What is the recommended rehabilitation plan 9 weeks after Achilles tendon repair?

Rehabilitation at 9 Weeks Post-Achilles Tendon Repair

At 9 weeks post-repair, you should be fully weight-bearing without a protective boot, actively working on progressive ankle range of motion (particularly controlled dorsiflexion), and engaging in structured strengthening exercises with the goal of returning to sports between 3-6 months. 1, 2

Current Phase of Recovery

At 9 weeks, you are well beyond the critical early healing phase and should be transitioning from protection to active rehabilitation:

• Weight-bearing status: Full weight-bearing in regular shoes should be established by this point, as protective devices are typically discontinued by 6-8 weeks 1, 2
• Ankle mobilization: Active range of motion should be progressing, with controlled dorsiflexion exercises now safe to perform 2, 3
• Protection phase complete: The initial 2-4 week mobilization period and subsequent 6-week protective phase are behind you 1

Specific Rehabilitation Activities at 9 Weeks

Range of Motion

• Progressive dorsiflexion: Work toward achieving full dorsiflexion range compared to the uninjured side, as the risk of repair compromise is minimal at this stage 2
• Plantar flexion: Should be unrestricted and actively exercised 2

Strengthening Program

• Calf muscle strengthening: This is critical at 9 weeks to address muscle atrophy and restore strength 2, 4
• Progressive resistance exercises: Begin with isometric exercises and progress to concentric/eccentric loading 2
• Functional exercises: Include heel raises (bilateral progressing to unilateral), toe walking, and balance training 2

Functional Activities

• Return to work: Most patients return to sedentary work by this timeframe; physical labor may require additional weeks 1
• Normal walking: Should be achieved without assistive devices 1
• Sport-specific training: Can begin light sport-specific activities with progression toward full return between 3-6 months 1

Evidence-Based Timeline Context

The evidence shows that while early aggressive rehabilitation (immediate weight-bearing and mobilization by 2 weeks) leads to faster functional recovery in the first 6 months, outcomes equalize by 12 months regardless of the specific early protocol used 1. However, more recent evidence suggests that immediate mobilization may increase re-rupture risk, with slowed-down protocols showing better tendon healing and functional outcomes 5, 4.

Key finding: Patients who followed "slowed-down" rehabilitation (removing heel wedges every 4 weeks rather than every 2 weeks) demonstrated better Achilles tendon resting angles, superior functional scores, and better calf strength at 12 months compared to traditional accelerated protocols 4

Critical Considerations at This Stage

Monitoring for Complications

• Tendon elongation: Excessive lengthening can occur with overly aggressive rehabilitation; monitor for persistent weakness or asymmetry 4
• Re-rupture risk: While highest in the first 4-6 weeks, continued compliance with gradual progression remains important 1
• Calf atrophy: Measure calf circumference and compare to the contralateral side 4

Common Pitfalls to Avoid

• Progressing too quickly to high-impact activities: Even at 9 weeks, the tendon is still remodeling 2, 4
• Neglecting eccentric strengthening: This is crucial for tendon remodeling and preventing re-injury 2
• Inadequate dorsiflexion restoration: Stiffness at this stage can lead to long-term functional limitations 2

Physical Therapy Recommendations

While the American Academy of Orthopaedic Surgeons notes weak evidence for specific physical therapy protocols, the available research strongly supports structured rehabilitation at this stage 1:

• Supervised therapy: Beneficial for ensuring proper exercise progression and monitoring for complications 2, 3
• Home exercise program: Should include daily stretching, strengthening, and proprioceptive exercises 2
• Frequency: Typically 2-3 sessions per week of supervised therapy with daily home exercises 2

Return to Sport Timeline

You should plan for return to sports between 3-6 months post-surgery, with 9 weeks representing the midpoint of rehabilitation 1:

• Low-impact activities: Can typically begin around 10-12 weeks 1
• Running: Usually initiated around 12-16 weeks with gradual progression 2
• Full sports participation: Generally safe at 4-6 months, depending on sport demands and functional testing 1, 2

Functional Milestones to Achieve

By 9-12 weeks, you should be working toward:

• Single-leg heel raises: At least 10-15 repetitions with good form 2
• Normal gait pattern: Without limp or compensatory movements 1
• Ankle dorsiflexion: Within 5-10 degrees of the uninjured side 2
• Calf circumference: Within 1-2 cm of the contralateral leg 4