Physical Therapy
Information on Physical Therapy. Get your leg back in shape!
- Achilles Tendon Rupture, Overview of the recovery stages, exercises, physical rehabilitation descriptions and illustrations. by Eric Berkson, MD (Orthopaedic Surgery of Quincy, Massachusetts General Hospital)
- Achilles Tendon Physical Therapy Exercises [videos] (Thanks Johnk!)
- The first 10 weeks of recovery: Tom’s Exercise Guide
- Tom’s excellent Exercise Chart (In either Excel or pdf format.)
- Home Program for Ankle Exercises:
Ankle and Achilles Exercises At Home
(http://www.permanente.net/homepage/kaiser/pdf/6909.pdf) - Mitch has written an excellent guide on his page (Thanks Mitch!): Physical Therapy Info
- Dennis’s week 7 Physical Therapy exercise sheet.
- Some tips to beat a swollen Achilles tendon, and the pain that comes with it.
- This should be done only if you are well recovered from Achilles surgery. Be sure to get your doctor’s approval or your physical therapist’s approval before doing the following exercies: Calf Exercises.(Thanks Tom!)
- Water Rehabilitation for Achilles Tendon Rupture Recovery:
Water Rehabilitation for Achilles Tendon Rupture and video (Dr. Ross, thanks for finding this)
Some info about Physical Therapy
- Electrical stimualtion addresses inflammation, muscle strength and spasm. (thanks Ross!)
- Ultrasound deals primarily with increasing circulation to the area. (thanks Ross!)
I just posted an excellent pdf about ATR overview, recovery descriptions, rehab exercises, etc. Written by Dr. Eric Berkson
If you are starting out on this journey I think this is a good guide to read first.
(It’s the first one on the list.)
http://achillesblog.com/physical-therapy/
Dennis - I came across this link that has a lot of good calf stretching and strengthening exercises. However, I must say that these exercises should only be performed after consulting with your doctor or therapist. Most of the exercises are probably best done once out of the boot, or even further down the road.
http://www.netfit.co.uk/members/calf_exercises_muscle/calf_exercise_exercises.htm
Tom -
Thanks, I posted this on the main site, under “Physical Therapy”.
Has anyone heard of a machine called a DynaSplint? Apparently once hooked up, it moves your foot up and down by itself. My doctor wants me to use it every evening as part of my PT but i’m a little worried. I’ve never heard of it before.
leeisme - I haven’t used it, but it looks like it can be useful. If your doctor recommends it, then I think it’s fine. It looks like a great little device that’ll help you get your foot moving.
Hi all,
I just came back from my first post op Dr. appt. (8 days). I was shocked that they cut the cast off. It sure felt good for a moment.
Dr. said he has never seen anyone heal so fast. He said he could take out the staples today, but will wait until next week. Absolutely NO swelling, no bruising, and wound look healed.
He recasted me, at full 90 degrees. He felt the tendon and said that surgery went amazingly well. He said I can start putting weight on it next week.
Walking boot in 3 more weeks, at which time he will start me on PT. I am absolutely ecstatic.
He said I only had 4% of tendon left.
The wound was at least 10 inchs long. It started on my heal, hooked up a bit, and then up to the calf.
I forgot my phone, but will take pics next week.
The new cast is shorter, with more toe out and lower beneath the knee.
The nurse said that mine was a clean tear, like someone cut it, and that helped in surgery.
Dr. expects me walking without crutches at 9 weeks post op.
Mike
Mike R - sounds like you had a great visit…I loved that feeling I had after my first post op appointment. It was so good for me to see the wound. Happy Healing!
MIke R–
glad to hear the visit went well…The fact that it was a clean tear and not “spaghettied” (frayed) means that the fibers should heal quickly. Take it one day at a time.
Doc Ross
Dennis,
I am 54 in one week.
I injured my AT on March 18th, and had surgery on March 25th. I injured it hiking when I jumped down on a rock, and my toe hit without my heel, and heard the snap. I had to hike another 1/2 mile out of a steep canyon after I did it, and might have caused much more harm doing so, but will neve know.
Well, I am out of the cast and into the boot. I start PT next Wednesday, 5 weeks post op.
I took my boot off a few minutes ago for the kids to see, and it was shocked when I saw the sagging small leg muscle, especially next to my good one.
I tried to move my foot just a tad, and it doesn’t work too well yet! That was a very strange feeling. It that par for the course at 4 weeks post op?
Dr. said the tendon is healing strong, and to put 50 - 60 lbs. of weight bearing on it. I am ok to ride a stationary bike, which I am on my way to do right now.
