Achilles Tendon Repair Introduction
Achilles tendon repair
Immediately following surgery, it will be normal to experience pain in your surgical site
It will be important during this phase to manage pain and swelling, and that information can be found in the Pain Management and Swelling Management section
Following surgery, you will remain in CAM boot until cleared by MD, and will be NWB (non-weight bearing) immediately after surgery.
Following the post-surgical precautions are crucial to ensuring your repaired achilles heals properly and preventing any complications
Achilles tendon precautions: NWB initially until cleared, avoiding any stretching into the calves and achilles, keeping the wedges inside the CAM boot until cleared
Lateral Ankle Ligament Repair Introduction
Lateral ankle ligament repair refers to repair of the ligaments of the lateral ankle, most commonly of the ATFL (anterior talofibular ligament) and CFL (calcaneal fibular ligament)
During the initial phase after surgery, protecting the surgical site, managing pain and decreasing swelling into the ankle will be important
Following surgery, you will remain in CAM boot until cleared by MD, and will be NWB (non-weight bearing) immediately after surgery.
Following the precautions set out by your surgeon will be important to ensure proper healing and to prevent any complications
Lateral ankle ligament repair precautions: Active ankle inversion, eversion, plantarflexion until cleared by your surgeon
Ankle Debridement Introduction
Ankle debridement involves “cleaning out” a joint by removing any bone spurs, fragments or damaged cartilage from your ankle joint
Immediately following surgery, it will be normal to experience pain in your surgical site
It will be important during this phase to manage pain and swelling, and that information can be found in the Pain Management and Swelling Management section
You will be classified as weightbearing as tolerated, meaning you will be allowed to place as much weight through your leg as you feel comfortable with.
Pain should be managed during this time and should not exceed 3-4/10, with 1 being minimal pan and 10 being excruciating pain.
Restoring strength and muscle activation will be important to prevent muscle atrophy and movement compensations
OATS Introduction
OATS procedure also known as osteochondral autologous transplantation involves taking healthy bone and cartilage from one area and implanting it into an injured area
With the OATS procedure, you will initially be placed in a cast in order to protect the surgical site.
Avoid impact to this area or any areas affected by this surgery, and follow the instructions of your MD before starting physical therapy.
Following surgery, you will remain in CAM boot until cleared by MD, and will be NWB (non-weight bearing) immediately after surgery.
Pain Management
Foam Rolling
The foam roller, massage ball, or massage gun can be helpful for relieving pain from stiffness and muscle guarding.
This foam rolling routine will address the muscles of the upper and lower leg.
Be sure to avoid putting pressure on the surgical site, and keep pain below 3-4/10.
Foam Rolling - Glutes
Sit on the foam roller and roll towards the outside of the hip. Gently massage the area by rolling up and down, and side to side.
This can be done for 1-2 minutes at a time, as often as necessary to relieve pain and soreness.
Foam Rolling - Quadriceps
Bring the foam roller to the front of the thigh. Gently massage the area by rolling up and down, and side to side.
This can be done for 1-2 minutes at a time, as often as necessary to relieve pain and soreness.
Foam Rolling - Hamstrings
Bring the foam roller to the back of the thigh. Gently massage the area by rolling up and down, and side to side.
This can be done for 1-2 minutes at a time, as often as necessary to relieve pain and soreness.
Foam Rolling - Calves
Bring the foam roller to the calf on the backside of the lower leg. DO NOT ROLL OVER THE SURGICAL SITE.
Gently massage the area by rolling up and down, and side to side.
This can be done for 1-2 minutes at a time, as often as necessary to relieve pain and soreness.
TENS
TENS (Transcutaneous Electrical Nerve Stimulation) can be helpful in relieving the pain following surgery.
Please purchase a Compex muscle stimulator, and follow the instructions provided in the video.
The TENS unit should be used for 20 minutes at a time, 3-4 times per day.
Swelling Management
Managing post-operative swelling is important for reducing pain, range of motion limitations, and inhibition of muscle activation.
Compression is a useful technique for improving blood and lymphatic flow towards the heart, and will be a key part of swelling management. Use of a compression wrap or sleeve during daily activity will be important.
Compression boots can be used for up to 30 min at a time, 1-2x/day, at the highest pressure level you are comfortable and is pain-free.
Ice should be used for 10-20 min at a time, with a 1:1 ratio of time spent on the ice to time spent off the ice. Prolonged exposure to a cold pack >20 min can damage sensory nerve receptors of the skin, leading to long term numbness. Use ice within these parameters as many times as you are able to each day, but a minimum of 3x. Ice combined with compression and elevation above the level of the heart is best practice.
Electric Stimulation for the outside of your lower leg can be used to simulate the pump action of musculature that normally returns blood to the heart. Stimulation can be applied in or out of the boot at an intensity level that produces visible muscle twitches without pain. Stimulation can be left on for up to 30 min at a time, followed by a 10 min rest, throughout the day during both rest and activity. This can also be combined with compression, ice, and elevation. A frequency of at least 3x/day is recommended.
