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1st Nov

2010

Achilles Tendon Ruptures

Achilles tendon ruptures are common injuries, usually caused by a sudden strong contraction of calf muscles as they are being put on stretch. This can occur when e.g. quickly changing directions while running, during jumping, or if stepping on an object with the front of the foot being forced upwards.

Although the injury is common in high intensity explosive elite level sports such as gymnastics, track and field jumping events, and American football, it is even more common in older athletes in recreational sports.

Former competitive athletes are especially prone to these injuries. Years of microtrauma to the tendon from prior high level sports and resulting tendon weakness from tissue degeneration, combined with reduced training after the athlete has retired from his sport, makes the former competitive athlete more susceptible to sustaining these injuries.

When the injury occurs, it typically feels as if you have been kicked or hit in the back of your lower calf. You immediately become unable to run, or even walk normally, as the calf no longer allows you to raise your heel up or control your leg as the weight is shifted forward over the foot.

NON-OPERATIVE VERSUS OPERATIVE TREATMENT

A complete Achilles tendon rupture can be diagnosed by a sports medicine physician or a physical therapist, and if necessary, be confirmed with an MRI scan.

Competitive athletes usually opt for surgical repair, which reduces the incidence of re-rupture, allows less immobilization and faster return to training and sports, and has been shown to lead to the least loss of muscle power and athletic performance.

Conservative treatment, which involves prolonged immobilization with the tendon at first shortened, and subsequently gradually lengthened in a cast or brace, may lead to sufficiently good outcomes in the sedentary or non-competitive recreational athlete.

REMAINING TENDON AND MUSCLE WEAKNESS

Several studies have shown that the elasticity of the tendon after Achilles tendon ruptures never returns to normal, even after surgical repairs. Even after surgery, studies have furthermore shown 12-48% loss of endurance and strength in the gastrocnemius/soleus (calf muscles) versus the non-injured calf, one year after repairs. This is especially noticeable when pushing your body weight up onto your toes.

This is why this type of injury can be career ending for high level dancers. This is also why only two thirds of NFL skill players return to the league after Achilles tendon ruptures, and then have 50% less playing time and nearly 50% decrease in power ratings as compared to prior to the injury.

However, most recreational athletes and certainly sedentary people recover sufficient function to handle activities without obvious or significant difficulties as long as they undergo appropriate rehabilitation.

REHABILITATION ESSENTIAL

As with other major musculoskeletal injuries, return of good or near normal function does not occur without well designed and over time progressed rehabilitation, and good exercise compliance by the injured person for up to one year.

Early on, proper tendon protection is essential to prevent tendon lengthening, and exercises are progressed from non-weightbearing without stretch, to eventually high intensity weightbearing exercise into, and from a stretched position. Gradual and pre-planned return to conditioning exercise and sports activities is also of high importance.

It is strongly recommended for all individuals who have sustained Achilles tendon ruptures, to see a physical therapist with a strong orthopedic and sports medicine background. We have had the opportunity over the years to help a large number of people return to activities and sports following these injuries and surgery.

Please do not hesitate to contact us via e-mail or phone if you have comments, or if we can be of any further help.

Best wishes,

Gunnar

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