Would you feel comfortable treating a ruptured Achilles tendon with exercise instead of surgery? For years, clinicians have been testing the efficacy of non-surgical alternatives to a countless number of injuries to give patients more evidence-based treatment options. While these treatments are still relatively new frontiers, a few trailblazers have been applying these protocols in real life to give a verdict of their value and safety. Researchers Lantto and colleagues are a part of this group, completing a study focusing on Achilles tendon ruptures and their both surgical and non-surgical exercise-based treatments.
Non-Surgical vs. Surgical Treatment of an Achilles Tendon Rupture
Over the course of four years, a total of 60 patients with an acute Achilles tendon rupture were randomly divided into two categories; surgical and non-surgical treatment. Non-surgical treatment began with one week of cast immobilization, followed by a functional brace for six weeks. At three months, patients began jogging (cycling and swimming exercises were also recommended) and participating in elastic resistance training. After 6 months, sports involving acceleration and jumping were allowed. As for the surgical group, surgery was simple end-to-end open repair, and postoperative treatment was identical to the non-surgical treatment.
Three outcome measurements were recorded:
- Leppilahti Achilles tendon performance score
- Isokinetic calf muscle strength
- RAND 36-Item Health Survey
The Leppilahti score is made up of subjective factors (pain, stiffness, muscle weakness, footwear restriction and subjective outcome) and objective factors (range of ankle active motion and isokinetic calf muscle strength score). After an 18-month follow-up, the groups DID NOT differ in terms of pain, stiffness, subjective calf muscle weakness, ankle joint range of motion, or subjective results .
Isokinetic Calf Muscle Strength
At 3-month follow-up, both groups achieved similar results; however, at 6-months, the advantage for surgically treated patients was a 16% to 24% difference throughout the ankle’s range of motion. At 18-month follow-up, surgically treated patients reached 10% to 8% higher values throughout the ankles range of motion
After administering this survey to each of the patients, the researchers found that surgically treated patients scored better results in physical functioning and bodily pain.
The Bottom Line
Rehabilitation exercises including elastic resistance training are almost as effective as surgery for Achilles tendon ruptures; however, surgery provides faster and better recovery muscle strength. If you’re thinking about opting out of surgery and leaning more towards the nonsurgical route, the TheraBand CLX will provide you the best -in-class elastic resistance training results.
After reading this, would you feel comfortable recommending exercise instead of surgery? Have you done it before? If so, what were the results?
Lantto et al. 2016. A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles Tendon Ruptures. Am J Sports Med. 44(9):2406-14