Rehabilitation of achilles tendon tears (operative and nonoperative)

The school of thought relating to optimal recovery after Achilles tendon rupture has evolved. While traditional protocols consisted of prolonged immobilization and restricted weight-bearing, early functional rehabilitation has now become the standard of care in both nonoperative and operative treatment settings. Early functional rehabilitation has demonstrated similar strength and range of motion outcomes to longer immobilization protocols, without an increase in rerupture rates. Some data further support improved patient-reported outcomes with early functional mobilization. This chapter discusses rehabilitation after Achilles tendon injuries and demonstrates sample early functional rehabilitation protocols for nonoperatively and operatively managed Achilles ruptures. Both global strategies for rehabilitation and specific exercises are discussed. Key differences among early functional mobilization protocols are highlighted between those undergoing surgery and those undergoing conservative treatment. Understanding the framework and principles of Achilles tendon rehabilitation can benefit clinicians and surgeons managing these injuries and physical therapists designing rehabilitative programming, in addition to helping guide patient expectations for recovery.