Electric Stimulation for the front of your lower leg can be used to simulate the pump action of musculature that normally returns blood to the heart. Stimulation can be applied in or out of the boot at an intensity level that produces visible muscle twitches without pain. Stimulation can be left on for up to 30 min at a time, followed by a 10 min rest, throughout the day during both rest and activity. This can also be combined with compression, ice, and elevation. A frequency of at least 3x/day is recommended.
Electric Stimulation for the back of your lower leg can be used to simulate the pump action of musculature that normally returns blood to the heart. Stimulation can be applied in or out of the boot at an intensity level that produces visible muscle twitches without pain. Stimulation can be left on for up to 30 min at a time, followed by a 10 min rest, throughout the day during both rest and activity. This can also be combined with compression, ice, and elevation. A frequency of at least 3x/day is recommended.
Muscle Activation
Restoring and maintaining muscle activation is important following surgery.
These exercises should be performed 1-2x/day but it is important to make sure pain levels do not exceed 3-4/10.
If any of these exercises aggravate the surgical area, STOP immediately.
All exercises can be performed in boot/cast.
Resisted Dorsiflexion and Eversion
Sit with the ankle lifted in a comfortable position with a mini band placed around the ball of the foot using the other foot.
Contract the calf to point the foot and ankle in your full range of motion.
Perform this exercise for 3 sets of 15 repetitions.
If your surgeon has advised against this exercise at this point, or if this increases aggravation, STOP
Ankle Pumps
Sit with the ankle lifted in a comfortable position.
Bend the ankle up and down ensuring that you are contracting the muscles on the front and back of the lower leg.
Perform this exercise as often as possible for sets of 30 repetitions.
If your surgeon has advised against this exercise at this point, or if this increases aggravation, STOP.
Prone Knee Flexion
Lie on your stomach, and with your surgical leg, bend your knee, bringing your heels towards your hips.
If you had a surgical procedure involving the knee or if this causes any aggravation, STOP.
Perform this exercise for 3 sets, 10 - 15 repetitions with breaks in between each set.
Straight Leg Raise
Lie on your back with the unaffected knee bent.
Maintaining a straight leg position, tighten the quadriceps muscle on the surgical side and raise leg to the level of the opposite knee.
If you had a surgical procedure involving the knee or if this causes any aggravation, STOP.
Perform this exercise for 3 sets, 10 - 15 repetitions with breaks in between each set.
Resisted Plantarflexion
Sit with the ankle lifted in a comfortable position with a mini band placed around the ball of the foot.
Contract the calf to point the foot and ankle in your full range of motion.
Perform this exercise for 3 sets of 15 repetitions.
If your surgeon has advised against this exercise at this point, or if this increases aggravation, STOP.
Kneeling Plank
Position yourself on your elbows and knees and hold this position while maintaining proper core bracing.
If you had a surgical procedure involving the knee or if this causes any aggravation, STOP.
Perform this exercise for 3 sets, holding for 20 - 30 seconds or to fatigue.
Seated Knee Extension
Sit on a chair or box so that your knee is bent to 90 degrees.
Contract the quadriceps muscle and straighten your knee with a controlled tempo.
If you had a surgical procedure involving the knee or if this causes any aggravation, STOP.
Perform this exercise for 3 sets, 10 - 15 repetitions with breaks in between each set.
Kneeling Side Plank
Position yourself on your side, with elbow stacked underneath shoulder and shoulder, hips and knee in a straight line, lift your hips towards the ceiling and hold.
If you had a surgical procedure involving the knee or if this causes any aggravation, STOP.
Perform this exercise for 3 sets, holding for 20 - 30 seconds or to tolerance.
Side Lying Hip Abduction
Lie on your side, with your surgical leg on top.
Maintain hip positioning by ensuring hips are stacked on top of each other.
To perform this exercise, maintain a straight leg position and raise the leg towards the ceiling, without any movement from the hips or lower back.
If you had a surgical procedure involving the knee or if this causes any aggravation, STOP.
Perform this exercise for 3 sets, 10 - 15 repetitions with breaks in between each set.
Quadruped Reaching
Position yourself on your hands and knees, and while maintaining a braced core, reach your arms in an alternating pattern, making sure to prevent any tipping from the hips.
If you had a surgical procedure involving the knee or if this causes any aggravation, STOP.
Perform this exercise for 3 sets, 20 alternating reaches with breaks in between each set
Range of Motion
Introduction and Precautions
Restoring and maintaining mobility in the spine and lower extremity is important following surgery due to the period of immobilization, changes in gait, and decrease in activity level.
It is paramount that you do not break the ankle range of motion precautions from your particular surgery.
Lateral ankle repair: No plantarflexion, inversion, or eversion range of motion.
Achilles tendon repair: No dorsiflexion range of motion or calf stretching.
Ankle debridement: All planes of motion are allowed.
OATS procedure: All planes of motion are allowed.
Ankle Range of Motion: Perform ankle range of motion within your precautions, for 20 repetitions per direction. Do not move through pain.
If any of these exercises aggravate the surgical area, STOP immediately.