He said I will be out of the boot in no more than 4 weeks.
What is the usual PT for the first week? i assume very light and lots of range of motion, right?
My PT is in mr Dr.’s office, and I have 5 weeks, three times a week.
He did say to keep the boot on all the time, except for showersand that I should be ditching the crutches in 2 weeks.
How did you guys do at 4 weeks?
Mike
Dennis,
I would like to be added to the atrpt. I tried and thought I set up my own blog, but I cannot find it
Off the the YMCA for my first bike work.
Mike
Mike R - I’ve added you to:
http://achillesblog.com/atrpt.php
Found your blog!
http://achillesblog.com/miker/
Mike R -
The PT was fairly lightweight the first week. Some ROM and some light resistance bands. My first PT was around week 7 though, and my ROM was pretty good.
I think you are right on par with the average. Brendan’s comment sums it up best:
Thank you guys for your posts…I have learned alot from you so far. This blog is awsome!
I have done the surgery on the 3rd of April and until now I am on cast, and my doctor wants me to visit him next week to remove the cast which will makes it total of 2 months on cast….is this normal?! I was unable to remove my leg for the past 2 months because of the cast, although i have heard on the net that its better to start moving the ankle to avoid having weak achilles tendon…and its better to start using the boot as early as possible….but I have not. I live in Dubai city and I am unable to find doctor that I trust ;-(
prince -
Are you bearing any weight on your cast foot? Well, I hope the averages at least give you a feel for what everyone is doing.
The earlier you start bearing weight, the less of muscle atrophy you’ll have. If you are still NWB, your doctor’s protocol does seem conservative.
I recommend that you also checking out: http://achillesblog.com/atrpt.com to see what everyone’s protocol has been like.
Thanks for putting up so much information. My doc had planned to have me in a hard cast for 3 months, but I discussed getting into a boot sooner last week & he said I’d have to go to another doctor - this is what he’s done and all he does (I had even taken in clippings from the medical journals/articles on the site and he glanced at them but would not consider researching alternative protocols). I called several other doctors and although my insurance will let me switch, I couldn’t find a doctor willing to take over care until 3 months post-op. Then, yesterday, I went into my doctor’s office for a medical release for work (I’d been working from home and was planning on going back to the office soon) and he agreed to switch me to a boot - however, he said I am doing my own thing as to how to progress since it is not his protocol. I was a bit surprised since I didn’t bring it up, but I figured I should take advantage of the opportunity and as long as I carefully research this (and get a qualified PT), I’ll be able to do this safely. As of the appointment yesterday when he took the 2nd hard cast off, he said it looks great.
So, I am in the boot & looking to see what ROM and other gentle things I can do safely. I’m at week 5 post-op (today) and at PWB (and have been for 3 weeks). These documents are a great resource to compare to other readings and to provide more details for when I am talking to the PTs.
Am I nuts for taking him up on the offer? Or is this worth doing it on my own for the benefits of being able to do ROM & other things before 3 months?
Has anyone here had a re-rupture or partial re-rupture? If so, does it feel like the original rupture when it happens? I hit the pool yesterday..7 1/2 weeks post op and was doing some walking in the pool with slight toe raises and then decided to do a lap with full kicking, etc., and I felt a twinge in the achilles. I immediately stopped and got out of the pool. Everything seemed okay, but today the scar looks different (small indent where the achilles originally ruptured) but I don’t feel any abnormal pain & I can still flex my foot and calf with no problems. Was also wondering if anybody knows anything about inadvertantly legthening the tendon due to too much stretching, etc., etc.? Has anyone else gotten in the pool at 7 1/2 weeks and used a kick board while kicking the length of the pool? Wondering if this is too much too early??? I appreciate anyones input on the above subjects.
My re-rupture did not feel the same. The pain the first time was like being hit with a bat, while the second time it was a sharp pain and a feeling that something kind of let go inside…. but I did not have surgery the first time, so it was not solid enough probably.
Hopefully you just over worked it with full kicking. I could not move my foot after re-rupture, it was painful and stiff.
I would ask for advice from the PT before doing full kicking.
Your foot might not be used to such fast moves, even if you are not bearing weight.
My surgeon told me not to swim when I asked at 6 weeks post op.
Hi Kevin,
If you have been doing toe/heel raises while walking without issue I would be surprised if swimming caused any serious injury. I haven’t been using a kickboard (don’t own one) but have been thrashing around at my comical ‘freestyle’ stroke at full throttle since 6 weeks and am considering taking my scuba fins along next time to increase the resistance, as it doesn’t feel close to the effort required to do a heel raise or pedal my bike (I’m at week 8.5 now).
