PT on the Net Research

Achilles Tendon Surgery, Decreased ROM


Question:

I have a client who had Achilles tendon surgery about one year ago, but he still has decreased range of motion.

Answer:

Before truly answering this question, we must understand that there are many different variables that have not been answered. I will attempt to answer and assume some things for us to be on the same page. First, I am assuming that the doctor has given your client the o.k. to go back to training. I will also assume that your client is fully cleared.

With that said, we must first access why the surgery was originally done. Was there any acute trauma that caused him to need the surgery or was it repetitive stress? Is the range of motion on the post surgery leg vastly different from that on the other side? The reason I ask these questions is that most people have tight calves and limited range of motion at the ankle anyway. The latest estimates are saying over 90 percent of Americans have limited extensibility of their ankle. This lack of mobility is due to our sedentary lifestyles. Because most Americans work in a seated environment and wear some type of heels on their shoes, we are constantly in a state of plantar flexion. This causes the muscles of the calf to shorten and causes us to have decreased range in dorsi flexion. With that said, now we can address the issue of lack of movement.

There are steps on the continuum of flexibility. First, we must restore the health of the tissue. We do this by breaking up the deposits that have accumulated. Following surgery, there is a good chance that scare tissue has developed. I would recommend a stretch stick. The stick has little plastic balls that rotate. You have your client roll the stick over the tight muscles to help break up any adhesions that may be there. After "cleaning" the muscle, you are ready for corrective stretches. There are pictures of calf stretches in the PTN Exercise Library you should review. Although your client had surgery on the Achilles tendon, we as trainers can’t really target the tendon for extensibility. We are focusing on the muscles that connect to the tendon, which will in turn create the extensibility you desire. After completing a regimen of the previously mentioned items, you may advance to a dynamic stretch, which would involve continuous movement. One stretch I would suggest is to get into a staggered stance a few paces back from a wall. Concentrate on keeping your back foot planted and putting force through the heel. Lean towards the wall until your hands are up against the wall. Make sure your foot is pointing straight ahead. The motion loses almost all of it’s effectiveness if you let the foot point out. Lift your front leg so that your hip is at 90 degrees. Slowly swing the front leg to the left and right generating the force through the hip complex. Be sure to contract the inner unit to protect the lower spine. The rotation should be done in a very slow and controlled manner. Let your ankle go through pronation and supination as you rotate. This will increase the extensibility at the ankle and may help your client.

Always error on the side of caution before prescribing this type of exercise for your client. Any time you add momentum and load to an exercise the chance of injury increase three fold. I would suggest taking range of motion measurements with a goniometer before you start and every three weeks or so after you start your stretching program. If after three weeks of a monitored and systematic flexibility program there are no marked results, I suggest you refer him back to the orthopedic surgeon who performed the surgery.