 24th, 2008 at 11:53 pm Said:

    This is a very nice and interesting article which tells about ATR rehab.
    ———————-
    lauran
    Alcohol Rehab

14. Daniel, on January 6th, 2009 at 1:07 pm Said:

    hi, it’s been about 8 weeks after my surgery and my foot can move upto angle 80-90 degrees to my leg. my first rehab is tommorrow and I am getting a bit nervous about the “re-rupture”. Is it possible to be re-ruptured during rehab sessions?

15. delaneybill, on March 31st, 2009 at 7:54 pm Said:

    Anyone who is really interested in the article tendon_info.pdf that Dennis has posted here can find the book for sale at this URL
    http://www.redwingbooks.com/products/books/TenLigHea.cfm

16. Don, on April 26th, 2009 at 11:22 am Said:

    For people with chronic achilles tendinosis this new procedure may be of interest.

    http://www.sciencedaily.com/releases/2009/04/090423132910.htm

    Don

17. José, on May 24th, 2009 at 5:59 pm Said:

    Hi: My name his José and I ruptured my achilles tendon about 8 months ago. I went under percutaneal surgery, inmovilization for a month, and then rehab for about 10 sessions. After that I started riding my bike and i kept doing rehabilitation at home. Im prety ok now, it dosen´t hurt and the length is normal, however I have an abormal hipertrofy. I had ecotomography made and acording to the radiologist, it looks awfull. My question is. Is there any treatment for this at this stage?

18. ray, on July 16th, 2009 at 4:37 pm Said:

    Ruptured in January and reraptured 12 weeks ago
    I have now been walking without aids over 2 weeks
    Physio in the morning still very worried of another rerupture. I have had no surgery

19. trisportgirl, on July 16th, 2009 at 9:54 pm Said:

    Ray, what happened when you re-ruptured?

20. annieh, on July 17th, 2009 at 4:49 am Said:

    Ray,

    It might help us all to know how it happened (as trisportgirl has asked) and why no surgery? All sounds very strange,

    Annie

21. sam66, on September 7th, 2009 at 5:22 am Said:

    In case anyone is interested in reading any other journal articles relating to ATRs, most of them can be accessed for free on the PubMed website via:
    http://www.ncbi.nlm.nih.gov/pubmed/
    or http://www.pubmedcentral.nih.gov/
    Just put the search terms you want in the search box and click.

22. jim, on September 30th, 2009 at 4:29 am Said:

    Well I ruptured mine on 7-24-09 at work, 2 months now. Not using a boot anymore. Paramedic/firefighter age 53, getting along pretty well I think. can’t really find clear rehab guildlines. how long does it takes to get back to running and climbing and the whole ball of wax?

23. Kathy, on October 1st, 2009 at 12:29 pm Said:

    rupurted mine 2 years ago ,no sugery cause no insurance ,so now my left lag muscles are still so weak what do i do?

24. Doc Ross, on October 2nd, 2009 at 4:05 am Said:

    Kathy
    Sorry to hear about the muscles. 2 years post op means that everything has healed as best as it will. In order to truly reach maximum medical improvement with this injury it is my opinion that surgery is the best option. Hopefully things have changed with respect to insurance. Make an appt with a orthopedist or podiatrist for recommendations.
    Good luck and I hope it works out.
    Doc Ross

25. James, on October 30th, 2009 at 8:46 am Said:

    I came across your page at http://achillesblog.com/atr-rehab-protocols/. I wanted to suggest adding a link to http://www.BioMedSearch.com. This is a free site that aggregates biomedical literature, similar to NIH’s PubMed (and in fact contains all of PubMed’s documents, plus more), but more comprehensive.

    While it already has more documents than PubMed, shortly several million additional full-text documents will be added that are not available anywhere else on the web, making BioMedSearch clearly the most comprehensive place to search biomedical literature.

26. Big Horn Bret, on November 12th, 2009 at 7:32 pm Said:

    Are you aware of any nutritional studies that indicate foods, vitamins or supplements that can assist with recovery and/or maintaining healthy connective tissue? I tore my gastroc last spring and my Achilles last week…wonder if I have an age (45 yrs old), genetic, training, or other issue. Awesome website that has been helpful to become knowledgeable so I can ask the right question of the doctor and physical therapist.

