March 22nd, 2013

Health N' Sports Dealing with an Achilles Rupture

Staff Report


Health N' Sports Dealing with an Achilles Rupture
photo from nano.org

Louisville Orthopaedic Clinic shares insight on the injury

As a part of the Louisville Orthopaedic Clinic, the Sports Rehab Team physical therapists are knowledgeable and trained in the latest advancements and techniques available in sports rehabilitation.

On a weekly basis, the Health N’ Sports Update will give information on prevention, recovery, and include special offers, as well as general health tips that would be beneficial to all. If there is a specific topic you’d like to know or hear more about, email future suggestions to editor@catholicsportsnet.com.

According to Greek mythology, Achilles was a Greek hero during the Trojan War.  He was rumored to be invincible except for a small area near his heel.  Legend says that Achilles died as a result of a wound to his heel.  Someone’s weakness was later known as an Achilles heel.  When referring to anatomy, the Achilles tendon connects the muscles of the calf to the heel or calcaneus.  This tendon is very large and is required to withstand and transmit large forces when the foot pushes down or plantar flexes.

Causes of Achilles Rupture

Basketball is on nearly everyone’s mind as March Madness goes into full swing.  Injury is a part of sport and basketball is no different.  Due to the high loads placed on the Achilles during jumping and running, basketball has seen its fair share of these injuries.  Force placed on the tendon during activity can be many times the athlete’s body weight.   Injuries to the Achilles tendon can be chronic in nature, such as tendonitis.  They can also be acute, such as first, second, and third degree strains.  A third degree strain is when there is a complete rupture of the tendon.  Tendonitis and minor strains can be treated conservatively through rest, immobilization, anti-inflammatories and physical therapy.  Complete ruptures need to be surgically repaired and should not be ignored.  Delaying a repair of a ruptured Achilles can lead to poor results.  Achilles tendon repairs take on average 6-9 months before the athlete can return to their sport or activity.

Many high profile athletes, such as David Beckham, Ryan Howard, and Elton Brand have suffered Achilles tendon ruptures.  Achilles tendon injuries occur in all levels of competitive athletes, but there’s a higher incidence rate among “weekend warriors.”  These athletes are particularly susceptible to these injuries due to the fluctuations between inactivity and high levels of exercise.  Other risk factors to serious Achilles injury include:

Weakness of the calf muscles

Tight calf (gastroc and soleus) muscles

Injections of steroid in or around the Achilles and continued high level activity

Pre-existing Achilles tendinitis

Certain antibiotics can place the tendon at higher risk of injury

Gout

Diabetes

Up to one third of people with complete ruptures report symptoms of Achilles pathology leading up to the traumatic event.  These symptoms should not be ignored and athletes should reduce their level of physical activity.

Signs and Symptoms

So what are the signs and symptoms of a severe Achilles injury?  Achilles ruptures are rarely subtle.  An audible and physical pop usually occurs during a forceful landing or pushing off of the foot.  Patients sometimes say they felt like they were kicked in the calf, which is actually the tendon rupturing.  They immediately have little to no strength when pushing off on the foot.  Walking is very difficult and they are unable to hop on the involved leg.  A defect is usually felt when palpating or feeling around the injury site.  The Thompson test is used in diagnosing an Achilles tendon rupture.  This test is done when the patient is sitting or lying on their stomach.  The calf muscle is then squeezed while watching the foot.  If the foot does not point down or plantar flex during the squeeze, a positive Thompson test, or probable significant Achilles tendon injury is noted.

Treatment

Treatment options for an Achilles tendon tear are very simple: operative or non-operative.  Partial tears can be treated conservatively by placing the patient in a boot with the foot plantar flexed or pointing down.  After weeks of immobilization, physical therapy is used to regain range of motion and strength.  Complete tears rarely heal by themselves and surgery is needed.  If ignored, the calf muscle retracts, leaving a large gap and the wound usually scars, which complicates a later surgery.

The chances of an Achilles tendon injury can be reduced, but it cannot be prevented.  Keeping your calf muscles flexible and strong can help avoid injuries.  Signs and symptoms of minor Achilles injures should not ignored and treated properly.   Always listen to your body! 

By: Mike Mehring, ATC

Comments by Presentation Academy Basketball Coach Dave Jackson on Basketball Injuries and Achilles Tendon Rupture:

“Over the last 20 years we have had five players with ACL injuries requiring surgery. One player had both knees at different times. We have sprained ankles most every year. Our biggest issue is with shin splints. We have several each year. Most work through the issue within a couple of weeks but one or two sometime last much longer. I would think a rupture of an achilles tendon would be from over stretching of the tendon, and I think it would be most common in older athletes in the pros or weekend warriors. To prevent achilles injuries, athletes should concentrate on strength training and proper conditioning. Basketball players can prevent many of their injuries with year round conditioning. Cross training could be by playing other sports or by maintaining strength and conditioning program. I would suggest rest and P.T. after surgery, and aggressive play can lead to more injuries of all kinds.”

Louisville Orthopaedic Clinic & Sports Rehab Center

Main Office: 502-897-1794

Physical Therapy: 502-897-1790

Website: louortho.com

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