What is the achilles tendon?
The Achilles tendon runs from the calf muscles (gastrocnemius and soleus) at the back of the lower leg and inserts in at the back of the heel. The achiiles tendon can tear as a partial rupture or a total rupture. A total rupture is more common in older men who are recreational athletes.
It sometimes occurs following a history of inflammation or degeneration of the tendon but nearly always results from a sudden event such as pushing off hard on the toes or suddenly bending the foot upwards.
Symptoms of a ruptured achilles tendon:
A sudden sharp pain as if someone has whacked you in the back of the leg with something.
This will often be accompanied by a load crack or bang.
You will be unable to walk properly and unable to stand on tip toe.
There may be a gap felt in the tendon.
There will be a lot of swelling.
A positive result for Thompson's test.
Treatment and rehabilitation of a total achilles tendon rupture:
What can the athlete do for a ruptured achilles tendon?
Seek professional help immediately. The sooner you get this injury operated on the more chance you have of making a full recovery. Any longer than two days and you could be in trouble.
Apply ice or cold therapy.
What can a Sports Injury Specialist or Doctor do?
Confirm the diagnosis.
Operate on the tendon.
Sometimes the leg is put in a plaster cast and allowed to heal without surgery. This is generally not the preferred method. It takes longer to heal and longer to start on rehabilitation.
How long might you be out of training for?
You can expect to be out of competition for 6 to 9 months after surgery. This is increased to 12 months if you just have the Achilles immobilized in plaster instead of operated on. There is also a greater risk of re-injury if you do not have the surgery.
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Rehabilitation (Total rupture of the achilles tendon)
The following guidelines are for information purposes only. We recommend seeking professional advice before attempting any self treatment.
Aim of rehabilitation
To allow the tendon to heal, reducing pain swelling and inflammation.
To restore the tendon and muscles to their original flexibility and strength.
To gradually return to normal activity and training levels.
There are two methods of treatment - surgery, and not surgery. The speed at which a patient can progress with the rehabilitation will vary and should at all times be done under the supervision of a qualified professional.
It will be a slow and gradual process and any attempt to rush it may result in re-rupture of the tendon. The timescale's indicated below are only a rough guide and you should always take the advice of your consultant.
Non Surgical approach
This will follow a similar pattern to that of the surgical approach although will take a lot longer.
A plaster cast will be applied in a plantar flexed position (toes and foot pointing down).
Sometimes after four weeks this may be altered to allow less plantar flexion. After 8 weeks the tendon is usually healed.
Surgical Approach (generally preferred method)
Immediately following injury:
RICE - Rest, Ice, Compression, Elevation.
Go as soon as you can to a sports medicine professional or accident and emergency unit.
Week 1 to 8
A plaster cast is applied after surgery. No stretching or exercise, just let it heal.
You may be able to work the upper body. Try to do something positive, it will certainly help your state of mind.
Week 8 onwards
Stage 1 - range of motion and flexibility.
Place heal raises (1-2cm) in the shoes to take some of the pressure off the achilles tendon.
Sports massage techniques and ultrasound can aid in this process by helping to realign the new fibres in line with the tendon.
Active stretching. Pull your toes upwards to stretch the achilles tendon. Very gently at first and gradually build up.
If active stretches produce no pain then passive stretches can commence. This involves someone or something assisting in the stretching process.
When a full range of motion has returned (the ruptured leg is as flexible as the other leg) then a gradual strengthening programme can start.
Balance exercises should also be introduced as the sense of balance and positioning is often decreased after tendon or ligament ruptures and if not re-gained, can lead to future injuries. Wobble boards (balance boards) are great for this.
Sports Massage
Sports massage can play an important part in the rehabilitation of this injury. It can improve blood flow to the area, help the muscles relax and become more supple. For more information: Click here
Stage 2: Strengthen the achilles tendon and calf muscles.
Great care must be taken when commencing a strengthening programme. There is a fine line between strengthening the tendon and re-injuring it.
You can start strengthening exercises as soon as they can be tolerated. It may be a full month after the cast comes off before exercises can begin.
The athlete may feel a little pain when you first start these exercises. If the pain is intolerable then do not continue. Gradually each day the pain should be less. The athlete should not attempt to increase the level of exercise until there is no pain during or after the exercises.
The strengthening exercises must be done after a gentle warm up and stretch. The muscles can be warmed up by raising the heels up and down on the toes while seated. Heat applied directly to the tendon for example by a hot water bottle can also help. Flexibility training must be continued throughout. Remember to ice after exercise, this will help keep inflammation down. Avoid explosive or ballistic movements or this may lead to a re-rupture.
Return to fitness
When the athlete has gone at least a week without pain then they may begin to return to training. If they feel pain when returning to training then stop. Begin each training session with a walk to warm up followed by stretching.
Day 1: walk 4 minutes jog 2 minutes repeat four times
Day 2: rest
Day 3: walk 4 minutes jog 3 minutes repeat three times
Day 4: rest
Day 5: walk 3 minutes jog 4 minutes repeat 4 times
Day 6: rest
Day 7: walk 2 minutes jog 6 minutes repeat 4 times
Continue this gradual progression until you can confidently run and resume normal training.
How long until I am back to full fitness?
Most athletes can expect to be out of competition for 6 to 9 months after surgery. This is increased to 12 months if the achilles was immobilized in plaster instead of operated on. There is also a greater risk of re injury if the athlete does not have the surgery.
http://www.sportsinjuryclinic.net/gallery/lowerleg/resisted_planterflexion.jpg
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