After an Achilles tendon repair, should you perform maximal contraction early?

• A. Yes
• B. Yes, with brace
• C. No
• D. Only with physical therapy

Answer: (C)

Maximal contractions early after Achilles tendon repair place high tensile forces on the healing tissue. The repair site is still weak in the initial weeks, and applying maximum muscle force can disrupt the sutured connection, cause gapping, or even re-rupture. Because of that, protecting the repair takes precedence, and heavy loading is avoided during the early healing phase. Rehabilitation instead emphasizes gradual, low-load activation, controlled range of motion, and progressive strengthening as healing advances, typically under supervision. If NMES is used, it should be for submaximal contractions to support prevention of atrophy and motor re-education without stressing the repair. Wearing a brace does not change this risk, and progression to higher loads is guided by healing milestones and clinician judgment.