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Achilles Tendon Tear

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Achilles Tendon Tear

Postby Augie Medina » Sat Jan 09, 2010 7:48 pm

In early December, I sustained a complete tear of my right achilles tendon. I was warming up for climbing at JT by running up a boulder a few feet and jumping back down, something I've done frequently. On one of the attempts I bounded up from the ground and planted my foot at such an angle as to put too much force on my foot. I heard a snap that sounded like a tree branch breaking and knew right away I'd torn my achilles. I opted for surgery for the repair after consulting with no less than 5 orthopedic surgeons.

My questions to those of you who have sustained partial or complete tears of your achilles tendon, did you have surgery or go the non-surgical route? What was your healing experience? How long before you were back to your previous physical activities?
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Postby RayMondo » Mon Jan 11, 2010 3:06 pm

A point to remind us all. Warming up with ballistic type movements lays us open to injury. We need to warm up and be supple beforehand. I've seen so many Achilles go twang in my sport. Likely that when you bounded, you didn't put too much force on your foot (it's built to take it), just that the tendon was tight and shortened, so the load came on it more suddenly across a short extension (like a short rope will snap before a longer one). See earlier thread which mostly agreed with stretching before doing anything:

http://www.summitpost.org/phpBB2/viewto ... highlight=
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Postby Augie Medina » Tue Jan 12, 2010 9:31 pm

RayMondo wrote:A point to remind us all. Warming up with ballistic type movements lays us open to injury. We need to warm up and be supple beforehand. I've seen so many Achilles go twang in my sport. Likely that when you bounded, you didn't put too much force on your foot (it's built to take it), just that the tendon was tight and shortened, so the load came on it more suddenly across a short extension (like a short rope will snap before a longer one). See earlier thread which mostly agreed with stretching before doing anything:

http://www.summitpost.org/phpBB2/viewto ... highlight=


Thanks Ray. BTW, what is your sport?
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Postby bajaandy » Wed Jan 13, 2010 4:15 am

Mountain Impulse...

Dude, I feel for you. I am now 10 months post-op for a complete rupture of the Achilles. Mine was torn while riding my longboard skateboard.
See this thread: http://www.summitpost.org/phpBB2/viewtopic.php?t=44096

Long story short... I am completely healed, (pun intended!) and climbing again.

I had a kick ass surgeon who did an outstanding job repairing my leg. Also a very good physical therapist. If you do indeed have a complete rupture, I can't think of any good reason to not have it surgically repaired. The first urgent care doc I saw gave me some crutches and said it was only partially torn. Went to my physician the next day and he said no way, off to the the specialist. Specialist ordered an MRI and referred me to the surgeon who ultimately did the job. (The surgeon told me he didn't even need to see the MRI because he could tell it was ruptured just by looking at it.) All told I was 12 days from injury to surgery. Surgery was done in the afternoon and I went home that night.

Recovery took a bit longer... In a surgical cast for just over a week. Got that changed out to a lighter fiberglass cast and got the angle of my foot increased. This happened almost once a week for about six weeks. Get the cast removed, stretch the Achilles, put a new cast on. After that I was into a boot.

The good news is that within about 3 months I was walking again pretty well. By 4 months I was hiking again. Just started back on the rocks about a month ago. (Probably could have started sooner but I just didn't do it.)

By the way, how old are you? I just turned 46. One of the docs told me that this is a "middle aged man's syndrome". Guess maybe a slow and progressive warm up will be the ticket from now on.

Good luck! Let me know if you have any questions.
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Postby foweyman » Wed Jan 13, 2010 11:43 am

bajaandy wrote:Guess maybe a slow and progressive warm up will be the ticket from now on. Good luck!


Yes, a slow progressive warmup is preferable to cold stretching (which I haven't seen used in a long time) Avoiding ballistic movements during warmup is not practical or desirable since even walking has a mild ballistic component and ideally the warm-up movements should be less intense versions of the ballistic movements that are done in the sport you are warming up for.
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Postby RayMondo » Wed Jan 13, 2010 3:01 pm

Mountain Impulse wrote:
RayMondo wrote:A point to remind us all. Warming up with ballistic type movements lays us open to injury. We need to warm up and be supple beforehand. I've seen so many Achilles go twang in my sport. Likely that when you bounded, you didn't put too much force on your foot (it's built to take it), just that the tendon was tight and shortened, so the load came on it more suddenly across a short extension (like a short rope will snap before a longer one). See earlier thread which mostly agreed with stretching before doing anything:

http://www.summitpost.org/phpBB2/viewto ... highlight=


Thanks Ray. BTW, what is your sport?


My sport, other than the mountains is tournament level Badminton (vets for my age, but I play down in age to seniors or younger). Take a look at the game in the link - played at top level to see why warmup and suppleness are key, so these guys rarely get injured despite the hammering their joints and tendons take. Watch most of the link (full screen) to see some graunching stuff. Pretty action packed, hey.
http://www.youtube.com/watch?v=C6HDaZTL ... re=related

I stretch 3x day, but never too hard (morning, before and after exertion, and before bedtime to achieve and keep full extension - hamstings took me 3 months). Rub the muscles before stretching.
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Postby Augie Medina » Wed Jan 13, 2010 8:10 pm

Bajaandy,

Thanks for your input. That's exactly the sort of detail about recovery I was looking for. I at first opted for the nonsurgical route and then changed my mind. I got my surgery a week and a half after the injury (up to that time I was in a boot). I consulted no less than 5 ortho surgeons and a sports medicine doc before making the decision. I am 63. I was put in a boot right out of surgery which is nice cause you can take it off when not walking around.

