Rehabilitating a Ruptured Achilles Tendon

There I was: one second I’m running along the beach, enjoying the surf spraying around my feet, feeling like a cast-member in the film “Chariots of Fire” and enjoying the fact that it was 7:00 in the morning and the summer crowds had yet to materialize, and the next thing I know I’m lying on my side in the sand, looking like I should be doing the Curly shuffle – a sharp pain in the Achilles tendon on my left foot. There was no echo of “boiiiing” that I heard right before I lost my balance and went down. I briefly recalled that it was almost a year ago when I blew out my lower back picking up a hammer of all things, and now it seemed I just ruptured or tore my Achilles tendon. Whoever said “middle age is a bitch” wasn’t kidding.

As the beach was still pretty empty, there wasn’t a lot I could do except sit up and inspect the damage: indeed it seemed like my Achilles tendon – instead of travelling straight down towards my heel – had taken a slight detour towards the ankle. There was noticeable swelling. I got up and hobbled into the lapping waves and calmly swam back to where I left my towel. I felt fortunate that I didn’t have that far to go and actually my foot felt a lot better submerged in the saltwater. But I could tell something was up.

Fast-forward an hour and I’m sitting in the “Pronto Soccorso” (emergency room) of the city hospital in downtown Gallipoli, where my family and I are spending our vacation (check out the AC Travel Archive for stories). Italy may have its faults, but “socialized medicine” isn’t one of them. Sure, I managed to burn through my entire morning waiting to be seen by a doctor, but I WAS seen, I was treated and it didn’t cost me anything.

The emergency rooms at Italian hospitals treat everyone according to a specific colour. Sounds crazy I know, but the doctors have assigned colours to signify the importance of injuries. For example, life-threatening injuries – those individuals brought in on a stretcher complete with IV tubes in their arms are assigned the colour RED. Obviously they are treated first. Serious but non life-threatening injuries get the colour Green. Sprains and breaks get the colour YELLOW and finally mild discomfort gets the colour WHITE. This system was put in place a few years back because emergency rooms were getting over-run with patients – many of them coming in with the silliest ailments – ingrown toenails and things. Anyway, my questionable tendon placed me in Category YELLOW and that meant that I had some waiting to do.

Around midday I was able to get seen. The doctor gave me a cursory look, and explained that I had a “partially ruptured” Achilles tendon. Nothing was broken. “Partially ruptured” didn’t seem like a good thing but the doctor explained that it’s like a piece of rope starting to fray. What seemed to me like a twist in the straight line of the tendon was the part where the tendon was “unravelling” so-to-speak. I could have completely ruptured the tendon or I could have snapped the tendon in two.

Now I don’t know how often individuals come in to the emergency room with a ruptured Achilles tendon, but this doctor seemed pretty excited about the whole thing and called in a few interns and he went on to explain what was going on while they threw out a variety of hypothetical treatments. One intern (I guess they were interns) felt they should “cut me open immediately, straighten out the tendon and put a cast on me up to the thighâÂ?¦” The other felt that the tendon would rehabilitate quicker using an “ultrasound vibrator
To diagnose Achilles tendon problems, the doctor will likely ask questions about your physical activities and perform an examination of your feet, ankles and legs. In my case, running on a sandy beach which fluctuated from soft to hard certainly made high marks as the cause of my injury. “. The doctor also performed a simple “test” referred to as the “Achilles Tendon Thompson Test”: with the patient lying on his stomach, the doctor gently squeezes the gastroc-soleus (the muscle above the tendon that runs over the calf) to see if the foot points forward. No movement is considered a positive test for an Achilles tendon rupture. Mine moved without incident. At least enough to demonstrate a partial rather than complete rupture or tear.
If it’s clear that the Achilles tendon is ruptured, you may be scheduled for surgery. If there’s a question about a partial rupture of your Achilles tendon, your doctor may order a magnetic resonance imaging (MRI) scan, a painless procedure that uses magnetic fields to create a computer image of the soft tissues of your body.

