Ruptures Of The Achilles Tendon Version
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 Rupture of the Achilles tendon is one
of the most devastating injuries which the competitive and
recreational athlete can suffer. Overall it is not
as common an injury as, for example, tendonitis of the elbow,
but it is much more difficult to treat in the higher levels
of competitive sports. Although it is not entirely
avoidable, there is much that can be done to reduce your
chances of suffering such an injury.
First it is necessary to understand the
anatomy of the area. The tendocalcaneus (Achilles tendon)
is the thickest and strongest tendon in the human body. It
is approximately 15 cm long and begins in the mid-aspect of
the calf and extends distally (towards the foot) to its insertion
on the heel bone (calcaneus). It actually originates
from three separate muscles which join together to form the
strong muscular group which is responsible for pushing the
foot downward to provide the push-off for propelling the body
forward. This is especially accentuated in sports such
as squash where a rapid push-off is required. It is obvious,
therefore, that when this tendon ruptures it is a major injury.
The classic history of the injury is that
it usually occurs in males, although it certainly occurs in
females as well. It most commonly affects people aged
30-50 but can cross all age groups. Unfortunately, it
can particularly affect athletes and will simply occur as they
are pushing off to reach forward, although it has been known
to occur when the athlete is simply in the ready position anticipating
forward movement. The classic story is that the athlete
feels a sudden pain in or just below the calf and, due to the
sudden nature of the pain and the sensation of a direct blow,
turns around to see who hit him with the tennis ball. The
sudden pain stops play immediately and medical attention should
be sought without delay.
The medical and surgical treatment is controversial
at times. This is mostly related to the fact that treatment
is difficult and there is no one simple answer to the problem. The
leg can either be operated on or casted for a prolonged period
of time, and there are proponents of both types of treatment. However,
with either treatment there is a long period of casting and
immobilization of up to ten weeks with a long and arduous course
of physiotherapy after the casting is over. Surgical
repair is most commonly advocated for the more distal (lower)
injuries which are closer to the insertion on the calcaneus
(heel bone). Often at higher levels of competition it
is a career-ending injury in spite of vigorous surgical or
casting treatment. Although the athlete is able to recover,
they rarely attain the high level of sport which they were
at prior to the injury.
It is obvious that the best thing to do
with the injury is to avoid it in the first place. This
can be done very simply with stretching exercises prior to
the workout. All stretching exercises, whether they are
done for the Achilles tendon or for any other muscle group
in the body, should be done with the speed of a glacier; that
is to say that they should not be rapid twisting motions or
pumping motions up and down. The affected area should
be put on a stretch and then held for 15 seconds just below
the feeling of discomfort. The best way to determine
exactly how much of a stretch should be put on a limb is strained
but still comfortable. The stretch should be held for
15 seconds and repeated several times prior to workout if the
best results are to be obtained. This also promotes flexibility
as well as protecting the tendon from injury.
By far the best treatment of this injury
is prevention itself and although the stretching exercises
do take a few minutes of time, they are well worth the effort
and should be part of every athletes warm-up to avoid this
devastating injury.
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