Achilles Injuries: Causes, Symptoms and Treatment Options
Achilles injuries are one of the most dreaded injuries by athletes. We’ve all seen highlights of Kevin Durant, Klay Thompson, Kirk Cousins and Aaron Rodgers injuring their achilles tendons and cutting their seasons short.
A fully torn achilles can keep a player sidelined for up to 12 months and many athletes never return to their sport with the same speed, agility and explosiveness as before the injury. It is estimated that athletes will typically recover up to 80-85% from their pre-injury level. This can lead to decreased productivity in their sport, less minutes in games and shortened careers.
The achilles tendon connects the calf (gastrocnemius) muscle to the heel bone (calcaneous). It is the strongest tendon in the human body and is essential in activities such as walking, running and jumping. Despite its size and strength, the achilles is prone to injuries especially amongst athletes and active individuals.
In this blog, we will explore achilles injuries from the causes, symptoms and treatment options.
Causes of Achilles Tendon Ruptures
Achilles tendon tears usually occur in athletes who are above the age of 30 and occur more commonly in males.
Overuse achilles injuries occur when the achilles tendon is subjected to repetitive stress such as running, jumping especially if these activities are done with improper mechanics.
Traumatic injuries occur during some form of physical activity when the person performs a quick change of direction or whenever the ankle is forced into dorsiflexion (toes towards shins) and the calf muscle is stretched and then contracts rapidly.
Symptoms of Achilles Tendon Injuries
Patients who have experienced achilles tears describe the feeling of being kicked in the back of the leg followed by pain.
They may hear a snap or tearing sound and may have difficulty walking. The patient may continue to be able to walk due to compensation from other muscles but may walk with a limp.
Additional symptoms include: tightness, stiffness and tenderness in the calf muscle and achilles tendons accompanied by swelling.
Treatment Options
Achilles injuries can be treated surgically or non-surgically depending on the severity of the injury.
Partial achilles tears only involve some tendon fibres and can be treated using a splint or a cast followed by physiotherapy. Full achilles tears or ruptures involve the entire tendon and may need surgery. Athletes may opt for the surgical route due to a lower risk of re-injury and quicker return to sport.
Whether a patient opts for surgery or not the recovery looks similar in both cases.
Initially, rest and ice will be used to decrease swelling and settle inflammation. Followed by physiotherapy to improve range of motion, increase strength and return the athlete to sport safely.
What Recovery Looks Like
Weeks 0-2: are focused on immobilizing the ankle and lower leg using a walking boot or splint to decrease risk of further injury and to start the healing process. Your physiotherapist will work on reducing swelling, inflammation and scar tissue. The patient will also be told to avoid weight bearing at this stage.
Weeks 2-4: Swelling, inflammation and scar tissue will continue to be worked on.
Light ankle range of motion and cardio in the form of cycling will also be included as long as the patient is pain free during those exercises. Light strengthening exercises will also be incorporated with the supervision of a therapist.
Normal weight bearing at this stage is not recommended especially after surgery. However, technologies such as an Anti-Gravity Treadmill can be used to decrease the athlete’s body weight to a safe level to begin working on walking mechanics and reducing compensations.
Weeks 4-6: Range of motion exercises and pain free stretching continue. Strengthening exercises are progressed and the patient will start to work on balance and walking mechanics. An elliptical machine can also be incorporated at this stage.
Weight bearing will be tested.
Weeks 6-8: Standing heel raises can now be added to the program. If an Anti-gravity treadmill is not available the patient will now start working on proprioception, balance, strength while weight bearing and re-training walking mechanics (gait).
The patient can also walk without the boot/splint and modalities to control swelling and inflammation continue to be incorporated into the treatment plan.
Weeks 8-12: In this stage single leg exercises can now be incorporated. All other strength exercises continue to be progressed.
Weeks 12+: sports specific training starts at this phase. It is important to remember that risk of re-injury is still possible at this stage. Avoid any sudden eccentric contractions or sudden push off activities.
6 Months +: Return to sport.
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People who tear their achilles tendon are usually able to walk because of the help from surrounding muscles. Patients will be able to walk but with a limp.
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Healing depends on the severity of the injury. Partial tears can heal on their own over time but it’s important to get the right guidance from a therapist to ensure proper healing occurs without compensations and risk of re-injury.
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It is important to remember that even at 12 weeks post injury the achilles tendon is still vulnerable to re-injury. Follow the advice of your physiotherapist closely to ensure a safe return to sport.
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A number of factors such as age, activity level and time of diagnosis will determine whether someone needs surgery following an achilles tear. Athletes wishing to return to high level sport will usually opt for surgery due to quicker recovery time and a lower chance of re-injury. Non-operative management is usually indicated for older individuals who are more sedentary. Be sure to speak with your surgeon to discuss which is best for you.
Conclusion
Achilles injuries can be devastating to an athlete but they don’t have to end their careers. With the guidance of a therapist providing proper care and attention to detail, athletes can return to sport without the fear of re-injury and continue to play the sports they love.
If you or someone you know has suffered an achilles injury please share this blog or reach out with questions !
Michal Dabrowski
Elevate Rehabilitation and Performance
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