I need exercises for rehabilitation of a pulled Achilles tendon for a runner.
As always, please refer your client out to the appropriate medical professional (most likely a skilled Physical Therapist) for rehabilitation and ultimately to gain medical clearance/guidance prior to beginning training. Dealing with injury and rehab is well out of the realm of practice of a personal trainer.
To really get to the root of the problem, we need to dig a little into some kinetic chain (KC) concepts. The KC basically refers to the body as one functional unit (bones, muscles, nerves, organs, etc.). All of these components must work in an optimal synergy to achieve a high and injury-free performance. Athletes (particularly runners) are highly subject to repetitive stress. By this, I mean repeating the same types, ranges, intensities and speeds of motion, chronically over an extended period of time (i.e., days/weeks/years/careers/etc.). Sports are repetitive stress. When this repetitive stress goes unchecked and unaddressed, muscular imbalances can/will occur. These muscular imbalances can weaken the core and eventually lead to faulty movement patterns. These faulty movement patterns over time can expose themselves as injury and pain (possibly a strained Achilles tendon in this case). So, what's being stated is that ultimately you are probably dealing with a repetitive stress/flexibility based injury.
Muscular imbalances occur by way of:
- RECIPROCAL INHIBITION: The concept of muscle inhibition caused by a tight agonist, which decreases the neural drive of its functional antagonist (i.e. short/tight overactive psoas = long underactive glute). This results in altered force couple relationships, synergistic dominance, and leads to the development of faulty movement patterns and poor neuromuscular control.
- SYNERGISTIC DOMINANCE: The neuromuscular phenomenon that occurs when synergists take over for a weak or inhibited prime mover (i.e. the hamstrings take over for the weak glute above). This causes faulty movement patterns, which leads to tissue overload, decreased neuromuscular efficiency and injury (strained achilles tendon).
- ARTHROKINETIC DYSFUNCTION: A biomechanical dysfunction in two articular partners, resulting in abnormal joint movement (arthrokinematics) and proprioception (i.e. increased excessive pronation of the lower extremity(s) during functional movement patters).
Once you've got clearance, it will be important to not simply look at the achilles tendon in isolation from the rest of the body (I'm assuming that the injury wasn't a blunt trauma and was performance based). Runners tend to suffer from fairly predictable patterns of injury due to the repetitive nature of running. Specifically, I would suggest assessing your clients hip flexor ROM (i.e., ability to extend the hips). Athletes should have 10 to 20 degrees of passive hip extension. Research has shown that a tight Psoas (primary hip flexor) can reciprocally inhibit the glute max. This "weakened" glute can cause increased transverse plane compensations in the lower leg requiring the gastrocnemius/soleus to remain under eccentric tension for prolonged time, leading to repetitive micro-trauma to the achilles tendon (causing a possible achilles strain).
Begin with an Integrated Kinetic Chain Assessment and proceed with an integrated flexibility protocol. The following PTontheNET.com profiles and assessments will help guide you through:
- POSTURAL PROFILE by Lenny Parracino
- MUSCLE BALANCE OR FLEXIBILITY PROFILE by Lenny Parracino
- OVERHEAD SQUAT: TOTAL BODY PROFILE by Lenny Parracino
- A SIMPLE GUIDE TO STRETCHING by Lenny Parracino
- SELF-MYOFASCIAL RELEASE TECHNIQUES by Alan Russell
Some basic beginning exercise progressions that may help are:
- FLOOR BRIDGE
- FLOOR PRONE COBRA
- QUADRUPED OPPOSITE ARM/LEG RAISE
- SINGLE LEG MULTI-PLANER LEG REACH
Images and descriptions of these exercises can be found in the PTN Exercise Library.
You may also want to consider having conversation with your client about temporarily ceasing any running as this may impede on her or his post-rehab progress.