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Achilles Tendon Injuries: how to fix

One of the more common complaints among patients is a pain above the heel, in the Achilles tendon.

This debilitating injury is seen commonly in athletes, where explosive forces are

channeled into the pencil-thin tendon that joins the calf muscles to the heel bond.  For example, when running backward in soccer, then suddenly changing direction and sprinting forward.  The acceleration/deceleration physics contrives to put hundreds of pounds per square inch into the Achilles tendon, causing it to stretch, strain, partially tear, or completely rupture.  The history is defining: it feels like someone "struck my heel with a board", followed by a sudden crippling pain, and inability to even bear weight on the limb.

For the weekend athlete, the injury is even more common.  In large part this is because we tend to sit all week at a desk, with our legs folded under us, and our feet pointing behind.  This shortens the Achilles and calf muscle, in much the same way that we see happening with wearers of  high heeled shoes (including cowboy boots).  When these contracted muscles are taken for a run, they are stretched with every push-off into the next step.  Especially in cases where pre-run stretches or warm-ups are skipped, the results are quite predictable: strains, partial tears, or, ultimately the complete rupture.

For minor strains, conservative measures such as ice and rest can suffice. Some will benefit from a temporary heel-lift in their shoe, to prevent stretching the tendon back out to its full length until it is ready. For more significant tears, often one needs physiotherapy, and possibly rest in a "boot" or cast.

When the Achilles tendon is completely severed, surgery is really the only solution.  Often this is done a few days after the injury, in order to wait until the bleeding has stopped.  Once sutured, the tendon heals slowly, due to its inherent poor blood supply.  (Think of a chicken leg, where the tendons are like clear plastic rope).  For virtually all such ruptures, the standard recovery time is over a year, often 18 months.  For a professional athlete, this can mean a career ending injury.

 One such patient that I treated was Wes Hart, of the Colorado Rapids in the MLS.  He had a classic injury on the field during the opening game of the 2001 season.   His surgery was done by team doctor Wayne Gersoff, who also followed with MRI images at intervals.  He was monitored and treated daily by Theron Enns, the team trainer, and encouraged to progress to more weight bearing and movement each week.  As an additional therapy, I treated him twice weekly with acupuncture needles placed deep into the tissues above and below the tear.  His speed of recovery was beyond expectations: he advanced so quickly that he was able to play for the final game of the same season, a mere sixteen weeks after his surgery. 

To recap, here are some tips to prevent Achilles tendon injuries:

1. At work: Try to keep your feet flat on the floor when you are at your desk, don't fold your legs and point your toes behind you.  This will train the calf muscles to shorten, meaning more pressure will come to the Achilles tendon when you stress it in athletics

2. Under your desk: Periodically straighten your leg, pull your foot up at the ankle until you feel your calf muscles engage.  Hold this for several seconds. 

3. Before sleep, stretch your calf muscles and your Achilles tendon. 

4. In the shoe store: make sure you have proper shoes, professionally fitted.  Step into the sizer, and make sure the shoe is comfortable all over, including over the Achilles tendon.  Don't keep your shoes too long, as they will lose their supportive function with regular use.  Most runners will need fresh shoes every six months, which is long before the shoes are looking worn.

5. Before exercise: Stretch after your initial warm up, as we discussed in another blog.  No bouncing, just smooth regular stretching.

Calf stretch/ exercise : 

Your Achilles tendon connects the muscles in the back of your leg to your heel bone. The calf stretch exercise can help prevent an Achilles tendon rupture. To do the stretch, follow these steps:

1. Stand at arm's length from a wall or a sturdy piece of exercise equipment. Put your palms flat against the wall or hold on to the piece of equipment.

2. Keep one leg back with your knee straight and your heel flat on the floor.

3. Slowly bend your elbows and front knee and move your hips forward until you feel a stretch in your calf.

4. Hold this position for 30 to 60 seconds. 5. Switch leg positions and repeat with your other leg.  

6. After exercise: More stretching, and an ice pack if you feel any pains over the calf or achilles mechanism. Also consider this stretch:

7. In the doctor's office: once you do present with an injury to your Achilles tendon, your doctor can take images to get a better sense of your severity.  At that point, one can prescribe from a list of options, from orthotics to physiotherapies, and from anti-inflamatory medicines  to medical acupuncture.

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