The first priority is to ensure wound healing. If a longitudinal incision has been made, this is often associated with a worse scar and care needs to be taken with the wound during the first few weeks. A longitudinal incision is generally used either because of the site of the tendon injury (distal to the ischial tuberosity) or because greater access is required due to significant tendon retraction or scarring of the sciatic nerve.
Patients can weightbear as tolerated and wean off crutches as comfortable. Many patients find they are able to walk immediately without additional support.
For avulsions from the ischial tuberosity, I generally regard 6 weeks as the time taken for reasonable healing to occur (Phase One), followed by another 6 weeks of maturation (Phase Two) before aggressive resisted strengthening exercises can be undertaken (Phase Three). For end to end tendon repairs of the tendon, these time frames can both be reduced to 3 weeks.
Avulsions from the ischial tuberosity:
Phase One Up to 6 weeks post-op
Phase Two 6-12 weeks post-op
Phase Three After 12 weeks post-op
End to end tendon repairs:
Phase One Up to 3 weeks post-op
Phase Two 3-6 weeks post-op
Phase Three After 6 weeks post-op
- Weightbear as tolerated. Walking as tolerated but care should be taken not to stride out up hills or stairs beyond the limits of comfort.
- Ride a stationary bike when comfortable.
- Walking in water.
- Double leg bridging.
- Jogging when comfortable.
- Progress from double leg bridging to single leg bridging.
- Increase speed of running.
- Light resisted hamstring curls.
- Nordic hamstring exercises either with exercise ball or TheraBand for support.
- Progress as tolerated in terms of unrestricted strengthening and running.
These notes have been prepared by orthopaedic surgeons at OrthoSport Victoria. They are general overviews and information aimed for use by their specific patients and reflects their views, opinions and recommendations. This does not constitute medical advice. The contents are provided for information and education purposes only and not for the purpose of rendering medical advice. Please seek the advice of your specific surgeon or other health care provider with any questions regarding medical conditions and treatment.