2013 Dec;41(12):2867-76 management of Achilles tendon ruptures. 1 0 obj The body then heals the tendon in the appropriate position. It arises near the middle of the calf and rotates approximately 90 degrees laterally during its course to insert on the posterior aspect of the calcaneal tuberosity [ 1, 2 ]. Cardiovascular: Upper body circuit training, Physical therapy appointments begin one to two visits per week. 0_'|,t0:!: . ^Fz,l6N}{D6Y?TP),#uz/i3F~bHG(BQ" The goal of surgery is to reapproximate the ruptured tendon ends in order to promote healing and restore overall strength. Detractors of conservative treatment argue that this option leads to a greater risk of a re-rupture when compared to surgical treatment. Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence-based treatment protocol. Review Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence . Dynamic neuromuscular control with multi-plane activities, without pain or swelling. Ankle strengthening with resistance bands. Knee Surg Sports Traumatol Arthrosc. E=wNh|3Ln]8iwGuxfws7xl+|Y0~Pu 2,3 Controversy still surrounds what the optimal treatment for achilles tendon ruptures is. /n%^xij_2]!J] n >!UGld <> Various treatment methods are used for acute and chronic rupture. Introduction Optimal postoperative rehabilitation regimen for acute Achilles tendon rupture (AATR) remains unclear. Very gently at first and gradually build up . One randomized controlled trail, one prospective comparative and five prospective non-comparative studies were identified. The clinical outcomes are similar regardless of the surgical treatment, but an accelerated rehabilitation program should be accompanied by good results. -, Unfallchirurg. endobj Achilles tendon rupture; Ankle mobilization; Evidence-based; Functional treatment; Immobilization; Rehabilitation; Surgical repair; Treatment protocol; Weight bearing. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> An objective assessment of surgical and non-surgical treatment. Begin physio guided active range of motion ankle exercises from week 3-4. Careers. Procedure: Conservative Management of Tendo-Achilles Rupture - Accelerated 8-week protocol Indications for Procedure: Tendo-Achilles Rupture Expected Length of Stay: n/a Surgeons: All orthopaedic trauma surgeons Scope of Practice These guidelines are designed to guide physiotherapists when treating patients following conservative management . II. [PubMed: 25059505]. Acute Achilles Tendon Rupture Repair Rehab The Achilles tendon is the biggest and strongest tendon in the human body and is formed by the tendons of the soleus and gastrocnemius muscles which both insert at the calcaneus. Bookshelf Rehabilitation following Achilles tendon repair is vital in regaining motion, strength and function. Treatment of acute Achilles tendon rupture in Scandinavia does not adhere to evidence-based guidelines: a cross-sectional questionnaire-based study of 138 departments . Rehabilitation phases after an Achilles tendon rupture The rehabilitation can be divided into four phases (1): The decision when a patient should proceed from one phase to the next is proposed to be based on both the recovery of the patient and the time since the injury. Design Scoping review. Cont. Injury. The Achilles tendon, which is about 12-15 cm long and comprises both the gastrocnemius and the soleus tendons, is the thickest, strongest and largest tendon in the human body. 179 0 obj <> endobj +2 b6b ] ]-oF%@ZUiV'US7\4yk@RAQA$EB-;D2yR"H#YH ~Z/K>S'E_ R>-C^^[i. (50% BW) by The use of early functional rehabilitation in the treatment of nonoperative Achilles tendon ruptures has been shown to provide patients with outcomes similar to operative treatments. 1 0 obj plantar grade only. No tackling, sudden unexpected change An insight is given into the mechanism of injuries of an ATR, related principles of rehabilitation, and RTP to give an insight into the course of recovery after ATRs. Application of Doctor-Nurse-Patient Co-Decision-Making Nursing Intervention Based on Evidence-Based Problems in the Rehabilitation of Acute Ankle Lateral Collateral Ligament Injury. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The American journal of sports medicine. