precautions for achilles tendon?

[lumpygravy]

Greetings PT forum.

While away from this sport quite a number of years ago, I ruptured/tore my left achilles tendon playing volleyball. According to the ortho it was pretty nasty and I opted to have it surgically repaired. It has been a number of years since the surgery, the post surgery PT and I feel that it is about 85-90% of where it was prior to the injury.

I returned to volleyball and played again (at the same level) for a year which was enough for me to say to myself that I didn't have anything left to prove and that I could quit without using the achilles tendon as an excuse.

Now I'm returning to this sport and here are my questions:

If you have experienced a similar injury what precautions/preparations did you take to:

1] protect the injury from reoccuring? and

2] accomodate the injured side so that you made smooth quick movements when you had to push off from that side?

Like vball, many field courses require sprinting from point A to point B in different directions. Unlike vball, our sport has a lot of down time where one will inevitably cool down between actually shooting (and sprinting).

I plan to get out to a park (or somewhere more open than my tiny backyard) and do some light jogging with some moderate sprints in the mix. If nothing else, I'll at least be able to gauge how hard I can push off my left side.

Any other suggestions?

[Jake Di Vita]

I've never had an Achilles injury, nor have I trained anyone that has. This post is purely speculative on my part since I don't know the details of your anatomy. The key in my eyes is slowly building up the stress to give the body a chance to get stronger before doing too much too soon. Remember that rehab doesn't stop until you are as strong or stronger than you were before the injury. The Achilles tendon is an amazingly strong ligament (literally capable of suspending a car above ground). I obviously don't know the details that led to your injury, but to tear a healthy Achilles would usually require a stunningly horrific event. There are things you can do on a daily basis to help mobilize and treat that area. I'd recommend you go to mobilitywod and do a search for "Achilles" in the past videos.

I don't know what your current training program looks like, but if I were coaching you I'd get you training with weights (no machines and no isolation exercises), rudimentary gymnastics, and short running drills at the earliest possible moment. Taking that ankle joint through its full range of motion under a load will be far more rehabilitative to your injury than running (back squats are king). Start off wherever your physical tolerance may be and progressively increase the stress as you get stronger and more mobile. I'd have you pay real close attention to that Achilles so you knew when you could push it and knew when you needed rest. Getting stronger and mobilizing that area consistently are likely tied for being the number 1 thing you can do to prevent further injury.

Good luck.

[lumpygravy]

Thanks Jake. Here's some backgound:

"... to tear a healthy Achilles would usually require a stunningly horrific event."

My favored position was setter. As such, I would have to sprint to a fairly specific designated position on the court from any one of six areas on the court. It was during the push off phase of sprinting to the setter's position that I ruptured the AT. It felt like a "pop" not unlike an ankle sprain except that after it happened, there was no way I could walk on it.

"... I don't know what your current training program looks like"

Being stuck in an office, I am diligent about walking the hills at lunch everyday. I ride a bicycle and walk the dog. That's about it for training.

The hills are in San Francisco so they are of a grade that can actually be a challenge. As much as possible I emphasize pushing through the ankle area as I stride uphill - think a whole bunch of calf raises.

When I ride, I try to emphasize keeping my ankles flexible and the up/pull return stroke.

Additionally, I do simple balance exercises i.e. rudimentary gynastics scales (balancing on one foot).

I will certainly view the link you provided. It seems I'm on the right track with jogging mixed with short moderate sprints.

Thanks again.

[gb32]

I ruptured mine last summer running sprints in my driveway(sounded like a gunshot). I explained to my Orthopedic Dr. that I was a practical shooter and what that entailed. I had it surgically reattached, did the rehab and was out of commission for 6 months. The main thing that I do at a match or practice is make sure I am adequately warmed up and stretched. If it's an all day event then I'll stretch again after any period of extended downtime, lunch for instance. I don't have any lingering effects from the injury at all. It did take me awhile to feel confident in it however. Certainly not an injury to be trifled with.

Gary Byerly

[Jake Di Vita]

Wow, I didn't realize you were in SF.

The blog that I linked to you is based out of SF. Perhaps it would behoove you to schedule an appointment with Kelly Starrett. I know that's probably the first thing I would do if I lived there.

[kevin c]

I missed this, J., but will post my experiences for the sake of providing some info.

I ruptured my Achilles at the Nationals about 14 years ago. I was driving hard out of a box, wearing soccer spikes on heavy soft clay, and it gave out (I managed to hop on one leg and finish the stage, though). Got it surgically repaired, and rehabbed. The tendon is back to it's preinjury status, but the muscle strength never came back completely because I didn't keep up with the exercises (my own fault).

My orthopedist, a friend of mine, described the injury as a common one for the "older athlete". Apparently there are those who don't have really good blood flow to the tendon, which worsens with age and predisposes to weakening over time. The main recommendation was to increase and maintain flexibility and strength, the first to reduce the sudden spike in load on the tendon when you do those hard push offs with the ball of that foot, and the second to improve circulation. Reruptures are fairly uncommon, if you rehab right. There usually aren't any restrictions placed on activity.

Basically, Jake is on the money with the advice he laid out. Keep fit, keep strong, keep flexible.

Edited January 13, 2011 by kevin c

[JohnGaultsGun]

I would not risk injury by following advice from a non-professional (sports) physical therapist. The problem with injuries is that once it's done the first time, it is much easier to do it again.

I would spend a little $$ to get some advise on injury prevention, stretching, and physical training. In my case, my PT began the process of painfully messaging my calf muscles to break up scar tissue from a previous injury. Once that was done, the stretching & exercise routine began. Haven't re-injured the leg since.

Hope this helps.

[Bear23]

Patients who are post rupture of the achilles can expect to get to 85% of the prior strength with rehab. You essentially loose a portion of the muscle and tendon strength.

I've repaired anything from an avulsion off of the calcaneus, to rupture of the tendon substance itself and complete tears to the muscle. the first and and the latter do the best. The tendon can handle transient loads of up to 13000 lbs, when disease sets in, i.e. tendonosis it will rupture at loads not even 20% of that.

I have had not one athlete get back to pre rupture athletic levels. But you should be able to shoot, just look at all the fat guys and bad knees out there.

[beastfrog]

Be very careful if you have to take any antibiotics (related to Cipro and Levaquin, especially). They have been known to cause achilles tendon ruptures. I found out the hard way, many years ago.

[lumpygravy]

... But you should be able to shoot, just look at all the fat guys and bad knees out there.

After the 15 year layoff, I'm one of those fat guys now