An Achilles tear/rupture is one of the most devastating acute injuries one can suffer with. This injury is usually due to a sporting cause, with up to 73% of injuries being sports related. Contrary to common belief, an Achilles rupture usually occurs with no preceding symptoms of Achilles pain/tenderness. It is almost always an acute and sudden trauma, resulting from forced ankle dorsiflexion whilst the tibia (shin) moves forward. To put it simply, it requires a large force that stretches both ends of the Achilles tendon. This ultimately leads to a failure of the tendon to tolerate the high tensile load.

Males are more prevalent then females. With males representing about 80% of cases. The onset of the injury primarily occurs between the ages of 30-49. Whilst the incidence in male athletes (before the age of 45) is approximately 5.4% according to data. The trauma of the injury and the significant functional impairments, lead to increased fear of returning to sport. For these reasons, a structured and evidenced based exercise rehabilitative program is crucial.

The symptoms of an Achilles tendon rupture, really point towards a simple clinical diagnosis. For those of us who have watched Australian rules football for example, are familiar with the athlete describing they heard a “snap” or “shotgun”. They then describe they looked behind them, as they believed they were kicked at the back of the leg. This description is common among athletes in contact sports. However, an Achilles rupture can occur in athletes such as ballet dancers and gymnasts. In fact, return to sport function in these athletes requires appropriate attention during the rehabilitation process. If these athletes lack strength in the ability to heel rise, then they will have crucial performance limitations.

The treatment for an Achilles rupture is either a surgical repair or conservative management. There has been a lot more athletes in modern times going down the conservative path of graded exercise rehabilitation. What treatment option you prefer will ultimately be determined by yourself, however education about similar results for both treatment options is important to know. The evidence for the best treatment option is highly debatable in the clinical research.

What seems to be in agreement however, is that early mobilisation seems to result in better outcomes!

One of the most important factors in an Achilles rupture is preventing elongation of the tendon as it heals. Elongation occurs as part of healing, with the amount of elongation correlating to heel rise height deficits long term. Heel rise height is crucial for strength, gait, and performance. With an increased tendon elongation, the amount of force generated by the calf complex is reduced. Furthermore, the degree of symptoms being worse is typically related to increased elongation.

How do we combat the structure of the tendon elongating?

In the first 6-8 weeks, the foot is typically placed in a CAM boot, where it has heel lifts to prop the ankle into a plantarflexed position (therefore, reducing tendon elongation). This results in the tendon ends meeting and healing can take place. The CAM Boot, allows early mobilisation with weightbearing (walking), with this occurring within one week of the injury.

Early mobilisation as was mentioned earlier is crucial for optimal outcomes long term. The early mobilisation in a controlled setting, allows the tendon to respond to load. This allows the tendon to be strengthened, with the load speeding up tendon strength in a shorter timeframe. Ultimately, the risk of re-rupture is reduced and importantly there is less tendon elongation occurring.

Return to Sport

An proper structured exercise rehabilitation program is needed to improve likelihood of returning to sport. Data at elite level basketball (NBA), found that 39% never returned to the professional level. Whilst those who did had a significant decrease in playing time and their performance. The rates of return to sport are similar for those having a surgical repair and those who went conservative management. Return to sport is possible (depending on the level of sport and the demands of that sport) in about 6-12 months. However, completing 12 months of appropriate rehabilitation is highly advised to reduce re-rupture probability.

The Reform Lab Osteopathy is unique in the fact, we provide our rehabilitation services out of the fully equipped elite gym Project Reform. This ensures, that your rehabilitation is not limited and you receive evidence based care.