Just a little trivia. Famous people and athletes who ruptured their Achilles tendon:
"The Rock" aka Dwayne Johnson
Dominique Wilkins
Vinny Testaverde
Elton Brand
Takeo Spikes
Todd Pinkston
Christian Laettner
Boris Becker
Yeremiah Bell
Donovan Bailey
Voshon Lenard
Jon Jansen
Cédric Carrasso
Reggie Hayward
Gabe Kapler
This is just a small list. If you know more please post.
Wednesday, March 19, 2008
We mock what we don't understand.
Here is an article I read about the surgical technique of repairing the Achilles tendon.
The patient is placed in the prone position with both prepped feet dangling from the end of the table. By placing the table in Trendelenburg, the feet receive less blood flow. An 8-cm to 10-cm longitudinal incision is made just medial to the Achilles tendon. A posterior lateral incision would place the sural nerve at risk and a mid-posterior incision can result in suture interference from the tendon repair site. After dissecting through the subcutaneous tissues, the paratenon is cut longitudinally with Mayo scissors. As the ruptured ends often have a "mop-end" appearance, some surgeons will wait one week before repair in order to allow the ends to better consolidate. After juxtaposing the ends, the tendon is sewn together with non-absorbable suture via a Krackow or Bunnell stitch. Prior to tying the suture ends, the tendon's dynamic resting tension is optimized by comparing it with the control side. A circumferential stitch is used to further strengthen the repair site. After closing the paratenon, the plantaris fascia can be fanned out over the repair site to help prevent adhesions with the undersurface of the skin. The subcutaneous tissue is then approximated with absorbable suture and the skin sewn together in a nylon mattress fashion. A fasciotomy of the deep posterior compartment can facilitate closure in cases with excessive skin tension. This allows for improved closure of the paratenon as well.
Despite the resurgence of the conservative camp in the 1970s, surgery has been the first choice of treatment for Achilles tendon ruptures in young fit individuals since the late 1980s. Advances in surgical techniques and new postoperative rehabilitation protocols have resulted in studies showing the advantages of direct tendon repair. With conservative treatment, extensive scarring often fills the gap between the torn tendons. This leads to a lengthened tendon, which, in turn, leads to decreased push-off strength. In separate studies, Helgeland and Inglis and colleagues showed that surgical treatment of Achilles tendon rupture resulted in increased strength. Cetti and colleagues and Haggemark independently showed that direct repair resulted in less calf atrophy when compared with non-surgical treatment. Mendelbaum and colleagues showed that those undergoing direct repair lost only 2.6% of their strength when undergoing isokinetic testing and that 92% of athletes were able to return to their respective sports at a similar level at 6 months postoperatively. Cetti and colleagues also showed a higher number of patients returning to their pre-injury athletic level. In addition, surgical repair appears to significantly increase the strength in those suffering re-ruptures. Those treated surgically for the second time increased their level of strength by 85% compared with a 51% strength gain in those treated conservatively.
Perhaps the most well known benefit of surgical repair is the decreased re-rupture rate. Despite favoring nonsurgical treatment, Nistor noted that those treated conservatively had an 8% re-rupture rate while those treated surgically had a 4% rate. Recent studies show an even greater difference. Cetti and colleagues reported re-rupture rates of 1.4% 13.4% for surgical and conservative repair, respectively. In a meta-analysis by Kellam and coworkers, re-rupture rates were found to be 1% and 18% for surgical and conservative repair, respectively. Even more impressive is a study by Inglis and colleagues who reported that none of the 44 patients receiving direct repair re-ruptured, whereas 9 of 24 patients treated nonsurgically did re-rupture.
In contrast to Nistor's 1981 study, more recent studies show an increased complication rate in those treated conservatively. One prospective randomized study reported complication rates of 11.8% in patients treated surgically vs 18% for those treated nonsurgically; 96.6% of the complications in the surgical group were considered minor. Leppilehti and coworkers noted that complications related to surgery did not significantly influence the long term outcome as most of them were minor wound healing problems which eventually healed.