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. ACHILLES RUPTURE: OPERATIVE PROTOCOL In this surgery, the torn ends of the tendon are sewn together with strong suture. partial weight Accelerated rehab protocol without surgery. May begin sports specific training drills: if returning to contact sport only controlled 4 However, this . Independent gait. Surgery is only the beginning of a long rehabilitation period. 2018. Walking). Kangas J, Pajala A, Siira P, Hmlinen M, Leppilahti J. J Trauma. We mostly see ruptures of the Achilles tendon in high-impact sports predominantly in the male athlete. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. Bookshelf stream Unable to load your collection due to an error, Unable to load your delegates due to an error. Brumann M, Baumbach SF, Mutschler W, Polzer H. Injury. health, rehab compliance and injury severity, our team has established time frames, precautions and progression criteria that help ensure a safe return to sport. The site is secure. Hydrotherapy may begin if wound healing is adequate. A prospective randomized study. Using Long-Duration Static Stretch Training to Counteract Strength and Flexibility Deficits in Moderately Trained Participants. s% i5iYd}mYSz;0Wj|*:2aO5ZmJeNWhqLx* EUgm"5l94`0;C1B]@-yH?0{2ER'fL-j6U,@tyS]?sZn|(E31-*=} **No hopping, Achilles Tendon Ruptures are common tendon injuries that occur due to sudden dorsiflexion of a plantarflexed foot, most commonly associated with sporting events. Epub 2014 Jul 24. stream Gentle calf stretching with a towel (not body weight). MeSH FOIA A systematic review of early rehabilitation methods following a rupture of the Achilles tendon. Passive dorsiflexion both with knee in extension and flexed to 35 - 400 until gentle stretch on achilles. 2021 May 21;36(4):e360407. 2011 Dec;17(4):211-7 An Achilles tendon repair surgery is a scheduled outpatient procedure done in an operating room located in a hospital or surgery center. Active ROM between 5 degrees of dorsiflexion and 40 degrees of plantarflexion. eCollection 2021. Accelerated rehabilitation following Achilles tendon repair after acute rupture development of an evidence-based treatment protocol. After open repair, early functional rehabilitation improves outcome, but there are risks of infection and poor wound healing. ACHILLES TENDON RUPTURE ACCELERATED REHAB PROTOCOL - Fowler Kennedy Sport Medicine. Healing time clock restarts from day of surgery rather than day of injury Pull your toes upwards to stretch the Achilles tendon. Injury2014;45(11):1782-1790. Multiple surgical and nonsurgical approaches to treatment exist, 28 and the superiority of one over the other remains controversial and depends on patient factors and preferences. %PDF-1.7 V.&!Na 1"}2C1[irXd8`<9f4X|(iTerx_&>uQMAv/>My]Zg}?;fl|Hpt. . 3 0 obj Pool exercises if the wound is completely healed. of the Achilles tear and repair. close menu Injury to the Achilles tendon causes pain along the back of your leg near the heel. Before Federal government websites often end in .gov or .mil. 1 0 obj Massen FK, Shoap S, Vosseller JT, Fan W, Usseglio J, Boecker W, Baumbach SF, Polzer H. EFORT Open Rev. Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. 1995 Jan;98 (1):21-32 Everything went well, had the staples removed yesterday. Achilles Tendon Rupture - Non-operative treatment rehabilitation guidelines 0-2 WEEKS REST (PHASE 1) Goals Rest, recovery and mobilise non-weight bearing safely on crutches Immobilisation Plaster cast/Rigid boot with foot pointing downwards 20 (with 3 wedges inside - 22/16/10, more if needed) (open!andclosed!kinetic!chainas!well!as!functional activities)-!start!withTheraband!tubingexercises! Consequently, the aim of our study was to systematically search the evidence available and define a precise rehabilitation programme after operative repair of acute Achilles tendon rupture based on the trials with the highest level of evidence. It is found at the back of the lower leg, just above the heel bone. Westin et al. Online Physical Therapy Protocol Quality, Variability, and Availability in Achilles Tendon Repair. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. Copyright 2014 Elsevier Ltd. All rights reserved. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0 should be applied. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 4 0 obj Mastering proprioceptive control in wearing normal footwear. 2016. x\n#}!{B^pq8h*S=rz YTWu]N]zGo?Sz$ByhTTu_[UtzrVZO7'. <> Bibliographic details: Brumann M, Baumbach SF, Mutschler W, Polzer H. Accelerated rehabilitation following Achilles tendon repair after acute rupture development of an evidence-based treatment protocol. Achilles tendon repair surgery is a type of surgery to fix a damaged Achilles tendon. Copyright 2014 Elsevier Ltd. All rights reserved. Plaster Cast or CAMBOOT with 20mm heel lift or VACOPED (2) plus wedge sole for 2nd week. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. 4 0 obj 3 What to Wear You can wear anything comfortable for your surgery appointment. Epub 2017 Jan 17. Results: Single leg stance with good control for 10 seconds. -, Am J Sports Med. The https:// ensures that you are connecting to the [1] [2] Achilles tendinopathy has a detrimental effect on physical and mental well-being [3] [4]. 8]z].U3wKI2 We mostly see ruptures of the Achilles tendon in high-impact sports predominantly in the male athlete. Impact control exercises beginning with two feet to two feet, progressing from one foot to the other, and then one foot to the same foot. Plaster Cast or CAMBOOT with 30mm heel lift or VACOPED (3) plus wedge sole for 1st week. Continue resisted inversion and eversion through range, Double leg stance out of boot; single leg stand in boot progressing to out of boot as balance improves. Low level calf plyometric exercises (fast CRs, tip toe Achilles Tendon Repair Rehabilitation Protocol Phase I (surgery to 2 weeks after): Splint/Boot: Locked 20-30 degree plantarflexion for two weeks Weight-bearing: Touchdown weight-bearing (TDWB) with crutches Cardiovascular: Upper body circuit training Patient Precautions: Keep elevated. In an acute Achilles Tendon Rupture, there are two options: If you have any questions please do not hesitate to contact Mr Goldblooms rooms on 0493051985.The Accelerated Rehabilitation Program has been developed by Mr Goldbloom in conjunction with Physiotherapists Brodie Leonard-Shannon and Brendan Mason from Back in Motion, Aspendale Gardens. government site. Hi folks, I am in week three post full Achilles rupture repair surgery. Keywords: 2014 Nov;45(11):1782-90. doi: 10.1016/j.injury.2014.06.022. Can begin upper limb sports specific training eg. Weight-bearing: Touchdown weight-bearing (TDWB) with crutches PMC Discussion. Emerg Med Int. Your surgeon and you will determine what is best for you by discussing your specific injury and goals. etc until cleared by Achilles tendon rupture is a common sports injury encountered in younger populations. 1990 Mar;18(2):188-95. -, Injury. MeSH Begin gait and ankle proprioception retraining. A systematic literature search in Embase, MEDLINE and Cochrane Library for prospective trials reporting on early functional rehabilitation after minimal invasive repair was performed. endobj eCollection 2023 Feb. Warneke K, Lohmann LH, Keiner M, Wagner CM, Schmidt T, Wirth K, Zech A, Schiemann S, Behm D. Int J Environ Res Public Health. HHS Vulnerability Disclosure, Help 2014. Ankle range of motion (ROM) respecting precautions. The Accelerated Rehabilitation Program lasts for 12 weeks and is supervised by your Physiotherapist. In chronic and neglected rupture, surgical treatment is preferred over non-surgical treatment. Everything went well, had the staples removed yesterday. in surgical group, after injury in nonop. hbbd```b``"Z@$"d8XDI90L~_DH`U&(H( X$D I]@k"_ 6' J Sci Med Sport. xwn $8sxkL=. *MoaoLzhN:fOad)t-h96.&JxEys4JUy-nEu  Achilles Tendon rupture: Post Surgery actions and recovery protocols and concerns. There is increasing evidence, summarized in systematic reviews, that one can successfully use a non-operative treatment protocol to manage patients who suffer an acute rupture of the Achilles tendon. Pain-free isometric ankle inversion, eversion, DF and submaximal PF. Avoid overstressing the repair (avoid large movements up and down, forceful PF while in a dorsiflexed position, aggressive passive ROM, and impact activities). 