As far as what a re-rupture feels like, I can’t say, but…the second time I went to the pool (around week 3.5 post-op) I slipped and weighted my bad foot, more than 50% body weight with no boot. That gave me a nasty twinge and it was sore for 24 hours afterwards, but everything turned out fine. My guess is that it may have been an adhesion tearing free. The pain was different to my original rupture, a sharp stabbing pain, whereas the ATR was more of an ‘electric shock’ sensation without normal pain (which I know is different to what many others experienced).
Good luck,
Dylan
Didn’t make it clear above that my ’slip’ was on the wet floor in the steam room, not in the pool, hence how I put so much weight on the foot!…
Hi Kevin,
I am 9 1/2 weeks into recovery from a total rupture and what you described sounds like a possible partial rupture.
As you mentioned an indent.
You might know by now what it is anyway.
Good luck to you.
Koru
For me this has not only been a journey of physical recovery but spiritual and mentaly as well as I needed a break.
I had to ask for help from a lot of my friends, to take my kids to school, do shopping , take me to the specialist etc.
I have taken this time to go within and appreciate time for healing and all the kind people that have come out of the woodwork, so to speak, to help me.
I just started driving again after 9 weeks taking care of me!
I do appreciate to have had this time and now I am ready to give back to what I received!
In July 08 I went through my first achilles surgery done by a Podiatrist. After weeks of being in cast, boot, and then physical therapy I continued to have pain. Ealier in March 09 I went to an Orhtopedic surgeon who did a different surgery in May 09. I am about four months out and PT was going great. I had been feeling good to the point the Doctor this past week released me from PT despite me telling him I was having a little pain. Possilby stepped on a stair wrong. I am finding that I may have reaggravated it base on the pain. Swelling and pain in the achilles and stinging in the heel. Has anyone ever gone through something like this? I hav ebeen dealing with this for almost two years.
Howdy everybody!
When I tore my ACL 6 years ago, I found a useful board similar to this and now that I’m recovering from my achilles, I’m glad I found this site. So much useful info and everyone sharing their experiences definitely helps.
As of today, I am 9 weeks Post-Op, FWB, and in a boot. However, I’m a bit concerned that I havent started PT yet. And according to my Doc, I won’t be until Mid-November (???) I know everyone’s recovery is different, but I didn’t have any complications post-op and was FWB at 7.5 weeks. I’m 28 years old and very active. I train 5 days a week and before my rupture, was playing basketball twice a week plus boxing. Not sure if its my “macho-ness” or ego thats making me anty, but I’m really starting to question why I have to wait 12 weeks before starting any physical therapy.
Any thoughts or advice would be great. Thanks!
- Kirby
“I’m really starting to question why I have to wait 12 weeks before starting any physical therapy.”
Indeed. So many of the doctors who do this surgery focus on what we “can’t” do, instead of what we *can* do. We tend to be fearful after this injury, so we typically do what they say.
I agree, 12 weeks is a very long time, unless your situation has unusual circumstances.
Good luck,
Doug
Maybe your doc is afraid of your macho-ness? He may think that if he allows you a little bit of work you will recklessly push yourself?
@Doug - Yeah, I hear you. I’m not one to make waves or question what my Doctor thinks is best for me. Koru’s post said it best that this is definitely a “mental trial” as well as a physical one.
@2ndtimer - Perhaps. We did discuss my lifestyle before the surgery so maybe its playing an impact on his plans for me. And to be honest, I probably would push myself, though definitely not recklessly or in a way that I might hurt myself again. I just think the fact that I cant “do” as much as I used to at the moment frustrates me.
Guess I’m just trying to gauge whether 12 weeks of no activity on the leg is average?
kirbynyc - welcome to the site. Just a quick question. I know that it was some time a go, but do you happen to remember where the ACL board was?
@Dennis: It was called Bob’s ACL Board. Definitely not as fancy as this blog, but there are a lot of helpful people as well and I think its still up.
As for an update, I’m thoroughly enjoying the boot. Feels so good to be walking again. After 3 and a half weeks, I get to see the Doc again this Thursday. Here’s to starting PT!!