Increased operative treatment also leads to more experience in treating complications effectively. For example, it is now shown that physical therapy can overcome many of the problems associated with adhesions between the repair site and the skin. Moreover, the vast majority of superficial wound infections can be treated effectively with limited weight bearing, oral antibiotics, and silver sulfadiazine (Silvadene). Once the tissue granulates, the wound can simply be treated with wet to dry dressing changes; only in rare circumstances is a local or a free flap necessary.
Those favoring surgical treatment also point out the relatively uncomplicated nature of the procedure. There is no evidence showing that primary augmentation is more effective than simple end-to-end repair in acute tears. Therefore, more extensive procedures using tendon transfers, flaps, or mesh are best left for use with delayed tears, in which the repair will be under tension due to the chronically retracted ends.
The patient is placed in the prone position with both prepped feet dangling from the end of the table. By placing the table in Trendelenburg, the feet receive less blood flow. An 8-cm to 10-cm longitudinal incision is made just medial to the Achilles tendon. A posterior lateral incision would place the sural nerve at risk and a mid-posterior incision can result in suture interference from the tendon repair site. After dissecting through the subcutaneous tissues, the paratenon is cut longitudinally with Mayo scissors. As the ruptured ends often have a "mop-end" appearance, some surgeons will wait one week before repair in order to allow the ends to better consolidate. After juxtaposing the ends, the tendon is sewn together with non-absorbable suture via a Krackow or Bunnell stitch. Prior to tying the suture ends, the tendon's dynamic resting tension is optimized by comparing it with the control side. A circumferential stitch is used to further strengthen the repair site. After closing the paratenon, the plantaris fascia can be fanned out over the repair site to help prevent adhesions with the undersurface of the skin. The subcutaneous tissue is then approximated with absorbable suture and the skin sewn together in a nylon mattress fashion. A fasciotomy of the deep posterior compartment can facilitate closure in cases with excessive skin tension. This allows for improved closure of the paratenon as well.
Despite the resurgence of the conservative camp in the 1970s, surgery has been the first choice of treatment for Achilles tendon ruptures in young fit individuals since the late 1980s. Advances in surgical techniques and new postoperative rehabilitation protocols have resulted in studies showing the advantages of direct tendon repair. With conservative treatment, extensive scarring often fills the gap between the torn tendons. This leads to a lengthened tendon, which, in turn, leads to decreased push-off strength. In separate studies, Helgeland and Inglis and colleagues showed that surgical treatment of Achilles tendon rupture resulted in increased strength. Cetti and colleagues and Haggemark independently showed that direct repair resulted in less calf atrophy when compared with non-surgical treatment. Mendelbaum and colleagues showed that those undergoing direct repair lost only 2.6% of their strength when undergoing isokinetic testing and that 92% of athletes were able to return to their respective sports at a similar level at 6 months postoperatively. Cetti and colleagues also showed a higher number of patients returning to their pre-injury athletic level. In addition, surgical repair appears to significantly increase the strength in those suffering re-ruptures. Those treated surgically for the second time increased their level of strength by 85% compared with a 51% strength gain in those treated conservatively.
Perhaps the most well known benefit of surgical repair is the decreased re-rupture rate. Despite favoring nonsurgical treatment, Nistor noted that those treated conservatively had an 8% re-rupture rate while those treated surgically had a 4% rate. Recent studies show an even greater difference. Cetti and colleagues reported re-rupture rates of 1.4% 13.4% for surgical and conservative repair, respectively. In a meta-analysis by Kellam and coworkers, re-rupture rates were found to be 1% and 18% for surgical and conservative repair, respectively. Even more impressive is a study by Inglis and colleagues who reported that none of the 44 patients receiving direct repair re-ruptured, whereas 9 of 24 patients treated nonsurgically did re-rupture.