2022 Jul 29;12(8):1824. doi: 10.3390/diagnostics12081824. 5 0 obj Disclaimer. <>/F 4/A<>/StructParent 0>> Achilles tendinopathy can be described as an insertional or mid-portion, the difference . %PDF-1.5 Early functional rehabilitation protocol for Achilles tendon rupture improved patient satisfaction, compared with standard immobilisation regimens, with reductions in minor complications and no difference in re-rupture rates. Close suggestions Search Search. 3 0 obj Hepatocyte Growth Factor-Induced Tendon Stem Cell Conditioned Medium Promotes Healing of Injured Achilles Tendon. q{b7\68wbZaX?MN3 ,iFaI!_>bT=BL~>k9Z'V>Y'Zo5M:Bt>Oby^|pRh/0UhclP"t~** 0! Initially a walking boot is used for the first 4-5 weeks. CAMBOOT with 20mm heel lift or VACOPED (2) and wedge sole for 3rd week. <> Study Selection Criteria Randomized . The only randomized controlled trial performed the most accelerated protocol demonstrating a superior functional outcome and fewer complications after immediate full weight bearing combined with free ankle mobilization. 2) Tendon shearing forces can rupture the Achilles. Would you like email updates of new search results? It happens most frequently while playing sports. Regular soft tissue treatments (i.e. sharing sensitive information, make sure youre on a federal After the Achilles tendon rupture repaired , patients were randomly divided into 2 groups, and the rehabilitation protocol was traditional rehabilitation protocol and accelerated rehabilitation protocol under ultrasonic monitoring , respectively, to study the difference in efficacy between the groups. endobj Unauthorized use of these marks is strictly prohibited. hb```>VNAd`0p`8pLYY[R'}500Tttt40( C1C(?4 An Achilles tendon rupture is a full or partial tear of the Achilles tendon. movements (not past plantar grade). Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. J Bone Joint Surg Am. Acta Cir Bras. bearing Patients showed significantly higher satisfaction, less use of rehabilitation resources, earlier return to pre-injury activities and further demonstrated significantly increased calf muscle strength, reduced atrophy and tendon elongation. Design of a randomized controlled trial. Our rehab protocols outline timing, precautions and progression criteria for returning to activity. This combination was most beneficial. Surgery is only the beginning of a long rehabilitation period. % The Thompson Test should be applied in all suspected cases Remember to brace or splint a rupture, even if suspected, in the resting equinus position for optimal healing and prevention of further injury )$Ffni(G"okg]3io m"7r ;NOsGL8ad{qF%k-+c0R N-1@i[L6Sy=0C4ddB2@g.! IM5^]rCFWD-0y- 9NL~4,MHJOh Rehabilitation following operative treatment of acute Achilles tendon ruptures: a systematic review and meta-analysis. CAMBOOT with 30mm heel lift or VACOPED (3) plus wedge sole for 2nd week. < Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? $AIsQ(P>U[bwA4po@-CIqRg ;qjt*]&a7Vc)]|1:|0_ <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 594.96 842.04] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Sport/work-specific balance and proprioceptive drills. 2020-2023 Mr Daniel Goldbloom | Privacy Policy | Disclaimer | Website design: Berwick - St John of God Consulting Suites. Accessibility Can commence light isometric calf exercises at low resistance and reps, not past plantar grade. Morimoto S, Iseki T, Nakayama H, Shimomura K, Nishikawa T, Nakamura N, Tachibana T. Regen Ther. Achilles tendon repair is performed after injury occurs to the Achilles tendon. Place heel raises (1-2cm) in shoes to take some of the pressure off the Achilles tendon. Clipboard, Search History, and several other advanced features are temporarily unavailable. Static balance exercises (begin in two-foot stance, then two-foot stance on balance board and gradually progress to single-leg stance). With!weighted!resisted . . It's important to get the right diagnosis so you can get the right treatment. ?h{vV4ECHD+A?E_Q-9U1DJY;p9 I* XX%|EjbwJH(g0Nf5.I ;v$c7H(d a_2d6QN&m 3{pn04,NMi"]C@C!r-\8yJY cMylwJ nOVn:K"ldCsseC! The non-comparative study reported high satisfaction, good functional results and an early return to work/sports following combined treatment. Please