Recovering from achilles tendon rupture

[Bubba Booey]

I'm hoping Bill Hartman sees this (and has some experience/thoughts):

On Feb 17, 2009, I completely ruptured my achilles tendon...I opted against surgery...instead I had it immobilized, using first a fiberglass cast then a walking boot, for nine weeks. I was full weightbearing for the last six weeks on the boot.

I have been out of the boot for 1 1/2 weeks, and for the past five days, have walked approx 3 miles per day, in an effort to begin strengthening the calf muscle.

My question is: when is it safe to begin performing full squats? I am normally accustomed to doing ATG squats....but recognize that full squats may put undue tension on my achilles.

I plan on going to physical therapy...but am curious what Bill thinks of doing full squats (e.g., can I perform them to parallel without worry of pulling on the scar tissue that has formed to reconnect my achilles)?

I did do bulgarian split squats on my good leg during these past nine weeks...so of course I have a major imbalance at this point. My thought would be to start with just the bar, and slowly progress up in weight over time.

Thanks!

[Cloud9Fitness]

Let me begin with saying the protocols for return to sport after Achilles rupture are being revised daily as the opinion on early mobilization continues to grow.

Now that you are weight-bearing I would suggest continuing full ROM with no load provided by a partner as tolerated to match your non-injured foot. I would also suggest beginning squats without the bar. Set the bar high and hold on to it and allow your upper-body assist your squat (imagine an assisted pull-up). The ATG squat will likely not affect your Achilles any greater than a squat to 90, but the eccentric load on the gastroc and soleus can be reduced with upper body assistance. As tolerated progress to body weight and additional weight as you feel comfortable. Patients of mine report with previous squats above 250lbs report moving to 135lbs squats within 2 weeks after full weight bearing (own weight daily for a week, 50lbs for two gym visits, 100lbs for two gym visits, 100+ etc). This schedule is completely experience based, no concrete protocols are set. Please not that their biggest complaint was the DOMs in there gluts and quads from a long layoff, not their Achilles.

In this time period you may also benefit from eccentric calf raises on a leg press machine from fully plantar flexed to neutral (no weight), fully plantar flexed to neutral (light weight) + fully plantar flexed to fully dorsi-flexed (no weight), and fully plantar flexed to fully dorsi-flexed (light weight). Non-controlled studies and experience have led people to perform similar exercises daily with weight increments of 20-30lbs/week or as tolerated.

I hope this gives you some helpful guidelines.

[Cloud9Fitness]

And to quickly answer your scar question...
Limited comparisons of early mobilization vs. immobilization groups report less scarring and sural nerve deficits in the early mobilzation groups. I suspect squats will not specifically increase adhesion or scar tissue.

[Bubba Booey]

Originally Posted by Cloud9Fitness

And to quickly answer your scar question...
Limited comparisons of early mobilization vs. immobilization groups report less scarring and sural nerve deficits in the early mobilzation groups. I suspect squats will not specifically increase adhesion or scar tissue.

I chose early mobilization, against the ortho's advice...I asked her to remove the fiberglass, below knee cast at three weeks, and provide me with a ROM walker boot. She advised non-weightbearing for three weeks...but I was full weightbearing during this time. I then adjusted the pins, providing for ROM from 20 degrees plantarflexion to 60 degrees.

I feel this early mobilization allowed for faster recovery, as the doc yesterday confirmed that the thompson test indicated results similar to my non-injured leg.

I like the idea of bodyweight squats, holding onto the bar initially.

My other thought is to perhaps do some bodyweight lunges, with the injured leg in front...but ensuring the foot is far enough in front of me to avoid dorsiflexion at the bottom of the lunge. I see you mentioned dorsiflexion in your information, but dorsiflexion beyond neutral still worries me...for risk of overstretching the achilles.

Thanks for your advice!