In contrast to Nistor's 1981 study, more recent studies show an increased complication rate in those treated conservatively. One prospective randomized study reported complication rates of 11.8% in patients treated surgically vs 18% for those treated nonsurgically; 96.6% of the complications in the surgical group were considered minor. Leppilehti and coworkers noted that complications related to surgery did not significantly influence the long term outcome as most of them were minor wound healing problems which eventually healed.
Increased operative treatment also leads to more experience in treating complications effectively. For example, it is now shown that physical therapy can overcome many of the problems associated with adhesions between the repair site and the skin. Moreover, the vast majority of superficial wound infections can be treated effectively with limited weight bearing, oral antibiotics, and silver sulfadiazine (Silvadene). Once the tissue granulates, the wound can simply be treated with wet to dry dressing changes; only in rare circumstances is a local or a free flap necessary.
Those favoring surgical treatment also point out the relatively uncomplicated nature of the procedure. There is no evidence showing that primary augmentation is more effective than simple end-to-end repair in acute tears. Therefore, more extensive procedures using tendon transfers, flaps, or mesh are best left for use with delayed tears, in which the repair will be under tension due to the chronically retracted ends.
Monday, February 4, 2008
You gonna tell me the difference between this guy and that guy is luck?
I am shocked the doctor has given me the okay to ditch the boot. I have been reading on the internet about many people’s experiences with this injury and they all appear to have different recovery times. Some orthopedic surgeons are conservative and some, like mine, are very aggressive. Every time I visit with my doctor I ask him, “When can I play basketball again?” Every time he gives me the same answer, “six months.”
Some people (who posted on http://www.achillestendonblog.com/) stated that they have reported not losing the boot until week 14 post operation! I am not using my boot at week 8 post operation. It appears every surgeon does things differently based upon their experiences. Every day my leg is getting stronger. The atrophy of my calf was bad, but I have noticed it is improving. When I first started walking without the boot, I walked with a severe limp. Now in just the past few days it has improved greatly. Although, the tendon still feels stiff. When I am walking I can feel the tightness of the tendon, almost like I haven’t stretched it in months (in which case I haven’t). I know I could not stand on my toes or walk up stairs if I wanted. As my limp dissipates, I cannot wait to see what I can do in a month from now.
Some people (who posted on http://www.achillestendonblog.com/) stated that they have reported not losing the boot until week 14 post operation! I am not using my boot at week 8 post operation. It appears every surgeon does things differently based upon their experiences. Every day my leg is getting stronger. The atrophy of my calf was bad, but I have noticed it is improving. When I first started walking without the boot, I walked with a severe limp. Now in just the past few days it has improved greatly. Although, the tendon still feels stiff. When I am walking I can feel the tightness of the tendon, almost like I haven’t stretched it in months (in which case I haven’t). I know I could not stand on my toes or walk up stairs if I wanted. As my limp dissipates, I cannot wait to see what I can do in a month from now.
Monday, January 14, 2008
Pop quiz, hotshot. What do you do?
Here is a general crash course of what you’re in for.
General Considerations:
- Time frames mentioned in this protocol should be considered approximate with actual progression based upon clinical presentation. Physician appointments as well as continued assessment by the treating practitioner should dictate progress.
- Avoid forceful active and passive range of motion of the Achilles for 10 - 12 weeks.
- Carefully monitor the tendon and incisions for mobility and signs of scar tissue formation. Regular soft tissue treatments (i.e. scar mobilization and friction massage) to decrease fibrosis.
- All exercises should be carefully observed for any signs of compensation or guarding.
- No running, jumping, or ballistic activities for 6 months.
- Aerobic and general conditioning throughout the rehabilitation process.
- M.D. appointments at Day 1, Day 8-10, 1 month, 2 months, 4 months, 6 months, and 1 year post-op.
0 - 3 weeks:
- Adjustable boot locked out at 30 of plantar flexion.
- Non-weightbearing for 3 weeks--no push off or toe-touch walking.
