1. On the rehabilitation after Achilles tendon rupture repair [turn] [practical]/s/blog _ 50d37d0601008tho.html

As an injured person with achilles tendon rupture, I underwent surgery to repair the achilles tendon, plaster external fixation, rehabilitation exercise and some physical therapy. It's recovering well now. Among the injured friends who recovered from self-exercise, my recovery speed is relatively good. Many friends in the group asked me a lot of questions about recovery. I think my friends trust me. On the other hand, my recovery situation is ideal, and my friends are eager to recover soon, so they will exchange recovery experiences with me. I want to write down my heart here and share it with my friends. I also hope to give my friends a reference and let them know more about the recovery of this injury.

I want to discuss the cause of achilles tendon rupture here. Except for a few people who were broken by trauma, most of my friends were injured in sports. And I learned that many of my friends were injured in a state of relative fatigue. When we exercise, we use our bodies, especially strenuous exercise, to make the function of our bodies decline rapidly. For example, let's play ball. We all know that the intensity of playing ball is great, but do we usually have a good physical reserve? Do we have enough warm-up activities? We usually play ball with our bodies, but special training and full warm-up are all for maintaining our bodies. The body is like a car, it is impossible to use it without maintenance. When we exercise, our body movements are directed by the brain, and then we coordinate our movements through nerves and muscles. When the body is tired, it may be a little uncoordinated or not so sensitive when executing brain instructions. This uncoordinated reaction may cause the muscles to exert their strength in the wrong way and increase the chance of injury. On the other hand, it may be affected by drugs. Many cold medicines contain ingredients that inhibit the central nervous system. In the instructions of general cold medicines, there will be reminders not to drive or operate machinery during taking the medicine. These drugs containing inhibitory components can also cause the body to be uncoordinated in executing brain motor instructions, and participating in sports during taking drugs will also increase the chance of injury.

For whatever reason, we are injured now, so we should talk more about recovery. Most of the injured friends are good athletes, and they are very concerned about whether they can gallop on the court in the future. Their urgency is understandable. But the recovery of this injury is not a matter of one or two days, and it is necessary to establish a good attitude first. It should be understood that this kind of injury is one of the slowest sports injuries, but as long as it is a scientific recovery, it is not a dream to return to the stadium. Many excellent athletes have also suffered this kind of injury, and they are no longer active after rehabilitation.

Postoperative recovery is staged, and the first thing to face is muscle atrophy. Postoperative external fixation is needed for a long time, and basic exercise can't be done. Leg muscle atrophy is certain, so how can we slow down the rate of atrophy? You should know that the preservation of muscle strength is the basis of later recovery. At first, many friends thought that they could do any exercise when they were fixed. The doctor also said that they should rest. In fact, there is also a fixed exercise method, which is very simple. Rehabilitation training should start from the first day after operation, and toe exercise is necessary, which can not only prevent the atrophy of muscles inside the foot, but also reduce swelling to some extent. Static contraction should be strengthened during plastering. In addition, if you are playing short plaster, you can do leg lifts and strengthen quadriceps exercises. Be careful not to slip and avoid the forefoot of the injured foot touching the ground during exercise. The general external fixation time is 4-6 weeks. Many friends began to fix the plantar flexion with long plaster, and changed it to short plaster after 3-4 weeks. The upper end of Achilles tendon connects soleus muscle and gastrocnemius muscle of calf, and the lower end connects calcaneus, which is a dense connective tissue with strong regenerative ability. Most of the injured friends are ponytail tears. If the suture strength during the operation is sufficient, that is to say, the strength of the repaired achilles tendon is stable enough, the connective tissue can heal within 3 weeks. To be on the safe side, it needs long-term fixation. There is also a second fracture or old fracture of the injured will be relatively extended for a fixed period of time.

