Tenex procedure rehab protocol for Achilles tendons

The Tenex procedure rehab protocol for Achilles tendons has much in common with the standard rehab for Achilles tendonitis, but there are a few important differences. This article has some useful week-by-week tips on Achilles rehab after a Tenex procedure, provides guidance on recovery times for Achilles Tenex procedures, and addresses questions such as when can you walk after a Tenex procedure. Remember, if you need help with an Achilles injury, you're welcome to consult one of our team via video call.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in most of our articles.

In this article:

1. Post Tenex recovery times for Achilles tendons

2. Post Tenex rehab protocol for Achilles tendons

3. How we can help

We've also made a video about this:

Post Tenex recovery times for Achilles tendons

If the correct rehab protocol (see below) is followed, most people should be able to get back to:

• pain-free walking in 6 to 8 weeks

• jogging in 12 to 16 weeks.

But recovery times can vary quite a lot. How quickly your Achilles tendon recovers after the Tenex procedure will depend on:

1. How strong your tendon was before you had the procedure. If your tendon had been painful for quite a long time and you’ve not been able to do much activity as a result, it may lack quite a lot of strength and require a much longer rehab period.

2. Your ultimate goal. Jumping and running sports place very high loads through the Achilles tendon compared to, e.g. walking. So, if your goal involves any of those activities, your rehab will likely take a bit longer.

3. General health. Conditions like diabetes can affect how quickly the body heals.

4. Menopause. There is compelling evidence that reduced oestrogen levels impact tendon recovery.

Post Tenex rehab protocol for Achilles tendons

Your rehab protocol might vary from this one and might take a bit longer, depending on your specific situation and goals. Your doctor may also want to review your progress before allowing you to move on to a next stage of rehab.

Week 1

Walking: You will likely be:

• placed in an orthopaedic boot

• given crutches

• advised to walk partial weightbearing (putting only some of your weight through that leg).

Rehab exercises: Gentle, pain-free movements can be started the day after the procedure – moving the foot up-and-down and side-to-side. 

Don’t force the movements – the idea is not to stretch the tendon, but simply to improve circulation. Stretching it aggressively at this stage will likely increase your pain.

Pain levels: You can expect to feel some discomfort. Aim to keep pain levels below 3/10 for all activities – rehab exercises as well as your usual daily activities. The principles of relative rest apply here.

Week 2

Walking:

• You can usually start removing the boot and gradually reduce how much you use the crutches until you can walk pain-free without a limp.

• Avoid walking barefoot. Wearing shoes with a slight heel on them (like most running shoes) reduces the strain on the Achilles tendon and can help you to transition from the boot more easily.

Shoes with slightly higher heels can reduce the strain on the Achilles tendon and help you walk more easily. Just check that the heel cup doesn't press too hard into the tendon and irritate it.

Rehab exercises: Same as Week 1.

Pain levels: Same as Week 1.

Weeks 3-6 (but might take longer)

Walking: You can gradually increase your walking as long as your pain during the walk and in the 24 hours afterwards remains below 3/10. Keep your speed slow initially; fast walking works the Achilles tendon harder and will likely cause increased pain.

Rehab exercises: It’s time to start with gentle strength training for the Achilles tendon and develop your overall control.

What rehab exercises you start with and how many repetitions, etc. will very much depend on your specific case; how strong your Achilles was before the procedure and also how sensitive it currently is.

Typically you might start with:

• Double-leg heel raises on a flat surface. Start out sitting down if standing is too difficult or uncomfortable.

• Do them slowly – this helps to improve control.

• You may start with only a few repetitions and slowly build up to doing at least 3 sets of 15 before progressing to a more challenging version, e.g. single-leg heel raises.

Seated heel raises is a good exercise to start with if your tendon is quite sensitive.

You can find an explanation of the different types of Achilles tendon strengthening exercises and how to adapt them here.

Sport and general fitness: 

• No running, jumping, cutting, or pivoting sports moves.

• General strength training for the body can help reduce the load on the Achilles but these exercises should initially not load the Achilles directly.

• The exercise options discussed in this article for Achilles tendonitis will also work during this stage of recovery.

Pain levels: Same as above.

Weeks 7-16 (might take longer)

Walking: Once you can walk 30 minutes at an easy pace without any discomfort, you can usually start increasing your speed a bit until you can manage a brisk pace; but no power walking yet.

Rehab exercises: These must now aim to build your tendon’s strength to the point that it is strong enough for your goal activity.

• If walking is your end goal, you must build up to doing single-leg heel raises with some extra weight.

• If a running-based sport is your end goal, you must build up to doing single-leg heel raises with heavy weights and include plyometric (hopping and jumping) exercises towards the end of your rehab.

• If your sport involves a lot of jumping, you should also aim for heavy-loaded heel raises, but your plyometric programme has to be a lot more advanced than that of a runner.

If your sport involves running or jumping, you must include plyometric exercises towards the end of your Achiles rehab.

Sport and cross-training: No running, jumping, cutting, or pivoting sports moves yet. Continue building general strength and endurance through activities that don't increase your tendon pain.

Pain levels: You should aim to keep your activities at a level that causes minimal discomfort (around 1/10); it's OK to be aware of your Achilles but you shouldn’t really be able to class it as pain.

Gradual return to sport

Once your physio is happy that you’ve built the strength and force you need for your sport, they will help you ease back gradually into full training and competition.

Rehab exercises can’t fully prepare your tendon for the forces it encounters during, e.g. a continuous run or a full match of football. You have to build this final bit of strength and endurance by doing small, easy sessions of your actual sport.

If you transition too quickly to your regular full volume of high intensity sport, your Achilles tendon is likely to flare up. You must ease into it over a few weeks.

For a runner, alternating between walking and running can work well. For someone doing a sport that involves sprinting or jumping, starting these at 70% of max and in lower volumes and then slowly increasing the intensity over several weeks may be helpful.

Making this transition too quickly is one of the main causes for Achilles pain to flare up again. So take that extra week or two and build the intensity and volume gradually. Take more recovery days than you think you need, and ensure you sleep and eat well.

How we can help

Need help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. All of us have a wealth of experience working with athletes across a broad variety of sports and ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.

References

Fick, B., Stover, D. W., Chimenti, R. L., & Hall, M. M. (2021). "The safety of ultrasound guided tenotomy and debridement for upper and lower extremity tendinopathies: a retrospective study." The Iowa Orthopaedic Journal, 41(2), 82.