enable it to take advantage of the complete set of features! Bethesda, MD 20894, Web Policies Graduated!resistanceexercises! We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. Goals: PT appointments are once every one to two weeks. scar mobilization and friction massage) to decrease fibrosis. Immediate full weightbearing and ankle motion exercise after repair of acute Achilles tendon rupture can provide a good rehabilitation option with a low re-rupture rate and satisfactory functional results. stream . Moderate load plyometrics at Physiotherapy Tailored and monitored by physio, Achilles Tendon Rupture Non-operative treatment rehabilitation guidelines, Achilles Tendon Rupture Operative treatment rehabilitation guidelines, Achilles Tendon Rupture Rehabilitation Videos, Big Toe (Hallux) 1st MTP Joint Fusion Surgery, General Information about Foot and Ankle Arthroscopy, General Information Injuries and Fractures, National Guidance Documents for Foot Surgery, Rest, recovery and mobilise non-weight bearing safely on crutches, Plaster cast/Rigid boot with foot pointing downwards 20 (with 3 wedges inside - 22/16/10, more if needed), Can carefully shower with waterproof cover over plaster cast/boot, Confidently weight bearing as pain allows using the crutches, Begin early, supervised, gentle ankle plantarflexion exercises, Maintain core, upper limb, hip, and knee strength, Rigid walking boot with foot pointing downwards with wedges inside boot, Can shower out of boot as long as very careful not to stand/stumble on foot, otherwise leave boot on with waterproof covering, Can weight-bear with crutches as discomfort allows in boot, Maintain spinal/hip/knee/toe range of movement, Can remove boot for exercises to gently actively plantarflex foot from position in boot to full range plantarflexion, Can dorsiflex back to position in the boot but not beyond, Progress to fully weight bearing but maintain use of crutches for balance if needed, Active ankle movement through available range of plantarflexion from position foot held in boot, Regain full inversion and eversion in available plantarflexion range, Aim for ankle plantigrade/foot flat by6-8 weeks in boot, Rigid walking boot with wedges being removed weekly to plantigrade position, Can remove one wedge per week until foot flat in the boot, Can perform active resisted plantarflexion, eversion and inversion with theraband, Can actively dorsiflex foot ONLY to position allowed by wedges in boot, No knee hyperextension to compensate for lack of ankle dorsiflexion, Aim to remove boot by weaning out by 12 weeks, Increase ankle and lower limb muscle strength, Boot with ankle plantigrade/ foot flat on the ground, Shower carefully so as not to stumble/forcefully dorsiflex ankle. A LOCATION OF STONY BROOK ORTHOPAEDIC ASSOCIATES. The achilles tendon accounts for 20% of all large tendon injuries 1 with an estimated incidence ranging from 11 to 37 per 100,000. In some cases, the Achilles tendon can tear, or rupture. Epub 2015 Sep 26. Lightsey HM, Noback PC, Caldwell JE, Trofa DP, Greisberg JK, Vosseller JT. FOIA Post-op weeks 2-3: boot at 20 degrees, sleep in boot, TTWB with crutches, no active DF. official website and that any information you provide is encrypted %PDF-1.7 2 0 obj Disadvantages. Tripping, falling or twisting your ankle can also cause an Achilles tear. The exercises stretch your Achilles tendon in ways that help it handle forces and stress better. This acute (sudden) injury occurs when the tendon stretches to its breaking point. Sometimes healthcare providers misdiagnose Achilles tendon injuries as a sprained ankle. Effect of Transdermal Fentanyl Patch Combined with Enhanced Recovery after Surgery on the Curative Effect and Analgesic Effect of Liver Cancer. J Bone Joint Surg Am 2010; 92: 2767 - 75. bearing Sports massage techniques and ultrasound can aid torn Achilles rehabilitation by helping to realign the new fibres in line with the tendon. Multi-plane proprioceptive exercises single-leg stance. Biomed Res Int. Patient 2 was a 38-year-old male soldier who experienced a complete left Achilles tendon rupture while exercising. This was the standard procedure (long back of the leg incision vs newer technique with a shorter cut and a heel incision). 