27. bosuntom, on November 24th, 2009 at 10:20 am Said:

    Cannot afford surgery as my insurance has recently lapsed. Is there any possible self-tratment for ruptured AT that might allow me to resume hillwalking and an active life. I am 66 and until this injury (3 weeks ago) I was always very active (walking/cycling/climbing rigging)
    I find it hard to accept I’m destined to be couch-potato.
    PLEASE help with any practical advice

28. linda atterton, on December 5th, 2009 at 10:45 am Said:

    What’s the difference between expected discomfort following advised trial of walking in boot without support and actual damage or god forbid re-rupture, how did people know?
    Thanks

29. Speedy Steve, on December 14th, 2009 at 9:22 pm Said:

    It’s nice to see and use this site. Spent a couple years with achilles problems that were probably small tears. Then had a bad “partial” tear on May 5, 2009. Never really recovered and limped around for 6 months and couldn’t regain strength. Then had a complete rupture November 20 and surgery November 24. I hear it can be a long hard recovery so I have been searching for info on rehab. You all know the normal questions like should I be moving more or resting…etc. The info here is very helpful. Thanks

30. Scary Larry, on December 16th, 2009 at 3:02 am Said:

    Scary Larry (54) from BC Canada says:
    I had ATR Surgery Aug.09/09 following a waterskiing mishap. I have been grateful for the information found in the ATR blogs as the surgeons do not offer an abundance of info. I had no idea how serious this injury was until I read up on it while waiting for surgery. Here is a record of my progress to date:
    Cast - 3 weeks (was not told to move toes as much as possible -which would have helped with swelling)
    Walking Boot - 4 weeks with physio / hydro pool / band exercises / light weight bearing / ditch crutches
    Stationary cycle and eliptical trainer were very helpful
    Riding Mountain bike -@ 9 weeks -gentle terrain -pushing with heel (not recommended-but I couldn’t help it). Walking with pronounced limp - short distance
    10-12 weeks - walking with less pronouced limp
    - Biking - moderate terrain / Walking at a brisk pace on the treadmill (bare feet) is a big help in returning to a normal walking gait (as I found I have to overcome the “habit” of limping). Now walking with slight limp
    16 weeks - the Big Test - Downhill Skiing Begins -spent several evenings walking around with ski boots on to ensure there were no new pressure points.
    Skiied moderate terrain - taking great care not to fall. Properly fitted ski boots offered great support and did not aggrivate the AT.
    17 weeks - skiing as prior to ATR . (just notice turns to injury side are weaker - careful not to push it)
    18 weeks - gaining strength - but no clalf raises yet.
    Note: I found that a tensor wrap helps with support and greatly reduces swelling.
    Hopefully some will find this info both helpful and encouraging.

31. normofthenorth, on June 3rd, 2010 at 12:50 pm Said:

    I’ve just started slogging through the various linked reports and web-pages that Dennis has linked above, and I find it a “mixed” group. Naturally, many of them were current in early 2008 when D tore his AT, which was a time when the consensus was still that surgery produces better results than non-surgical immobilization. (Heck, that’s why I had my first ATR repaired surgically, in late 2001! But not my second one, in late 2009.)

    If anybody wants to see a copy of a fairly fast rehab protocol that’s been proven to produce good results in a large number of patients, both WITH and WITHOUT surgery (and you SHOULD!!), I’ve posted one at http://achillesblog.com/normofthenorth/the-non-surgical-protocol-ive-been-following/ . It was faxed to my sports-med surgeon by the staff at U. of W. Ontario that did the latest randomized study of “op” vs. “non-op”. The discussion of that protocol and that study and others is on my blog, on the page that D has linked above (with “Thanks Norm”).

    For those pondering or facing ATR surgery, D’s first link above on that subject. entitled “Surgery or Casting, a meta analysis. Debate continues” is a very interesting article, but I don’t think it’s really about “Debate continues”! (Except maybe in the US, which is so biased in favor of ATR surgery that anything that shows that it’s not useful is considered a “debate”!)

    Here’s the “bottom line” of that article:
    “In Conclusion

    [b]Based on a critical analysis of the best available evidence, active, healthy adults with acute Achilles rupture should undergo conservative treatment with functional bracing and early weightbearing.”[/b]

    (1) That sounds much more like “Debate Over” than “Debate Continues”, doesn’t it?
    (2) “functional bracing” means a HINGED BOOT. That’s my fave “appliance”, too, after two ATRs!
    (3) “Early weightbearing” in this article means starting immediately, post-op or post-non-op. The article cites two studies that show benefits from that “instant” FWB, which I haven’t read yet. That is MUCH quicker than in the UWO protocol that I followed, which (a) included 2 weeks of NWB and 2 weeks of PWB, (b) used a FIXED boot not a HINGED one, and used it for EIGHT weeks, so ankle flexion was only in PT and home exercise until then.

