Is Physical Therapy an Alternative to Surgery for Achilles Tendon Rupture?

January 14, 2015 in STSMPT

An Achilles tendon rupture is a serious injury for both dedicated and recreational athletes. The injury involves actual tearing of the Achilles tendon (partial or complete). You know you may have experienced an Achilles tendon rupture when:

  • You have sudden pain that feels like a stab or a kick in the back of the ankle or calf. The pain often subsides into a dull ache.
  • You experience a popping sensation in that area.
  • You see swelling in that area.
  • It’s suddenly difficult to walk upstairs or uphill. It’s more difficult to rise up on your toes.

This injury typically occurs with forceful jumping, forceful pivoting, sudden acceleration in running, tripping and accidental falls. If you experience this injury, practice rest, ice, compression, and elevation (RICE) until you can get treatment and further guidance.

This injury is serious and will respond best to very prompt treatment. Surgery is common, but, with all that physical therapy can do, is surgery required? There is no international consensus on this question. Swedish researchers recently studied that question and presented their results at the Annual Meeting of the American Association of Orthopaedic Surgeons. The Swedish surgeons divided 97 patients with Achilles tendon rupture into a surgery group and a physical therapy group.

All patients were put in a cast which was soon replaced by a brace. Outcomes were evaluated using the Achilles tendon Total Rupture Score and the Physical Activity Scale. The outcomes between surgery and physical therapy were no different on all patient-rated scales. In functional testing, the outcomes were the same for all but one test. Surgery patients performed better on the heel-rise work test and showed better plantar flexor muscle endurance. In addition, the physical therapy group experienced a 12% re-rupture rate at one year while the surgery group had only a 4% re-rupture rate.

While physical therapy outcomes were very similar to surgery, surgery did result in better performance in plantar flexion and preventing re-injury. So while some injured people could reasonably choose to forgo surgery for various reasons, dedicated athletes may want to take into consideration the possibility of slightly better functional outcomes and the possibility of reduced risk of reinjury. At one year, the injured leg remained weaker than the non-injured leg in both groups. This fact underscores the difficulty of recovering from this injury and the importance of having a good physical therapist on your team to guide recovery, even after a successful surgery.

Source: Nilsson-Helander K, Silbernagel K, Thomee R, et al. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med. 38 (11): 2186-93.

Achilles Tendon Rupture

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