- Pain and edema control (i.e. cryotherapy, electric stim, soft tissue treatments).
- Toe curls, toe spreads, gentle foot movement in boot, straight leg raises, knee flexion/extension.
- Well-leg cycling, weight training, and swimming for cardiovascular conditioning.
3 - 8 weeks:
- Gradually increase weight bearing from toe-touchdown to partial as tolerated. After 6 weeks, okay to progress to full weightbearing.
- Walking orthosis adjusted 5 degrees a week until 10 degrees of plantar flexion. After 8 weeks, okay to wear shoes with a heel (i.e. cowboy boots, 1/4 " heel lift in shoes).
- Isometrics of uninvolved muscles, light active dorsiflexion of the ankle until gentle stretch of Achilles. Slowly increase the intensity and ranges of isometrics of Achilles within the range of the boot.
- Slowly increase passive range of motion and stretch on the Achilles after 6 weeks.
- Proprioception exercises, intrinsic muscle strengthening, PNF patterns (not to Achilles)
- At 6 weeks, okay to add stationary cycling with heel push only. Deep water workouts.
- Soft tissue treatments daily.
8 - 12 weeks:
- Full weightbearing with heel lift as tolerated, gait training.
- Wean into a regular shoe over a 2-4 week period.
- Begin and gradually increase active / resistive exercises of the Achilles (i.e. submaximal isometrics, cautious isotonics, Theraband)
- Manual full passive range of motion of the Achilles--nothing forceful.
- Progress to cycling in shoe, swimming.
3 - 6 months:
- Wean off heel lifts (if not already).
- Closed chain exercises: controlled squats, lunges, bilateral calf raise (progress to unilateral), toe raises, controlled slow eccentrics vs. body weight.
- Cycling, VersaClimber, rowing machine, Nordic Track (gradually).
- Unless excessive fibrosis present, should be discharged into a home program.
6 months - 9 months:
- Progress training jogging / running, jumping and eccentric loading exercises, noncompetitive sporting activities, sports-simulated exercises.
- Return to physically demanding sport and/or work.
General Considerations:
- Time frames mentioned in this protocol should be considered approximate with actual progression based upon clinical presentation. Physician appointments as well as continued assessment by the treating practitioner should dictate progress.
- Avoid forceful active and passive range of motion of the Achilles for 10 - 12 weeks.
- Carefully monitor the tendon and incisions for mobility and signs of scar tissue formation. Regular soft tissue treatments (i.e. scar mobilization and friction massage) to decrease fibrosis.
- All exercises should be carefully observed for any signs of compensation or guarding.
- No running, jumping, or ballistic activities for 6 months.
- Aerobic and general conditioning throughout the rehabilitation process.
- M.D. appointments at Day 1, Day 8-10, 1 month, 2 months, 4 months, 6 months, and 1 year post-op.
0 - 3 weeks:
- Adjustable boot locked out at 30 of plantar flexion.
- Non-weightbearing for 3 weeks--no push off or toe-touch walking.
- Pain and edema control (i.e. cryotherapy, electric stim, soft tissue treatments).
- Toe curls, toe spreads, gentle foot movement in boot, straight leg raises, knee flexion/extension.
- Well-leg cycling, weight training, and swimming for cardiovascular conditioning.
3 - 8 weeks:
- Gradually increase weight bearing from toe-touchdown to partial as tolerated. After 6 weeks, okay to progress to full weightbearing.
- Walking orthosis adjusted 5 degrees a week until 10 degrees of plantar flexion. After 8 weeks, okay to wear shoes with a heel (i.e. cowboy boots, 1/4 " heel lift in shoes).
- Isometrics of uninvolved muscles, light active dorsiflexion of the ankle until gentle stretch of Achilles. Slowly increase the intensity and ranges of isometrics of Achilles within the range of the boot.
- Slowly increase passive range of motion and stretch on the Achilles after 6 weeks.
