As an injured person with a ruptured Achilles tendon, I underwent surgery to repair the Achilles tendon, and then went through external fixation in a cast, and then went through rehabilitation exercises and experienced some physical therapy means. Now I am recovering very well, and I am considered to be recovering better and faster than other injured people who are recovering by themselves. I would like to write my experience here and share it with my friends, and I also hope to give them a reference to have more knowledge about the recovery of this injury.
I want to discuss here first why the Achilles tendon is ruptured, except for a few people who cut it because of trauma, most of my friends are injured while playing sports. And I understand that a lot of friends are injured in a more fatigued state, we are using the body when we exercise, especially strenuous exercise will make the body’s functions decline rapidly, let’s say playing ball, we all know that the intensity of playing ball is great, but we usually have a good physical reserve? We have a very adequate warm-up activities? We usually play ball is the use of the body, but special training and adequate warm-up is to maintain the body, the body is like a car, just use without maintenance is not possible. When we exercise the body’s movement is directed by the brain, and then through the nerves and muscles to coordinate the action. Fatigue when the body in motion, in the implementation of brain instructions may be a little uncoordinated or less responsive, this uncoordinated response may cause the muscle to force the wrong way, which increases the chance of injury. On the other hand, it may be affected by drugs, there are a lot of cold medicine have inhibited the central nervous system, in general the instructions of cold medicine will be in the period of taking drugs do not drive, do not manipulate machinery and other reminders, these drugs containing inhibitory ingredients will also cause the body in the implementation of the brain’s motor instructions in coordination, taking drugs to participate in sports will also increase the chance of injury.
Whatever the reason, we are now injured, so it is more important to talk about recovery. Most of the injured are good sportsmen, are very concerned about the future is not still able to gallop on the field, the mood is understandably anxious. But this injury recovery is not a day or two, so first establish a good mentality is necessary to understand that this injury is one of the slowest recovery in sports injuries, but as long as the scientific recovery to return to the field is not a dream, there are many excellent athletes are also affected by this injury, after rehabilitation is not active again on the field it.
The post-operative recovery is phased, the first to face is muscle atrophy, after surgery to a longer period of external fixation, the basic movement can not do, the leg muscle atrophy is certain, then how to slow down the rate of atrophy it, to know the preservation of muscle strength is the basis for recovery later. Many friends began to think that all fixed what exercise ah, the doctor did not also say to rest well. In fact, there are also fixed exercise methods, very simple oh. Rehabilitation training should start from the first day after surgery, toe movement is necessary, which can not only prevent the atrophy of the inner foot muscle, but also a certain effect of swelling. During the period with the cast should strengthen the static contraction exercise, in addition, if the cast is short can do high leg raising, strengthen the quadriceps exercises, exercise should be careful not to slip, to avoid the forefoot of the injured foot on the ground. The general duration of external fixation is 4-6 weeks. Many friends start with a long cast in plantarflexion and change to a short cast near functional fixation after 3-4 weeks. The upper end of the Achilles tendon is connected to the calf flounder and gastrocnemius muscles, and the lower end is connected to the heel bone, which is a dense connective tissue that has a strong regenerative capacity. Most of the injured people have a cauda equina tear. If the suture strength is sufficient during surgery, which means that the repaired Achilles tendon is strong enough to heal in 3 weeks, the connective tissue should be fixed for a longer period of time to be on the safe side. There is also the case of secondary or old ruptures where the fixation time is relatively longer.
The second stage of recovery is to do after the removal of external fixation, after a long time of external fixation, finally the injured foot can see the light of day, is not the removal of external fixation can walk. The dorsiflexion angle of the injured foot is still at a low level, and the serious lack of strength, flexibility and balance are not enough to meet the functional requirements of normal walking. Without the protection of external fixation, this is still a dangerous time window for secondary rupture. (When it comes to the time window of secondary rupture, it is also divided into stages. Generally speaking, 6-8 weeks is the first dangerous time window of secondary rupture, when the external fixation is just removed, such as unexpected sudden weight-bearing on the forefoot, causing rapid plantar flexion reaction, it is more likely to occur secondary rupture, 10-12 weeks is the second dangerous time window At this time, the Achilles tendon is physiologically starting to replace the original fibrous scar with healthy tendon tissue, so strenuous exercise should not be performed, especially avoiding rapid forefoot weight-bearing. However, slow walking should not be a major problem in terms of time.
