Congratulations - you've reached the 6-month mark. This is a significant milestone in Achilles rupture recovery, and for many people, it represents the beginning of return to sport and full activity. But as you'll learn in this guide, recovery isn't "done" at 6 months. This phase is about safely returning to the activities you love while protecting your investment in healing.
The 6-Month Milestone - What It Really Means
Your Tendon at 6 Months
At 6 months post-injury, your tendon has made remarkable progress, but the remodelling process continues.
- Approximately 80-90% of ultimate tensile strength
- Type I collagen predominates (the strong, organised type)
- Collagen fibres are well-aligned along stress lines
- Tendon stiffness is approaching normal
- Still undergoing ongoing remodelling
What this means: Your tendon can handle significant loads and return to sport becomes possible. But maximum strength isn't reached yet, and continued care remains important.
Why Recovery Isn't "Done" Yet
Many patients expect to be "finished" at 6 months. The reality is more nuanced.
Ongoing processes:
- Tendon remodelling continues for 12-18+ months
- Calf muscle continues to strengthen
- Proprioception continues to improve
- Mental confidence takes time to rebuild
Realistic Return Timeline
| Timeline | Who Returns | Notes |
|---|---|---|
| 6 months | Consideration begins | Ambitious, not always recommended |
| 7-8 months | Elite athletes | With careful management |
| 9 months | Most recreational athletes | Realistic for full return |
| 12 months | Professional standard | NBA standard, sensible approach |
| 12-24 months | Full maturation | Final tendon maturation |
Important Perspective
The Year-Long Journey to Full Strength
| Time Point | Approx. Strength | Notes |
|---|---|---|
| 3 months | 60-70% | Boot just removed |
| 6 months | 80-90% | Return to sport consideration |
| 9 months | 90-95% | Most recreational sport return |
| 12 months | 95-100% | Near full recovery |
| 18-24 months | 100%+ | Full maturation |
Calf muscle recovery: At 6 months, most people still have noticeable calf asymmetry. Full recovery can take 12-18 months. Ongoing calf strengthening is essential - continue exercises long-term to maintain function.
Return-to-Sport Criteria
Return to sport should be criteria-based, not time-based alone. These are the key benchmarks.
Strength Tests
- 25+ single-leg heel raises on injured side (ideally >90% limb symmetry)
- Isokinetic strength >90% limb symmetry (if tested)
- Isometric strength ability to support 2.5-3.0x body weight in calf contraction
Hop and Jump Tests
- Single-leg hop for distance: <10% asymmetry vs uninjured side
- Triple hop test: <20% asymmetry
- Vertical jump: approaching symmetry
Functional and Mental Readiness
- Pain-free jogging: 10+ minutes continuous
- Sport-specific movements: cutting, pivoting, sprinting without pain
- Psychological confidence: feeling ready to return, low fear of re-injury
Psychological Readiness
Physical readiness alone isn't enough - you need to be mentally ready too.
- Confidence in your tendon's ability to handle load
- Willingness to push yourself appropriately
- Ability to distinguish normal sensations from warning signs
- Acceptance of some residual risk
- Significant fear of movement or re-injury
- Avoiding activities you're physically capable of
- Hypervigilance about every sensation
- Anxiety that interferes with performance
Addressing psychological barriers: Gradual exposure to challenging activities, working with a sports psychologist if needed, talking to others who've successfully returned, celebrating progress step by step.
Starting to Run Again
Prerequisites for Running
- 25+ single-leg heel raises
- Pain-free walking for 30+ minutes
- Good balance and proprioception
- Physiotherapist approval
- Completed pre-running plyometric preparation
Walk-Jog Progression
| Week | Protocol | Sessions |
|---|---|---|
| 1 | Walk 4 min, jog 1 min × 5 (25 min total) | 3 sessions |
| 2 | Walk 3 min, jog 2 min × 5 (25 min total) | 3 sessions |
| 3 | Walk 2 min, jog 3 min × 5 (25 min total) | 3 sessions |
| 4 | Walk 1 min, jog 4 min × 5 (25 min total) | 3 sessions |
| 5 | Continuous jogging 15-20 min | 3 sessions |
| 6+ | Gradually increase duration, then add speed | 3-4 sessions |
Rules for progression:
- Pain should be 0-2/10 during and after
- Next-day soreness should resolve within 24 hours
- If symptoms increase, step back to previous week
- Don't run on consecutive days initially
Proper Running Technique
Good running form protects your tendon and optimises performance.
- Cadence: Aim for 170-180 steps per minute (higher cadence = less impact per step)
- Foot strike: Midfoot landing recommended, avoid heavy heel striking, don't over-stride
- Posture: Slight forward lean from ankles, relaxed shoulders, core engaged, head up
- Consider: Running gait analysis with physio, video analysis
Surface and Footwear
Surface progression:
- Treadmill (consistent, slightly cushioned)
- Flat track or path (predictable, firm)
- Road (harder surface)
- Trail (uneven, more challenging - later)
Avoid initially: Hills (especially downhill), cambered surfaces, uneven terrain, sand.
Footwear: Well-cushioned running shoes, appropriate for your foot type, not overly worn. May benefit from mild heel raise initially.
Avoiding "Too Much Too Soon"
The 10% Rule
Warning signs you're doing too much:
- Increasing pain during runs
- Next-day soreness lasting >24 hours
- Swelling that doesn't resolve
- Stiffness getting worse rather than better
- Performance declining
Plyometric Training and Jumping
When to Start Plyometrics
Plyometric exercises (jumping, hopping, bounding) are essential for return to most sports but must be introduced carefully.
Prerequisites: 25+ single-leg heel raises, successfully completed walk-jog programme, pain-free with current activities, passed basic hop test, physiotherapist approval.
Plyometric Progression
| Level | Exercises |
|---|---|
| 1 | Two-leg hops in place, small box jumps (both legs) |
| 2 | Two-leg lateral hops, forward hops for distance |
| 3 | Single-leg hops in place, step-ups with hop |
| 4 | Single-leg lateral hops, single-leg forward hops |
| 5 | Bounding, depth jumps, sport-specific plyometrics |
Key points: Start with low-level, progress gradually, allow 48+ hours between sessions, stop if painful.
Preventing Re-rupture and Long-Term Care
Re-rupture rates are low (2-4%), but the consequences are significant. Here's how to minimise risk.
Do
- •Continue calf strengthening exercises long-term (2-3 times per week indefinitely)
- •Warm up thoroughly before activity
- •Progress gradually - no sudden increases in volume or intensity
- •Listen to your body and rest when needed
- •Maintain overall fitness and flexibility
Don't
- •Rush back to high-impact activities
- •Ignore pain or unusual sensations
- •Skip warm-ups or cool-downs
- •Stop strengthening exercises once you "feel better"
Long-Term Maintenance
Continue calf strengthening exercises 2-3 times per week indefinitely. This maintains tendon health and reduces re-injury risk. Think of it like brushing your teeth - ongoing maintenance for long-term health.
Protecting the Other Achilles
There's a small increased risk to the other Achilles (about 2-6%). Bilateral calf strengthening helps protect both tendons.
Life After Full Recovery
Most people make excellent recoveries and return to their previous activity levels. Here's what to expect long-term.
Summary: Your 6 Months+ Checklist
- Meet all return-to-sport criteria before returning
- Follow a structured walk-jog programme
- Progress plyometrics gradually
- Continue calf strengthening long-term
- Warm up properly before all activities
- Follow the 10% rule for volume increases
- Address psychological readiness
- Work with your physio on sport-specific goals
- Listen to your body and rest when needed
- Celebrate your progress!