To my surprise, the doctor concurred with the use of ultrasound, crutches, and a heel boot to keep my foot straight and keep the weight off my tendon. He scribbled something on a piece of paper, while someone else stuck a pair of crutches in my hands. I was informed to proceed up to the fourth floor where I would find “rehabilitation services”.

Shortly after, I as back in another waiting room, in line with a lot of other folks who had problems ranging from strains to breaks. There were a few people in wheel chairs. Naturally everyone enjoyed recounting their injuries, like it was some red badge of courage to be displayed. All I knew was that I couldn’t walk – at least not without crutches – and that was seriously cutting in on my time at the beach. In the meantime, I had time to kill. Funny how only 24 hours earlier I was writing an article about “proper insulation” in a home and now I’m at the hospital waiting for my “sonic vibrator”.

Far from being something I could use to turn on my wife, the “ultrasound vibrator” looked like a small pistol with a large disk attached to the barrel. I turned it on, the disk started to vibrate and I placed it on the back and sides of my Achilles tendon like I was instructed. I think I started to feel better, but that may have been the placebo effect of being in a hospital. Similar to your toothache going away when you walk into the dentist’ office. The doctor explained that the ultrasonic waves increased the healing in my tendon by stimulating blood flow and flexibility.

This walking boot allows the ends of your torn tendon to reattach themselves on their own. This method can be effective, and it avoids the risks, such as infection, associated with surgery. Which is good; because not only do I hate needles, but I hate being cut open. However, the likelihood of re-rupture is higher with a non-surgical approach, and recovery can take longer. If re-rupture occurs, surgical repair may be more difficult.

Anyway, I had a choice: come in everyday and use the sonic vibrator” or pay a “rental fee” and take it home for 6 weeks. The heel-boot was free. I opted for “Plan B”. as it would be much easier to use at home, and also because I would only be in Gallipoli for another week or so.

Which brings me to the present: now I have even MORE time to write, as I’m supposed to stay put and not place a lot of weight on my foot, so as not to irritate the Achilles tendon. Swimming is a good thing as along as I don’t kick my feet, flex or twist the ankle. I’ve done some research on my own, not because I don’t trust the doctor but because I’m curious and I have discovered that this particular injury afflicts thousands of individuals each year. The majority are athletes, but the rather than seasoned professionals it’s the “weekend-warrior” who gets sidelined the most.

I’ve always tried to stretch before I run, honestly I probably do more and this injury proves it. To help prevent an Achilles tendon injury from happening to YOU, gently stretch your Achilles tendon and calf muscles before taking part in physical activities. Perform stretching exercises slowly, stretching to the point at which you feel a noticeable pull, but not pain. Don’t bounce during a stretch.

To further reduce your chance of developing Achilles tendon problems, follow these tips:
– Avoid activities that place excessive stress on your heel cords, such as hill-running and – jumping activities (especially if done consistently).
– If you notice pain during exercise, rest.
– If one exercise or activity causes you persistent pain, try another.
– Alternate high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming.

Strengthening your calf muscles also can help prevent injury to your Achilles tendon. To strengthen your calf muscles, practice toe raises:
– Stand flat, and then rise up on your toes.
– Hold the elevated position momentarily before slowly dropping back down to a stand. – Emphasizing the slow return to the ground will help improve the force-absorbing capability of your calf muscle and Achilles tendon.
– Start with raising just your body weight. Later, you can add hand weights as you do this exercise or raise your body weight on just one foot.

Suffice to say, I won’t be skipping rope for awhile. At least no for 8 weeks or so. The god news is that I’ve been looking for an excuse to swim more and it looks like I found it. The bad news is that the “stay off your feet” prescription seriously hampers the rest of my travel-plans this summer. But it could be worse; I could be recovering from surgery and waiting for the stitches to be removed. And like I said, Inow have even MORE time to write.

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