Rehabilitation and Return to Play Following Achilles Tendon Repair

Transcription

1

2 Rehabilitation and Return to Play Following Achilles Tendon Repair Monte Wong PT, DPT, SCS, ATC, CSCS Assistant Athletic Trainer/Physical Therapist Philadelphia Eagles

3 Mechanism of Injury 1.) forceful plantar flexion of the foot while the knee is extended (sprint start) 2.) unexpected dorsiflexion of the foot (stepping onto a curb or into a hole) 3.) violent dorsiflexion when jumping and landing on a plantarflexed foot

4 Achilles Tendon Rupture Full permission was granted on presenting this case by the athlete

5 Eagles vs. Texans 11/2/2014

6 I popped my achilles. It s gone

7 Achilles Tendon Rupture MRI- 11/3/2014 Confirmation of tear 3-4 cm proximal to the insertion of the calcaneus Evaluation by Foot and Ankle Specialist- 11/4/2014 Open achilles tendon repair- 11/5/2014

8 Achilles Tendon Rupture Fun facts: Had a contralateral achilles tendon rupture (2010) The location and type of tear was the same It happened at the same spot of the field

9 Achilles Tendon Rupture

10 Acute Achilles Tendon Repair Postop Protocol Plaster splint applied in OR to maintain plantarflexion for 2 weeks Remove and being gentle active dorsiflexion and plantarflexion (no passive stretch) Suture removal when incision healed (2-3 weeks) Strict NWB for 4 weeks

11 Acute Achilles Tendon Repair Post- op Protocol Begin WB in boot at 4 weeks with heel lifts that are gradually reduced in height Begin plantar flexion against resistance but avoid dorsiflexion Accommodate shoe with option of heel lift at 8 weeks

12 Acute Achilles Tendon Repair Postop Protocol Begin running activity at 12 weeks postop; pool helpful Avoid attempts at single limb heel rise for 4 months Anticipate gradual dorsiflexion- don t push it Expect return to play at 6-12 months, patient and position dependent

13 Protocol Modification 2 weeks plaster cast 2 weeks hard cast in neutral 2 weeks NWB in boot 4 weeks progressive WB in boot with heel lift 2 weeks progressive WB in shoe with heel lift No Ankle ROM exercises until 4 weeks

14 Protocol Modification Pool running at 12 weeks Follow up with surgeon at 4 months post op No football related activities until 7 months post op

15 Thoughts: Hypomobility Cast Time frame RSD/CRPS (decreased weightbearing) Goal setting: To be back stronger than ever

16 0-4 weeks- hip and knee ROM exercises 4-6 weeks Maintain hip and knee ROM Soft tissue/scar mobilization Joint mobilizations (subtalar and talocrural) Light AROM in all planes Toe intrinsic strengthening exercises Neuromuscular Re- ed

17

18 Week 6 Progressive WB in boot with gradual decrease in heel lift Each week, heel lift decreased in height Gait training Land (assistive device) Evenup device Continue to work on ROM through exercise and manual therapy

19

20 Week 8 Full Ankle AROM and PROM No antalgic gait in the boot No assistive device with ambulation Request on working on gait in the pool

21 Hydroworx Exercises Walking Side shuffles Cariocas Minisquats Step ups Lateral step ups

22 Week 10 Progress into shoe and wean off heel lift Restore normal gait Progressively wean off assistive device Aqua therapy Continue to work on ROM of the ankle Continue to maintain hip and knee ROM Can we finally bike yet???

23 Week 12 Follow up with team physician Progress to land based activities Strengthening and proprioceptive activities Coordinate with strength and conditioning coaches Start pool jogging Start Alter G

24 Achilles Tendon Repair

25

26

27 Week 16 Follow up with surgeon No restrictions to rehab Will be cleared for football activities at the end of June

28 Week 16 Full AROM and PROM of the ankle 5 out of 5 ankle strength in all planes Able to perform 10 heel raises without difficulty Running on the alter G, at least 90% bodyweight at 7.0mph with no issues

29 Goal: prepare to return with team for Phase 1 Offseason Program as tolerated (in 8 weeks) Work on linear running (speed, endurance) Work on change in direction (cutting, pivoting) Work on power (plyometrics) Work on agility (footwork) Work on sport specific skill patterns

30 Directional changes s T- test W drills Plyometrics 2 legged to 1 legged Multidirectional Change of surface Over obstacles

31 Agility drills Ladders hurdles Skilled patterns Routes Blitzes coverages

32 Current status: Per MD request, not engaging in full contact with team Participating in all activity with progressive ramp in reps Lifting with strength coaches with no restrictions

33 Pearls Good communication lines with both the surgeon and the athlete Set goals Progress in a forward fashion Keep it simple Always have a reason as to why you are doing what you re doing

34 Thank you