During the first two weeks of external fixation removal, weight-bearing exercises on the injured foot should be absolutely prohibited to protect the surgical site, and active exercises (by active exercises I mean exercises without any external force including one’s own body weight) should be the main focus at this time, with ankle pump, internal and external rotation, ring turn, and toe exercises becoming a daily compulsory course. The exercises for leg strength are still based on static contraction, standing straight leg raise and other exercises. The inability to walk does not mean that you cannot touch the ground. Due to the atrophy of the internal muscles of the foot, the injured foot will feel pins and needles when touching the ground at this time, so it is especially important to practice toe exercises. After sitting down, touch the ground with the injured foot or gently drag it on the ground to increase the sense of contact with the injured foot and prepare it for future walking exercises. At this time, you can make your own high heels to wear, which can protect the injured foot from plantarflexion caused by the rapid landing of its forefoot. Many friends are concerned about the adhesions at the Achilles tendon, but most of them are not very serious and will gradually improve as the function recovers.
From the third week after removal of the external fixation, you can do partial weight-bearing exercises (partial weight-bearing means weight-bearing between 15% and 100% of body weight, full weight-bearing means 100% of body weight. You can wear high heels and then let your heels hit the ground first if possible. (If you point the ground with the toe, the ankle joint is prone to rapid plantar flexion, when the Achilles tendon instantly increases, there is a risk of secondary rupture). At this point, use the crutches to support part of the weight, the weight supported by the affected foot can slowly increase with the further recovery of leg strength. The extension exercises of the Achilles tendon should still be active exercises, and some resistance exercises can be added, such as using a rubber rope to gently do resistance ankle pump, the strength should not be too large. Internal and external rotation exercises can also use the rubber rope to increase some resistance. If possible, you can also do the minimum resistance exercises on a bicycle rider, or do underwater gymnastics in the chest-deep water of the pool. This period is mainly a two-pronged exercise, on the one hand, the extension exercises, mainly active ankle pump, supplemented by internal and external rotation and ring turn. On the other hand is the exercise of leg strength, straight leg raise, supine air pedal bicycle action, resistance ankle pump, resistance internal and external flip, toe movement, etc.. The principle that we should master is to do what we can, not to overexert ourselves. When doing strength exercises, the movements should be slow, slow to collect and slow to release, so that it is a full strength exercise, if the speed of the movements is very fast, there is a lot of inertial force rather than a full movement.
To make it easier for you to understand the progress of rehabilitation, I have used the time unit of weeks to illustrate the stages. In fact, the degree of injury varies from person to person (partial fracture, total fracture, secondary fracture, and old fracture) and from person to person, so the progress of rehabilitation varies from person to person, and the pace of progress can be adjusted according to the specific situation of each person. For example, I have a good strength base, so I can increase the strength every 4 days. The transition between each phase is also very important. After the removal of external fixation in the 4th-6th weeks, if the strength recovery is still possible, you can gradually transition from partial to full weight-bearing. Heels should still be worn during this period, and the height can be reduced as the dorsal extension angle increases. You can gradually transition from double crutches to single crutches and then to canes, gradually increasing the weight bearing of the affected foot, using single crutches and canes should be used on the uninjured side, so as to share some of the weight. At this time, after a period of ankle pump exercise, the angle of dorsal extension can generally reach more than 90 degrees, at 90 degrees, you can start sitting heel lift training, through the heel lift to increase the strength of the posterior calf muscles.