Need advice! I am 9 weeks post op. Had my cast removed 7.5 weeks post op. Had extensive repair/reconstructive work done during surgery. Doc told me put as much weight on the foot/leg the day he removed the cast and begin PT pronto - which I did. I am walking (taking steps!! I wouldn’t call it walking!) with one crutch. Seems my foot is swelling quite a bit but with ice and elevation it goes down. About 5 minutes after I have it back on the floor - it swells up again. Is this normal? Also, I am having alot of nerve sensation in the rupture area and in the heel. Has anyone else had this occur?
Any info or advice is much appreciated!
thks in advance!
Hi Susan,
I am 8 weeks post surgery. I was in a cast for 6 weeks. Once removed I have been going to physiotherapy twice or three times a week. As soon as my leg came out of a cast I was told to be careful and to nurse it. The physio has been massaging it and has given me some exercises to get the circulation going.
I totally disagree with you doctor telling you to put as much weight on your leg as possible, there is no use rushing the healing process now that you have been through so much. Take it easy and be patient. Go to a physio and ask him or her advise.
I too had bad swelling but since the circulation has been better the swelling has gone down drastically. I too had the nerve sensation but after a while this too dissapears.
I am walking now but with a limp and a walking stick. But I am improving everyday.
Be patient is my advise.
All the best for the new year and happy healing.
Tim Martin
Hi Tim,
I will be 8 weeks post-op tomorrow. I have the circulation problem as well. When my leg is up, it is not swollen and the color is normal. When I hold it down, it changes to darker red-purpulish color. I have been doing PT for 3 weeks - mostly ROM excersises. What excersises do you do to improve circulation?
Thank you,
Marina
Hi Marina,
I am doing a lot of ankle an calf exercises and I am actually going to gym now and under a trainer am working on my upper legs, it really does help. Every evening I work my leg in the pool by dong plenty of kicking, I then take a hot bath then I massage my leg with a product called Iceman. I push all the swelling up my leg and I massage my lymph glands in my groin. This I have been told by the physio takes all the fluid out. You should try this as it does do a world of good.
I am also walking for a mile and a half, slowly with my walking stick.
I hope this helps and let me know how you are doing from time to time.
All the best,
Tim
Tim,
Thank you - this is very helpful! I will hopefully see the doctor today (it is snowing here so I hope he does not close his office) and will find out when I am allowed to walk. As of now, I am told to put my injured foot down and immitate the walking movement on crutches but not to walk on it. My PT would really like to get me walking but my foot needs to move another 20 degree to get to a flat position so will see what my doctor says. I cant wait to do to the pool.
What ankle and calf excersises are you doing? I am doing foot lifts up (30×5), alphabet (x5), and toe crutches (30×5). I am also keeping my foot on the floor trying to push through the heel as often as I can.
Have a great New Year and may all the trouble stay in 2009 and the 2010 bring you only health and happiness !
Hi,
My partner snapped his achilles just over 6 weeks ago. He was in a full cast for 8 days then a backslab/half cast. We went and see the ortho surgeon yesterday and all we got told was that when we got home for him to take the cast off and start stretching it. Nothing about support ie boot or strapping, and she doesnt want him to do physio as she thinks its best he does it on his own. I have been searching the web for stretches ect, as we are both sort of scratching our heads unsure of what he should be doing and how often or anything. She was very vague about the whole lot. Has anybody else had this happen or should we go seek a different dr and get some more advice. I honestly think he needs physio so we know the boundries and where he should be at, plus wether or not it needs some supporting still. we are both wary about the injury happening again *cringe* or him doing damage because of no real guidance. Cheers for any help
If it was me, I would finding another doctor. It sounds like the doc you saw doesn’t want anything to do with you once the surgery is completed. You need to find a physical therapist who knows what to do.
Hahh Gerry, you are so right. Its just like in Three Men in a Boat by Jerome K. Jerome -reading the medical enciclopedia you will conclude that you have every desease that is described there.
That said this site has been tremendous source of information and support for me - THANK YOU DENNIS!!!
mshap - you’re welcome!
happy healing!
I ruptured my Achilles tendon (actually about 70 to 80 % and then delamination) on 12/29/2009 had surgery on 1/6/2010 and NWB until 2/2/2010 and then a walking cast until 3/4/2010. It is now 2/14/2010 and I am now at home and shuffling around without my walking boot. I started PT with elector stimulation and mild flexibility exercises. I should probably say that I have had very little pain from since the rupture. The Dr. noted that I have more flexibility and strength and less swelling than most. The plan is for me to be in shoes on 3/4/2010 and doing more active PT and back to competitive tennis in June. I am wondering if those who are competitive athletes who have had a ATR how they have progressed back to competition?