The purpose of this study is to evaluate the effects of early mobilization versus traditional immobilization rehabilitation programs after surgical Achilles tendon repair on the mechanical (torque-angle and torque-velocity relationships) and electrical (neuromuscular activation) properties of the plantar- and dorsiflexor muscles, gastrocnemius medialis morphology (muscle architecture), functional performance, and the mechanical and material properties (force-elongation and stress-strain relationships) of the injured and uninjured Achilles tendon. The hypothesis is that the early mobilization could reduce the deleterious effects of the joint immobilization and improve the tendon healing.
Participants were allocated into one of two intervention groups (traditional immobilization or early mobilization). Traditional immobilization group (45 days of plaster cast immobilization; after the immobilization period, subjects received instructions on how to perform a home-based exercise program) Early mobilization (six weeks of physical therapy program; three times per week; one to two hours of exercises for regaining range of motion and muscular endurance) Control group (subjects had no history of lower limb injury, and were matched in age and anthropometric measurements to subjects that performed physical rehabilitation and to subjects that remained immobilized.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Enrollment
48
After surgery subjects were immobilized in a plaster cast, with the ankle positioned in gravitational equinus; weight bearing was not allowed. Two weeks post-operatively, the cast was removed and the patient was immobilized with a new plaster cast, with the ankle in the same position. Four weeks post-operatively, the ankle was plastered in neutral position (i.e. with the sole of the foot perpendicular to the shank), and weight bearing was encouraged. Six weeks post-operatively, the plaster cast was removed The home exercise program consisted of active exercises and stretches to improve ankle range of motion, and resistance and balance exercises
The physical therapy started two weeks after the surgery and lasted six weeks, during which a removable brace was used. Therapy sessions, three times per week in the six-week period, included one to two hours of exercises for regaining range of motion and muscular endurance.
Exercise Research Laboratory, School of Physical Education, Federal University of Rio Grande do Sul
Porto Alegre, Rio Grande do Sul, Brazil
Heel rise test (HRT)
Heel rise height is an expression of ankle plantarflexor functional performance and was assessed using the HRT.
Time frame: Heel rise height was measured 3 times during the study: three, six and more than 12 months after surgical repair.
Muscular torque change
Torque is an expression of the muscular strength and was assessed by dynamometry
Time frame: Torque was measured 3 times during the study: three, six and more than 12 months after surgical repair.
Ankle range of motion change
Ankle range of motion was assessed by goniometry during active and passive dorsiflexion and plantar flexion.
Time frame: Ankle range of motion was measured 5 times during the study: 15 days, 45 days, three, six and more than 12 months after surgical repair.
Muscular architecture change
Muscular architecture (muscle thickness, pennation angle and fascicle length) was assessed by ultrasonography
Time frame: Muscle architecture was measured 4 times during the study: 45 days, three, six and more than 12 months after surgical repair.
Plantarflexor muscle volume change
Plantarflexor muscle volume was estimated from calf muscle thickness and limb length using the equation proposed by Miyatani et al. 2004.
Time frame: Plantarflexor muscle volume was assessed 4 times during the study: 45 days, three, six and more than 12 months after surgical repair.
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