    Below that link, we find “WebMD’s nice overview on ATR surgery and whether it’s right for you.” I find this much less “nice” than Dennis does, because it repeats a number of pro-surgery myths that have been disproven by the best and newest studies — higher AT strength from surgery, better performance in sports from surgery, etc., etc. It seems like a typical US-based pro-surgery “summary”, whose bottom line hasn’t changed since the last 4 studies showed that it’s based on old myths. Misleading vulnerable people who’ve just had a crushing injury and are facing an important decision is NOT “nice”, in my books!

    BTW, I am this site’s biggest fan, recommender, and participant, so please don’t take these comments as putting down “our” Dennis! He’s put together the best site on the Internet on this subject, working harder and better at this “sideline” than many of work at our jobs! And he’s still “spilling blood” over it, almost 2.5 years after his own ATR! God Bless, and Please Don’t Stop!

    Unfortunately, the job of maintaining a full and balanced and up-to-date Annotated Bibliography of ATR Rehab Protocols, Publications, and Studies is a monster job, which I think no FIVE of us have the energy to do. . . Heck, huge “professional” sites like WebMD SHOULD be doing a good job of it, and they’re blowing it badly, IMHO!

32. normofthenorth, on June 25th, 2010 at 2:43 am Said:

    I’ve started a little “crusade” to get a bunch of other websites — including WebMD — to stop repeating the old myths. Details on my blog, in the comments to the “surgery vs. non-operative” page. Others I’ve contacted recently include Mayo Clinic and U. of Michigan. No substantive responses back yet, but it’s only been a day or three.

    The Wikipedia article now generally speaks the up-to-date truth, but that’s because I edited it myself! I fear that some pro-surgery person will reverse my edits, but they’ve stayed put for a couple of days so far.

    So it’s possible that the link to WebMD can stay put, and WebMD will start presenting “the whole truth”. . .

33. Chris, on June 25th, 2010 at 5:19 am Said:

    Had op 7 weeks ago!! Had been in 3 casts 2 weeks in each! Now in boot for the last week, Have had some rubbing on scar which had made leg painfull, have been walking around house without boot slight pulling on scar but not painfull! Able to walk with limp with limited heel to toe movement! Is it best to wear boot all the time, Am I doing damage? Have boot for another 3 weeks!

34. jski, on June 25th, 2010 at 1:16 pm Said:

    Chris-
    My suggestion would be to use crutches with the boot while easing into a heel-toe gait and do not start walking without the boot until you can walk normally in the boot without crutches. Take the boot off for PT and be VERY careful if moving around without it. Keep the boot on most of the time and avoid setbacks.

35. normofthenorth, on June 25th, 2010 at 3:07 pm Said:

    Chris, lots of patients here walked around the house bootless before being told to do so. Most did OK, some not so much. At 7 weeks, if you keep your “bad” foot in front of the other one, and if your foot doesn’t complain from the weight, and if you avoid “false steps” (be careful, no distractions, watch where you’re going, etc.!), then you’re likely to be OK. Many new protocols call for weaning off the boot starting at 8 weeks, sometimes sooner,

    Why are you limping in the boot? If it gives you full support, so you can roll over the boot’s toe with your shin (and the top of the boot) taking all the strain off your ankle, you should be able to boot-walk pretty straight, and fast.

    If the bottom of your foot is rebelling against the pressure of FWB, that’s not uncommon. Solutions include delaying the FWB and/or padding your foot with soft footbeds and the like.

36. mikek753, on June 27th, 2010 at 2:57 am Said:

    Chris,

    at first make sure you can balance on one leg in the boot
    and you should NOT have any pain doing it
    than only stay on one foot hanging for something and than balance on one foot.
    I would NOT recommend barefoot right away, use 1+ cm inserts in shoes to reduce pressure on tendon.
    All those are logical steps and your foot just might not be ready for this after so much immobility!!!

    Ask your PT and do it first under supervision!!!
    Think about risk management.

37. Chris, on June 28th, 2010 at 7:13 pm Said:

    Thanks for the advise! Ended back in hospital as scar was infected!! (not a blood blister as I thought) Scar had been rubbing on stich in tendon It has been cleaned and I am back on antibiotic’s for a week. It is alot better wearing the boot no pain at all now! Thanks for your advise I will try and not rush my recovery! Have been told it is best not to drive for 6 months do you think this is a little over the top! Have read that you can resume driving a manual after 12 weeks! And my wife’s driving scare’s the hell out of me!!