I'm now at a month after surgery; my tendon is healing very strongly, but I did have a little complication when my wound opened in one spot. I'm also lucky to have a good friend and neighbor who is an ortho surgeon right across the street from me and any time I've had any questions or concerns he's ready to come over and check me out.

I realize everyone is different but your recovery stages are about what I expected and am hoping for. Thanks again for sharing. I figured close to a year before getting back to rock climbing, but I'm glad to hear you were back to hiking in four months.

Thanks to all you others for your suggestions on stretching.

Augie
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Postby MoapaPk » Wed Jan 13, 2010 8:27 pm

Does a completely torn tendon ever "heal" without surgery? I've known people to rip ACLs completely, and the ligaments just withered away.
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Postby Augie Medina » Wed Jan 13, 2010 10:03 pm

MoapaPk wrote:Does a completely torn tendon ever "heal" without surgery? I've known people to rip ACLs completely, and the ligaments just withered away.


First, I think that tearing ligaments, especially around the knee, is a completely different matter than with a tendon. Nevertheless, I do remember a friend that tore her achilles tendon completely 12 years telling me that she was advised she'd have a "limp" foot if she didn't have surgery. But apparently, the current thinking, based on the studies, is different today.

According to all the ortho surgeons I talked to, the answer is definitely YES, an achilles, even with a complete tear will heal without surgery. It heals with scar tissue, just like a surgical repair does (of course the surgical repair includes suturing of the separated ends). What's more, all said that recovery time is about the same. Three of the five ortho docs I consulted generally lean towards surgery while two generally advise against surgery. They all were in agreement that the medical literature regarding this injury is not conclusive whether surgery or nonsurgery is the optimal route.

However, they also all agreed that the literature, while not conclusive, does suggest a lesser reinjury rate for surgically repaired achilles tendon with the implication that you will maximize the strength of the tendon with surgery. Thus, all pro athletes with this injury get surgery. One of the docs who is an outdoors person said that if I wanted to continue rock climbing, surgery was the best choice for the strongest possible repair. A sports medicine doc friend of mine reminded me that trail running ( on uneven and rocky terrain), a favorite activity that we share, puts a lot of stress on the ankle/achilles and thus he counseled surgery.

Why would you not have surgery? Surgery's main risk is infection. Infection is a small risk to be sure, but it is still there and with this type of injury it is a big deal if it happens. The area has a very limited blood supply. So some ortho surgeons say, if you don't engage in strenuous activities which stress the ankle, you'll be just fine without surgery.
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Postby RayMondo » Wed Jan 13, 2010 10:29 pm

Especially on the Achilles, a movement to avoid is a double bounce (rebound). Say you've loaded it heavy by jumping / stepping up high, then partly unloaded it (without the heel touching down), but spring off hard again, it places a shock load. The sort of occassion when things can go twang if it is not fully supple.

People who desk work are more liable to Achilles and hamstring problems because for hours on end these parts are not extended. So move around regularly. Placing the heels near to you, rather than your feet out straight, will keep the Achilles more extended.

This exercise helps, and will illustrate if you are tight in the hamstrings and Achilles:
Lie on the floor, on your side (prop up your head with the hand), then with lower leg z-bent for balance, raise other leg in the air and hold your toes with corresponding arm. If the leg doesn't straighten, then the hams are tight. Work on extending them for a few months (gradually, don't overstrain or jerk) and the leg will fully straighten. You eventually find that you can pull the toes right down. Then you are supple enough in hams and Achilles.

Got pain in the sole when walking. Also attibutable to nervous tension. For that, one needs to get the head sorted!
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Postby Augie Medina » Wed Jan 13, 2010 11:34 pm

Thanks again Ray. Actually, I've always been pretty good about stretching every single day even in the office. My hamstring flexibility is good; I've always paid particular attention to strengthening and keeping flexible the hamstrings because I still do speed work on the track.
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Postby bajaandy » Thu Jan 14, 2010 1:54 am

Augie,

Glad to hear that you're making good progress. And thank your lucky stars that you're in a boot and not a cast! I can't begin to tell you how frustrating it was to have to wrap my lower leg in a plastic bag just to take a shower. Ugh.

I too had a small spot just at the top of my incision that took longer than the rest to heal. My doc figured it was just a stitch that was giving me some trouble. But it never actually opened up.

As I mentioned in my other thread, I was more then willing to give up a full climbing season in order to get a full and complete recovery. Sounds like you have the same inclination.

Best of luck to you. Keep the positive vibe.

Andy
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Postby ksolem » Thu Jan 14, 2010 2:17 am

Since you are healing an area known to have poor circulation, regular aerobic workouts which get the blood flowing will accelerate your recovery. Obviously you can't run for now. Ask your doc about using a rowing machine. That might be really good for you.
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Postby Dave Dinnell » Thu Jan 14, 2010 4:52 am

An attractive, I mean a good massage therapist might be helpful. Or, at the least, consistent self massage to the area to help increase circulation.
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Postby RayMondo » Thu Jan 14, 2010 8:21 pm

To add to ksolem's note on circulation, though I expect Pasadena is pretty mild, I found that wearing warm salopettes helped circulation when I was after healing a partial tear of knee meniscus. Another region that is poorly supplied by blood vessels.

My injury occured because I hadn't warmed up enough. Lesson learned and never a sport injury since. 1980.
Last edited by RayMondo on Fri Jan 15, 2010 1:38 pm, edited 1 time in total.
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