What rehabilitation protocols have been described for initiating and progressing running following Achilles tendon rupture?

Achilles tendon rupture (ATR) is a common and functionally limiting injury, particularly among active individuals, with recovery extending well beyond initial tissue healing. Contemporary rehabilitation approaches emphasize early mobilization and progressive loading to restore tendon mechanical properties and functional capacity; however, the transition to running remains a complex and variably described phase of care. Running reintroduction represents a critical milestone, placing substantial mechanical demand on the healing tendon, which is known to tolerate high loads during activities such as running and jumping. In clinical practice, progression to running is often guided by a combination of time-based milestones, functional criteria, and clinician judgment, with no universally accepted parameters to determine readiness for return to running. Current literature suggests variability in how and when running is introduced following ATR, with reported timelines often ranging from approximately 3 to 5 months or longer depending on surgical, rehabilitative, and individual patient factors. Although some studies have proposed structured, informed loading progressions for the Achilles tendon, how these approaches are applied to return-to-running remains unclear. As such, the purpose of this scoping review is to identify and describe the existing rehabilitation protocols outlining the initiation and progression of running following ATR.