The Achilles tendon, also known as the calcaneal tendon, is a large strip of fibrous tissue located at the posterior side of the ankle. It attaches the strong calf muscles to the heel bone (calcaneus). Achilles tendon is the largest tendon in the body. Upon contraction of the calf muscles, the Achilles tendon gets tightened and allows the heel to be pulled up. This enables a person to stand on tiptoe and point the foot. Achilles tendon helps in various functions such as walking, running, and jumping. Achilles tendon rupture is a condition where there is a complete or a partial tear in the tendon commonly occurring around 2 inches above the heel bone. A total rupture occurs more frequently than a partial one. This is common in older athletes with a history of inflammation and degeneration. Activities such as pushing off forcefully from the toes such as while starting a race also causes the tendon to rupture. Surgery is the preferred choice of treatment.
Causes of Achilles Tendon Rupture
- Weakening of Achilles tendon due to age.
- Lack of activity or exercise.
- Previous tendinitis of the Achilles tendon.
- Medical conditions such as arthritis and diabetes.
- Use of medications such as corticosteroids and certain antibiotics may also increase the risk of rupture.
- Sports which require forceful jumping or running e.g. basketball, tennis, racquetball and badminton etc.
- Falling from a great height or suddenly stepping into a hole or off of a curb may cause overstretching of the tendon and result in a rupture.
Symptoms of Achilles Tendon Rupture
- Sudden, acute pain at the back of the calf or ankle as if hit by something very hard.
- A snap or a pop may be heard.
- Difficulty in walking and standing on tiptoe.
- A gap may be felt in the tendon.
- Bruising and weakness of the ankle.
- Severe swelling is present.
- Thompson's test shows positive result.
Treatment of Achilles Tendon Rupture
- It is vital that athlete should seek immediate medical attention as sooner the treatment is done, the higher the chances of a complete recovery are there.
- R.I.C.E. technique should be applied.
- NSAIDs such as ibuprofen and naproxen help in reducing pain and inflammation.
- The leg may be put in a brace or a plaster cast to allow healing without the surgery.
- Surgery is required for repairing the tendon.
- After complete healing, physical therapy should be started to prevent stiffness and to improve range of motion.
Achilles Tendon Rupture Recovery Period
It may take around 6 to 9 months for complete healing after the surgery and before the athlete can return back to sports training. The period of recovery increases if the leg is immobilized in a plaster cast instead of being surgically repaired. The risk of re-injury also increases if surgery is not done.
Rehabilitation Program for Achilles Tendon Rupture
Week 1 to 8
- After the operation, a plaster cast is applied.
- The athlete should rest the leg and avoid any activities including stretching or exercising.
- Upper body workout can be done.
After Week 8
- Heel raises around 1-2 cm should be used in the shoes to help decrease pressure off the Achilles tendon.
- Ultrasound and sports massage techniques help in realigning the new fibres in with the tendon and helps in the recovery process.
- Dynamic or active stretching can be started. The toes should be pulled upwards gently to stretch the Achilles tendon. The duration can be increased gradually.
- If the active stretching causes no pain, then passive stretches can be started. It involves another person or a thing to help with the stretching process.
- After full range of motion is achieved, strengthening program can be started gradually.
- Balance exercises can also be started to regain the sense of balance and positioning. Wobble boards or balance boards help in balance exercises.
Sports Massage for Achilles Tendon Rupture
Sports massage helps immensely in rehabilitation from Achilles tendon rupture. It helps in improving blood circulation to the injured area, helps in relaxing the muscles and making them more flexible. It also helps in reducing swelling and preventing accumulation of adhesions.
Sports Massage Techniques
Patient should seek medical advice before starting any massage or exercise.
- Effleurage: This technique is used to initiate massage and for even oil application. It also helps in warming up the tissues in order to prepare them for deep massages. Effleurage should be done on the entire calf so that it covers the complete tendon and the site where the tendon attaches to the muscle. The pressure should be applied from the heel and upwards to the knee, then to external side of the leg before slowly returning to the heel. This technique is repeated.
- Transverse Mobilization: In this technique, consecutive transverse pressure is applied using the first finger of one hand and the thumb of the other hand. This technique stretches the tendon transversely one way and the other way. It helps in increasing the mobility and flexibility of the tendon. Excessive oil usage must be avoided as it makes this technique difficult to perform.
- Stripping the Achilles Tendon: Continuous pressure is applied along the entire length of the tendon.
- Cross Frictions: Mild pressure is applied in a transverse direction to the Achilles tendon using the first two fingers. Excess oil makes this technique difficult.
- Circular Frictions: Pressure is applied in a circular direction by keeping a finger on both the sides of the Achilles tendon. The tendon should be felt beneath the fingers. This massage may not be comfortable, but it should not be painful also so that it results in the athlete stiffening their muscles.