The second stage of recovery is what to do after the external fixation is removed. After a long period of external fixation, the injured foot can finally see the light again. Is it possible to walk without the external fixation? At this time, you can't leave in a hurry. At this time, the backward extension angle of the injured foot is still at a low level, the strength is seriously insufficient, and the flexibility and balance are reduced, which is not enough to meet the functional requirements of normal walking. And without the protection of external fixation, it is still a dangerous time window for secondary fracture. (when it comes to the time window of the second fracture, it is also phased. Generally speaking, 6-8 weeks is the first dangerous time window for the second fracture. At this time, if the external fixation has just been removed, if the forefoot has unexpected load, it will cause rapid plantarflexion reaction, which is more likely to cause secondary fracture. 10- 12 weeks is the second dangerous time window. At this time, the achilles tendon is. But from the time point of view, walking slowly should be no problem. The third time window is the preliminary practice of jumping, and the practice of jumping should also be carried out step by step through simulated jumping, small jumping and big jumping. Generally speaking, it is the key to prevent secondary injury to avoid sudden force on the forefoot. When the external fixator was just removed, most friends would find that their injured feet were swollen and the achilles tendon was thick and hard. This phenomenon is normal. Take it easy. At this time, the achilles tendon has healed, but it is not a normal tissue structure. It is a fibrous scar tissue with poor elasticity, so it is thick and just normal. With the completion of tissue reconstruction, the achilles tendon should gradually soften and harden. In order to solve the problem of swelling, many friends know to soak their feet with traditional Chinese medicine or warm water, but some friends think that ice compress is better. Isn't this hot and cold contradictory? Why use it at the same time? As mentioned above, the achilles tendon has healed, but it has not yet formed a normal tissue structure. Coupled with the trauma caused by the operation itself, many capillaries have been destroyed, and it will take time to form a good blood circulation. Soaking feet with traditional Chinese medicine and warm water can promote blood circulation, remove blood stasis and soften tissues, which is a good auxiliary method before stretching. We will feel a little swollen and sore after exercise. If ice is used here, the capillaries will contract, which is effective for detumescence and pain relief. In other words, the process of hot compress-stretching exercise-muscle strength exercise-flexibility exercise-finishing exercise-ice compress can be adopted. It should be noted that hot compress, that is, the water temperature of soaking feet should not be too high, just warm water. The water temperature used by many friends is too high, which aggravates the swelling.

In the first two weeks after the external fixation is removed, it is absolutely forbidden to carry out weight-bearing exercise on the injured foot and protect the surgical site. At this time, we should take active exercise (the so-called active exercise refers to the exercise without any external force, including our own weight), and ankle pump, varus, rotation and toe exercise should become compulsory courses every day. Leg strength exercises are mainly static contraction, standing straight leg elevation and other exercises. Being unable to walk doesn't mean you can't touch the ground. Because of the atrophy of the muscles inside the foot, the injured foot will feel tingling when it touches the ground, so it is particularly important to practice toe movement. After sitting down, touch the ground with the injured foot or drag it gently on the ground to increase the contact feeling of the injured foot and prepare for the future walking function exercise. At this time, you can wear homemade high heels, which can protect the injured foot and prevent the plantar flexion reaction caused by the rapid landing of the forefoot. Many friends are worried about achilles tendon adhesion. In fact, the adhesion of most friends is not very serious. With the recovery of function, this phenomenon will gradually improve.

From the third week after the external fixation is removed, partial weight-bearing exercise can be carried out (partial weight-bearing refers to the weight between 15% and 100%, and complete weight-bearing refers to 100%. You can wear high heels and try to land your heels first. If you touch the ground with your toes, it is easy to cause rapid plantarflexion of your ankle. At this time, the instantaneous tension of Achilles tendon increases, which is in danger of secondary fracture. At this time, part of the weight is supported by crutches, and the weight supported by the affected foot can gradually increase with the further recovery of leg strength. The stretching exercise of achilles tendon should be active, and some resistance exercises can be added, such as gently making an ankle pump with a rubber rope, not too hard. You can also use rubber rope to increase some resistance in eversion practice. If conditions permit, you can also practice the minimum resistance of the bicycle riding machine, or do underwater gymnastics in the chest-deep water of the swimming pool. This period of time is mainly two aspects of exercise. On the one hand, it is malleable exercise, mainly active ankle pump, supplemented by eversion and rotation. On the other hand, it is the exercise of leg strength, such as straight leg lift, supine air pedal, ankle pump resistance, varus resistance, toe movement and so on. The principle that everyone should master is to do what they can, and not to push too hard. When doing strength exercises, they should move slowly, slowly and slowly. This is the whole process of strength exercises. If the action speed is fast, a lot of it is inertia rather than the whole process of movement.