In between, note that
First, not to pad the heel when the forefoot should not land. Second, fatigue in training should be instant rest. If the leg trembles, the training should be suspended. You can do micro-squat exercises with hand support to increase the strength of the quadriceps. Some of my friends’ back extension angle is not very ideal, so they are very anxious, there are psychological reasons for this, probably because they do not dare to do stretching exercises too hard, active stretching exercises should be safe. Hot compresses followed by extension exercise is also a good method. From the safety point of view, it is better to increase the back extension angle slowly and not to rely on artificially strong wrenching to increase the back extension angle.
After a few weeks of exercise, the strength of the legs should be able to bear the full weight, friends now most want to do is to walk normally. The adjustment of walking gait is divided into three areas. That is, strength, ankle mobility, and proprioception. For strength, both sides of the thigh, calf muscle symmetry is very important, for mobility, the ankle joint should be at least 95 degrees before the forefoot stomp action, on the proprioception, but also need to have a better sense of balance to do. Walking time should be gradual. If the walking time is 10 minutes per day at the beginning, increase by 5 minutes every three days, and reduce the amount if there is pain and discomfort. The principle of walking time should not exceed three quarters of the maximum time. However, walking training is definitely not a complete functional training. Ankle mobility training, muscle strength, muscle endurance training, proprioceptive training, etc. should still be practiced specifically. The heel lift exercises can be performed in a sitting position – high sitting position – standing position – single foot heel lift with hand support, and the body weight can gradually transition from the good foot to the injured foot in a process to gradually increase the intensity.
After 6-8 weeks of rehabilitation exercises, the angle of dorsal extension can generally reach 95 to 100 degrees, and excessive stretching of the Achilles tendon may cause lengthening of the Achilles tendon. At this time the gait is basically normal, some friends feel good at this time, but at this time it is still dangerous if they do running and jumping. There are also many friends who are very anxious to go to work, the gait is normal, but also consider the traffic problems, cycling is not desirable, in case of an accident with the forefoot to support is very dangerous. Squeeze BUS also need to be careful, let people kick to what to do? In the unit but also to solve the problem of going to the toilet and going up and down the stairs! This is not a good time to squat, the unit does not have a toilet how? Generally speaking, deep squatting is to be practiced only when the back extension angle reaches close to normal. Here we also need to talk about the skills of going downstairs (downstairs still need skills, normal people simply did not consider this problem, but for us this is indeed a problem). When you go downstairs, you should try to use the heel of the affected foot to land, the forefoot can be slightly forward, that is, the forefoot is hanging at this time, the side of the healthy foot to move down quickly to reduce the support time of the affected foot.
Friends are also very concerned about physical therapy, such as ultrashort wave, wax therapy or something, I personally think that this is only some auxiliary treatment means, can help reduce swelling, softening, beautify the scars, but definitely not instead of functional exercise. If you have the conditions, you can do more physical therapy, but the functional exercise must also be further enhanced with the recovery of strength and the increase of dorsal extension angle. The dense connective tissue of the Achilles tendon needs six months to complete the migration replacement, so in this six months, people like us who are rehabilitating themselves, do not carry out strenuous running and jumping, especially those who still want to return to the court, strengthen the strength of the ministries is also a full preparation for the restart of running and jumping exercise after six months. Do not fight unprepared battles oh. After six months, you can start special exercises. It takes nearly a year for our Achilles tendon to reach its highest strength. That is to say, close to six months of exercise, we are able to gallop on the field again. Some athletes recover quickly, but their relatively aggressive recovery means taking risks. We don’t need to take such risks, it’s safer to be relatively conservative.
Finally, I have summarized the principles of Achilles tendon rehabilitation through my personal experience: a good mindset, safety first, functional exercise is the top priority, and progress should be slow rather than hasty. Time, confidence, and perseverance are what will make us recover!
Achilles tendon rehabilitation takes a long time, confidence and patience are indispensable.
During fixation, prevent atrophy and elevate the leg with static contraction.
The first two weeks after the removal of the fixation, the heel is padded and not weight bearing.
Afterwards, weight-bearing slowly added, resistance to increase the force of a good way.
Muscle strength and mobility, the two together to grasp the recovery is fast.
Proprioception is also important, practice cat walk in a straight line.
Half a year to grow new tissue, special training to increase.