Achilles Tendon Rupture
Case study: 35-year-old male presents with inability to flex right ankle. Subject reports that while leading a fast break in a basketball game, he heard a loud pop from the back of his leg. Exam suggests a right Achilles tendon rupture.
Soccer great David Beckham recently brought this devastating injury to public attention, but Achilles tendon ruptures have always been infamous in the ER thanks to weekend athletes. The men I usually see might have had some warning from Achilles tendonitis—soreness and stiffness where the tendon meets the heel—prior to the blowout, but usually this injury comes out of the blue. And it comes with sound effects: The Achilles is the thickest and strongest tendon in the human body, so when it pops, people often hear it. If the rupture is complete, you won't be able to fully flex your ankle.
Achilles tendon ruptures occur primarily in sports requiring abrupt jumping or bursts of sprinting, such as basketball, soccer, and tennis, as well as running and track-and-field events. Ruptures can be treated surgically (doctors go in and reattach the tendon) or nonsurgically, with simple casting. (The rerupture rate in patients who don't go under the knife is higher.) Either way, you're looking at up to 6 months before returning to action.
Lunge and lean. It's no coincidence that most Achilles ruptures happen to athletes between the ages of 30 and 40. As we age, the water content of tendons declines, making them stiffer and less able to tolerate stress. Stretch your Achilles tendons regularly and always after your game or workout. Never do it prior to warming up. Here's how: Stand facing a wall with both palms resting against it. Take one step backward with your left foot. While keeping both heels on the ground, slowly lean into the wall, bending both your right and left knees at the same time. Hold for 30 seconds, and switch legs. Extra credit: Sit in a full squat with both heels on the floor for as long as you're comfortable.
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Get hip. Achilles tendons pop due to overload, and the overload comes from a lack of pelvic control. Your pelvis tilts forward, which shifts your center of gravity forward, increasing the load on your calf muscles and Achilles tendons. To build pelvic stability, do basic planks and side planks (two 45-second reps of each) as well as half-kneeling hip flexor stretches. To do the hip flexor stretch, kneel on your right knee with your left leg extended at a 90-degree angle. Lunge forward, keeping your back straight and tightening your butt. Hold for 30 seconds. Do 3 to 5 reps, switch legs, and repeat.
Heed the warning. If you have tenderness or pain above the heel—symptoms of Achilles tendonitis—avoid activities that place excessive stress on your Achilles, such as jumping and hill running. As a general rule, alternate high-impact sports, such as running, with low-impact sports, such as biking or swimming. If there's significant pain, give yourself proper rest, because there's a reason something hurts. Your body is telling you the Achilles is inflamed and needs RICE so you can slowly return to activity. Otherwise, a rupture may sideline you for a year or more! And that's not good for guys like us.
Additional injury-avoidance guidance provided by Bill Hartman, P.T., C.S.C.S., co-owner of Indianapolis Fitness and Sports Training.