Here, in order to facilitate everyone to understand the progress of rehabilitation, I used a week's time unit to explain each stage. In fact, the degree of injury of each of us is different (partial fracture, complete fracture, secondary fracture, old fracture), personal physique is also different, and the progress of rehabilitation varies from person to person, so we can adjust the progress according to the individual's specific situation. Like me, the strength foundation is better. Basically, I can gain some strength every four days. The transition between each stage is also important. 4-6 weeks after the external fixation is removed, if the strength can be restored, it can gradually transition from partial load bearing to full load bearing. At this stage, you should still wear high heels, and the height can be reduced according to the increase of the back extension angle. You can gradually transition from crutches to crutches, and then transition to crutches, gradually increasing the load of the sick foot. Crutches and canes should be used on the uninjured side, so that part of the weight can be shared. At this time, after a period of ankle pump movement, the backward extension angle can generally reach more than 90 degrees. At 90 degrees, you can start sitting lift heel training, and increase the strength of the muscles at the back of the calf through lift heel. In the meantime, note 1: it is not advisable to touch the ground with your front foot without the heel pad. Two: If you are tired during training, you should have a rest immediately. If your legs are shaking, you should stop training. You can do hand-held squats to increase the strength of quadriceps. Some friends are anxious because their back stretching angle is not ideal. There are psychological reasons for this, which may be that you dare not exert yourself when doing stretching exercises. Active stretching should be safe. Stretching after hot compress is also a good method. From the safety point of view, it is better to increase the back extension angle slowly than to increase the back extension angle by manual pulling.

After several weeks of exercise, the strength of the legs should be able to bear all the weight. What friends want to do most now is to walk normally. The adjustment of walking gait is divided into three aspects. Namely strength, ankle range of motion and proprioception. For strength, the symmetry of thigh and calf muscle strength is very important. For flexibility, the ankle joint should be at least 95 degrees before the front foot can be trampled. For proprioception, a good sense of balance is needed. Walking time should be gradual. If the daily walking time is 10 minutes at first, then increase it by 5 minutes every three days. If there is pain or discomfort, it can be alleviated. In principle, the walking time shall not exceed three quarters of the maximum time. However, walking training is definitely not a complete functional training. Ankle activity training, muscle strength, muscle endurance training, proprioception training, etc. , still need special practice. Lift heel exercises can be based on sitting posture-high sitting posture-standing posture-lift heel with one leg supported by hands, and the body center of gravity can gradually transition from good foot to injured foot, thus gradually increasing the intensity.

After 6-8 weeks of rehabilitation exercise, the dorsal extension angle can generally reach 95 degrees to 100 degrees, and excessive stretching of Achilles tendon may lead to elongation of Achilles tendon. At this time, the gait is basically normal, and some friends feel good at this time, but it is still very dangerous to run and jump at this time. There are still many friends who are in a hurry to go to work and have normal gait, but they have to consider traffic problems when they go to work. It is not advisable to ride a bike. In case of an accident, it is very dangerous to support it with your front foot. Be careful when you squeeze the bus. What if someone kicks you? At work, we have to solve the problems of going to the toilet and going up and down the stairs! At this time, it is not appropriate to squat. What if the unit doesn't sit? Generally speaking, squat can only be practiced when the back extension angle is close to normal. Here I also want to talk about the skills of going downstairs (do you still need skills to go downstairs? Normal people have never thought about this problem at all, but it is really a problem for us. When going downstairs, try to use the heel of the affected foot to come to the ground, and the forefoot can lean forward slightly, that is, the forefoot is suspended at this time, and the side healthy foot should move down quickly to reduce the support time of the affected foot.

Friends are also very concerned about physical therapy, such as ultrashort wave and wax therapy. Personally, I think these are just some auxiliary treatments, which can help reduce swelling, soften and beautify scars, but they can never replace functional exercise. Conditional friends can do more physical therapy, but functional exercise must be further enhanced with the recovery of strength and the increase of back extension angle. Achilles tendon, a dense connective tissue, takes half a year to complete migration and replacement. Therefore, in the past six months, people who are doing self-rehabilitation exercises like us should not run and jump violently, especially those who want to return to the stadium. Strengthening the strength of each department is also a full preparation for resuming running and jumping exercises after half a year. Don't fight an unprepared battle. Special exercises can be started after half a year, and it takes nearly one year to reach the highest strength of achilles tendon. In other words, after nearly half a year's exercise, we can gallop on the court again. Some athletes recover quickly, but their relatively radical recovery means also need to take risks. We don't need to take such a risk. It's safer to be relatively conservative.

