Achilles Tendon Rehab: Hydrotherapy with Post-Op Patients

Achilles tendon rupture, a prevalent injury, particularly among athletes, can effectively be managed through a comprehensive Achilles tendon rehab program that incorporates hydrotherapy as a key component. Non-surgical treatment usually involves immobilization followed by a gradual return to activity. Complete rupture of the Achilles tendon typically necessitates surgical repair.

Hydrotherapy can be highly beneficial for individuals recovering from an Achilles tendon rupture. The buoyancy of water significantly reduces the weight-bearing demands on the injured leg, minimizing pain and stress on the healing Achilles tendon.

This hydrotherapy protocol is designed to highlight the rehabilitation process following a full Achilles tendon disruption. As a physical therapist who has personally navigated this journey, learn how the SwimEx pool provides an unparalleled environment for early mobility, weight bearing, and ambulation exercises.

Note: people recovering from injury or surgery should consult their health professional before undertaking a physical exercise regime.

Hydrotherapy exercises: Achilles tendon rehab for post-op patients

1. Early mobility exercises

This first video demonstrates using a SwimEx to perform early mobility exercises. This footage includes some of the exercises used in my own rehabilitation following the surgical repair of a full disruption of my Achilles tendon. The aquatic environment in a SwimEx goes well beyond just providing a comfortable environment to start moving. It provides additional ways to manipulate activity for optimal therapeutic effect. Note the use of water depth and the level of weight bearing used based on water depth. This is easy in a SwimEx, particularly when using the work stations.

Observe the adaptability of foot positioning and patient immersion levels at various water depths. Having the current off or having the current on allows further activity modification. And, because of the laminar water flow in a SwimEx, the resistance is uniform across the pool and at any depth. You can use simple motions or more complex functional movements. Then, by choosing the patient orientation to the current purposefully, you can facilitate or inhibit movement or muscle activity, resist or assist motions for the ankle and foot and incorporate resistance or assistance for functional movement patterns. When you have a SwimEx, the depth of your aquatic therapy programs will reach a new level.

2. Weight bearing progression

This next video highlights weight bearing progression. The therapist can direct the patient in weight transferring tasks, progressing to single leg standing tasks and ultimately to heel off tasks. By using the current, the patient can be supported or challenged. The use of the current relative to the stance limb and relative to the movements the rest of body is a useful way to enhance the support or challenge. Changing the depth of the water changes not only the amount of weight bearing but also the amount of support or resistance.

Physical therapists and athletic trainers can fine-tune the rehabilitation process by adjusting various factors, including the type of exercises, water current intensity and direction, and patient immersion level, to achieve the optimal level of weight bearing and facilitate controlled progression. This level of rehabilitation is tolerated much earlier in the course of care when performed in the aquatic environment. When done in a SwimEx therapy pool, there is maximum control of the essential variables in progressing weight bearing.

3. Incorporating 3DMAPS®

For those familiar with 3DMAPS® functional training from Gray Institute®, you can see that the SwimEx is an excellent tool for incorporating 3DMAPS® early in the rehabilitation process. With the current off, you have enough room to perform sagittal plane, frontal plane and transverse plane lunges with ease. Then, you can use the current to facilitate or challenge any movement in the plane you desire. The current can be used in the plane of motion, both from the same side or the opposite side. You could perform right frontal plane lunges with the current from the right or right frontal plane lunges with the current from the left. You can also use a different plane for the current, including non-cardinal planes of motion. For example, you could perform right frontal plane lunges with the current from anteromedial or anterolateral.

Although not shown in the video, you could use hand paddles with the current on, creating a transverse plane load, think Paloff exercises. You can also vary the depth of the water or add vertical components to the movements. SwimEx models with work stations offer the highest opportunity to meet your patient at their current ability so that you can take them to their desired ability.

4. Ambulation

This video shows how the SwimEx can promote early ambulation and return to function. The aquatic environment naturally slows things down and provides additional tactile input from the water. This improves proprioceptive input as well as provides enhanced kinesthetic awareness during activity. When this is coupled with the observant therapist or athletic trainer, gait training and normalization of ambulation is fostered.

From a sports and recreational athlete perspective, this is just the beginning. Therapists and athletic trainers can leverage their creativity to design a seemingly endless array of ambulation, sport-specific, and functional tasks, incorporating water current intensity and direction plus water depth to facilitate the normalization of any imaginable functional movement. As the patient progresses, this would include foot work and return to activity, in my case tennis, movements. Sport-specific tasks can be especially great for patient motivation and engagement. Enabling patients to experience the feeling of being an athlete early in their rehabilitation can significantly increase their compliance and satisfaction. My personal experience confirms this positive impact! With a SwimEx as a rehab tool, the therapist or athletic trainer is only limited by their own imagination when creating a comprehensive plan for return to activity.

By harnessing the unique properties of water, hydrotherapy facilitates early mobilization, weight-bearing exercises, and functional training, expediting the recovery process and restoring optimal function to individuals affected by Achilles tendon rupture. The versatility and adaptability of a SwimEx pool make it an invaluable tool for physical therapists and athletic trainers. Unlike competitor pools, many SwimEx pool models provide the ability to treat multiple clients, at different depths, simultaneously. Experience therapeutic potential of the SwimEx pool for swift and successful Achilles tendon rehabilitation.

~ Authored by Thomas J Marston, who is a Physical Therapist in Bristol, RI. Thomas graduated with honors from Boston University College of Health and Rehabilitation Sciences in 1994, with a Master’s degree in Physical Therapy. He received his Doctorate of Physical Therapy from SUNY Upstate in 2010. He has more than 29 years of experience, with special focus on the shoulder.

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