38. GerryR, on June 28th, 2010 at 8:08 pm Said:

    Chris,
    I have to have a lot of experience with infections caused by the internal non-absorbing sutures that are used for ATR repairs. I’ve had four surgeries as a result of the internal sutures, the last one being on May 20 to remove them entirely because they had created an abscess which no amount of antibiotics could fix. For the first time since about early August I do not have a large lump on at the site of the original incision. I’m back in PT full speed now and may actually be able to resume running in another week or so. I hate to sound pessimistic but you may well be headed for the same thing I ultimately had to do. There is ample evidence available that the braided internal sutures they use can and do cause infections and abscesses. I had to shop around for a surgeon who would listen and ordered an MRI which showed the abscess.

39. charmcity, on July 6th, 2010 at 5:24 pm Said:

    I am six weeks out from surgery on a total ATR, in a hinged boot, and walking carefully at home on bare feet. I went swimming and pool walking this past weekend for the first time. The tendon is tight, but I feel like I am making good progress with walking and stretching exercises. Does anyone have an opinion as to whether physical therapy is necessary? If I had unlimited time and money, I would not hesitate to do it, but if I am making progress on my own, is it worth it?

40. gunner, on July 6th, 2010 at 5:28 pm Said:

    I’ve had great success using a PT. Been about 8 times (now 18 weeks post ATR) and received continuous adjustments to my exercise regimen as the tendon and leg permitted, including different drills to do in a pool. I’d recommend you try it if you can find a good PT, tell him/her your situation and work out a schedule you can afford. Also, take Norms (normofthenorth blog) protocol and get a specific set of exercises for each 2-4 week progression.
    Glad to hear you’re in the pool. Feels great, doesn’t it?

41. jski, on July 6th, 2010 at 11:30 pm Said:

    charmcity,

    Formal PT is great if you need instruction and motivation, otherwise it might not make sense if you are on a budget and doing well without. If you are unsure of yourself definitely try a few sessions. If you are walking, swimming, exercising, and stretching for the purposes of rehab then you are already in physical therapy and you are the therapist.

    I have a medical professor, an ER doc, and a PT in my family. Do I ask for their advice? Sometimes, but not for my ATR rehab.

    Take care.

42. espaa, on July 14th, 2010 at 3:08 pm Said:

    HOLA ! just found this site, looking for help after a total Achilles tendon rupture while jumping of joy while watching my team, Spain, win the World Cup….seriously…just jumping when they scored during quarter finals, and POP it went..sooo weird, but I knew exactly what had happened.
    Had surgery already, on a cast now for 10 days and then we´ll see.
    Looking for the best way and fastest to recover from this.
    I´m not an athlete, but I was before, I am a busy mom of 2 young kids and will settle to be able to ski again.
    Thank God Spain won the Cup in the end…..my cast decorated with Spanish flags.
    Thanks
    Ana

43. normofthenorth, on July 14th, 2010 at 5:29 pm Said:

    No problem being able to ski again, maybe even at the very beginning of the season. (I spent a week at Whistler starting at 17 weeks, no problem — at least to my AT!)

    One good modern REASONABLY fast recovery protocol that produced very good results (with and without surgery) in a careful study is at bit.ly/UWOProtocol . For one of the FASTEST ways to recover post-op, you should check achillesblog.com/doug53 . Nobody’s done a study to check the re-rupture rate going at that speed, but Doug healed fine — 100% success, 0 statistical significance!

    BTW, how are you so clever that you “knew exactly what had happened”, when so many of us didn’t have a clue?

44. GerryR, on August 15th, 2010 at 11:59 pm Said:

    Why is it that spammers always have really poor grammar.

45. KristinWA, on August 22nd, 2010 at 6:51 pm Said:

    To Espaa,
    I also popped my achilles during the World Cup. The event was when Landon Donavon scored after the 90th minute. Overall, I was rooting for Spain to win!! Yeah!

    I am in an aircast, with partial weight bearing. I see my OP on Wednesday and am really looking forward to some PT. I have not read too many rehab protocols but I think mine must be somewhat conservative. I wonder why so many people rerupture or have their other side rupture. I think my foot and ankle were feeling funny for a good while before the break. I noticed the link questioning the fluoroquinolone connection had disappeared. quite a few years ago I had a reaction to Cipro and wonder if there could be a connection to the breakdown of my tendons.

    Could someone point me to a discussion on this board that explores this possibility? Thanks. THis is a great resource.

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