Finally, I summed up the principles of achilles tendon rehabilitation through personal experience: good mentality, safety first, functional exercise is the most important, and the progress is relatively slow. Time, confidence and perseverance will make us recover!

Achilles tendon takes a long time to recover, and confidence and patience are indispensable.

Anti-atrophy during fixation, static contraction and leg elevation.

Release the fixation in the first two weeks and raise the heel without load.

It is a good idea to gradually increase the load and increase the resistance in the future.

Muscle strength and mobility, both events recovered quickly.

Proprioception is also very important. Practice the cat walking in a straight line.

After half a year, new organizations will grow and special training will be added.

Touching the ball after laying a good foundation is better than before injury.

Rehabilitation plan after achilles tendon rupture

Published by Liu Chongzhi on 2006-10-513: 36: 00.

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After our hospital successfully restored the Achilles tendon of Zhao Hongbo, the world champion of synchronized skating, many patients wanted to know more about rehabilitation treatment methods. For this reason, we also established the QQ group of Achilles tendon recovery. Some netizens summarized some plans based on our answers. However, any plan is dead, and only the real implementation is effective for yourself. Here is an introduction to the international Achilles tendon rehabilitation program. I hope you can learn more about it and restore your function as soon as possible in strict accordance with the doctor's requirements.

Achilles tendon repair and rehabilitation program

0-2 weeks:

The short leg bracket is fixed and the ankle is in a neutral position.

Under tolerable circumstances, use crutches to partially bear the load.

Ice compress+-local pressure/pulse magnetic therapy

Perform active plantarflexion, varus and valgus, knee flexion and ankle protection.

Anti-abduction training of quadriceps femoris, gluteus and hip joint

3 weeks:

The short leg bracket is fixed and the ankle is in a neutral position.

Use crutches to walk gradually with heavy load.

Active+auxiliary ankle plantarflexion/varus and valgus training (+-balance board training)

Accelerate the movement of ankle joints (tarsal joint, subtalar joint and tibialis joint) when ankle joint is in neutral position.

Anti-abduction training of quadriceps femoris, gluteus and hip joint

4 weeks:

Active ankle extension training

Resist active plantarflexion, varus and valgus with rubber elastic rope

Partial load gait training-constant speed and low resistance training (> 30 degrees/second)

Treadmill Training for Heel Rehabilitation with High Sitting and Low Resistance

5 weeks:

Take off the ankle brace, and some patients can go outdoors for training.

Leg-lifting heel training

Partial load-bearing gait training-equal resistance training in isokinetic exercise (20-30 degrees/second)

Low heel rehabilitation treadmill training

Crawl training (someone should protect you when you recover)

6 weeks:

All the patients were trained to walk on the flat ground outdoors.

Sitting posture routine Achilles tendon stretching training

Low resistance (passive) rotational muscle strength training (varus resistance, valgus resistance) two groups

One-leg balance training (gradual transition from healthy side to affected side)

Walking gait analysis

8 weeks:

Squat slightly under the protection of the ankle (Achilles tendon stretches under the premise of enduring pain)

Moderate resistance (passive) rotational muscle strength training (varus resistance, valgus resistance) three groups

Toe lifting training (high resistance soleus muscle training) when sitting and bending your knees

Toe-lifting training with knees straight in sitting position (high resistance gastrocnemius training)

Support the body weight on the balance bar and strengthen the autonomous gait training.

Lift heel training of standing posture+-EMG stimulation.

Re-education of gait under running platform

Treadmill training for forefoot rehabilitation (about 15 minutes)

Balance training (balance board)

12 weeks:

Standing leg triceps extension training

Heel resistance training in standing posture (toe landing, EMG stimulation if necessary)

Endurance training of forefoot rehabilitation treadmill (about 30 minutes)

Gait training with feet up and landing, with an interval of 12 inch, centripetal and centrifugal control.

Go uphill in the forward direction and downhill in the reverse direction.

Trampoline balance training

16 weeks:

Flexibility training

Run the program to start.

Multi-point isometric training

6 months

Comparison of lower limbs

Isokinetic exercise test

Gait analysis and research

Lift the heel on one leg for 30 seconds.

Remind again: In addition to the consideration of postoperative time, the rehabilitation process will be adjusted or even delayed due to some complications and severe pain.