4 0 obj Brumann, M., Baumbach, S. F., Mutschler, W., & Polzer, H. Accelerated rehabilitation following Achilles tendon repair after acute rupture-Development of an evidence-based treatment protocol. jumping, running. Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence. The tendons twist from proximal to distal as they insert into the calcaneous, creating a shearing force. 2010 Dec 1;92(17):2767-75. doi: 10.2106/JBJS.I.01401. One study allowed early mobilization leading to excellent subjective and objective results. 2021 Jun;24(6):536-543. doi: 10.1016/j.jsams.2020.12.005. Operative versus Nonoperative Treatment of Acute Achilles Tendon Ruptures: A Multicenter Randomized Trial Using Accelerated Functional Rehabilitation Kevin Willits, Annunziato Amendola, Dianne Bryant, Nicholas G. Mohtadi, J. Robert Giffin, Peter Fowler, Crystal O. Kean and Alexandra . Achilles (uh-KILL-eez) tendon rupture is an injury that affects the back of your lower leg. Carefully monitor the tendon and incisions for mobility and signs of scar tissue formation. Methods: Seven studies were included. National Library of Medicine weight The site is secure. Epub 2017 Jan 17. Strengthening (can be performed Immediate weight bearing in a functional brace, together with early mobilization, is safe and has superior outcome following minimally invasive repair of Achilles tendon rupture. government site. Frankewycz B, Krutsch W, Weber J, Ernstberger A, Nerlich M, Pfeifer CG. Accessibility The .gov means its official. Treatments are chosen based on the size of the tendon defect. 24 staples. endobj Consider taking a more conservative approach to range of motion, weight bearing, and rehab progression with tendon augmentation, re-rupture after non-surgical management, revision, chronic tendinosis, and co-morbidities, for example, obesity, older age, and steroid use. An official website of the United States government. endobj . 4d1olrz?+Vg.TxH38@ g%L CAMBOOT with 10mm heel lift or VACOPED at (1) with flat sole for 4th week doi: 10.1590/ACB360407. postop. 2022 Oct 14;19(20):13254. doi: 10.3390/ijerph192013254. Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? . Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. and transmitted securely. Initiate balance exercises (double leg wide base narrow . No wound complications. 1.Introduction. For best outcomes, the Achilles tendon repair is typically performed within 2 weeks of the injury and recovery is expected to take between 6 to 9 months. Four trials compared early ankle mobilization to immobilization. Active ankle eversion/inversion. Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. To correct these problems, a physical therapist may show you exercises or use hands-on techniques to ease the tension. Epub 2010 Oct 29. NCI CPTC Antibody Characterization Program, Foot Ankle Surg. Achilles tendon rupture is a clinical diagnosis. Cardiovascular: replicate sport/work-specific energy demands. <> Arch Orthop Trauma Surg. Hydrotherapy, stationary cycling. ^C< ^/PgN`r3~LV*m{ (3Nl(+J?~I %%EOF Objectives To (1) describe which resistance exercises are used in the first 8 weeks of treatment for acute Achilles tendon rupture and (2) assess the completeness of reporting of the exercise descriptions. Cardiovascular: stationary bike, StairMaster, swimming. SWE is a convenient noninvasive method to determine the progress of the healing process after tendon injury. Conclusion: This article describes a high-quality accelerated functional rehabilitation program that begins with early diagnosis and appropriate patient selection to allow initiation of the nonoperative protocol. Jogging, increase exercise intensity, Sports specific drills, Full active ankle range of movement with dorsiflexion as tolerated, Progress muscle strengthening from open chain to closed chain during this period, Single leg stance, eyes closed, wobble board/ BOSU, Double heel raise progress to single heel raise, Dorsiflexion equal to contralateral side, no need to push to extreme, Hopping, Mini hurdle jumps, Straight line running, Introduce cutting/side to side/ carioca/ figure of 8 runs, Normal activity, explosive actions and return to sport.