- Proprioception exercises, intrinsic muscle strengthening, PNF patterns (not to Achilles)
- At 6 weeks, okay to add stationary cycling with heel push only. Deep water workouts.
- Soft tissue treatments daily.
8 - 12 weeks:
- Full weightbearing with heel lift as tolerated, gait training.
- Wean into a regular shoe over a 2-4 week period.
- Begin and gradually increase active / resistive exercises of the Achilles (i.e. submaximal isometrics, cautious isotonics, Theraband)
- Manual full passive range of motion of the Achilles--nothing forceful.
- Progress to cycling in shoe, swimming.
3 - 6 months:
- Wean off heel lifts (if not already).
- Closed chain exercises: controlled squats, lunges, bilateral calf raise (progress to unilateral), toe raises, controlled slow eccentrics vs. body weight.
- Cycling, VersaClimber, rowing machine, Nordic Track (gradually).
- Unless excessive fibrosis present, should be discharged into a home program.
6 months - 9 months:
- Progress training jogging / running, jumping and eccentric loading exercises, noncompetitive sporting activities, sports-simulated exercises.
- Return to physically demanding sport and/or work.
Monday, January 7, 2008
Something caused all this. But what caused...that cause?
Causes of Achilles tendon rupture
Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you move your foot. Injuries to your Achilles tendon result from repeated stress on the tendon, which may be caused or aggravated by:
-Overuse
-Running on hills and hard surfaces
-Poor stretching habits
-Tight calf muscles
-Weak calf muscles
-Worn out or poor fitting shoes
-Flatfeet
Injuries to your Achilles tendon can often result from taking part in an activity involving stop-and-start footwork for which you're not conditioned or for which you haven't stretched properly. This might include playing tennis, racquetball or basketball for the first time after a long break.
Sometimes, though, injuries can occur from simply putting too much stress on your Achilles tendon in the course of a simple activity, such as gardening. Occasionally, even highly conditioned athletes may rupture an Achilles tendon.
As you age, the risk of Achilles tendon rupture may increase. If you don't exercise regularly, the Achilles tendon may weaken and become thin, making it more susceptible to injury.
Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you move your foot. Injuries to your Achilles tendon result from repeated stress on the tendon, which may be caused or aggravated by:
-Overuse
-Running on hills and hard surfaces
-Poor stretching habits
-Tight calf muscles
-Weak calf muscles
-Worn out or poor fitting shoes
-Flatfeet
Injuries to your Achilles tendon can often result from taking part in an activity involving stop-and-start footwork for which you're not conditioned or for which you haven't stretched properly. This might include playing tennis, racquetball or basketball for the first time after a long break.
Sometimes, though, injuries can occur from simply putting too much stress on your Achilles tendon in the course of a simple activity, such as gardening. Occasionally, even highly conditioned athletes may rupture an Achilles tendon.
As you age, the risk of Achilles tendon rupture may increase. If you don't exercise regularly, the Achilles tendon may weaken and become thin, making it more susceptible to injury.
An Incident!
This is how I ruptured my Achilles tendon. Feel free to share your stories. I was playing a pickup game of basketball at my local Lifetime Fitness. I had already played one game earlier and was starting my second game. I was on the left baseline of the court when my teammate gave me a give and go pass. Only when started to go it felt like Bruce Lee gave me a kick to the back of my left heel. I knew right away something was right. I have sprained my ankles plenty of times. This was not an ankle sprain. It was a bizarre feeling at first. My foot literally did not work. I would try to walk and my foot would not respond. Everyone told me there heard a loud pop, but I didn’t hear anything. After icing for about ten minutes I grabbed my stuff and limped home. It really did not hurt that much, and I can see why some people do not see their doctor as soon as possible. The next day I saw my primary physician, and he recommended me to an orthopedic surgeon. The surgeon game me the Thompson Test and stated I have ruptured my left Achilles tendon. I thought I would be given an MRI or something. Nope. Just a date for the surgery I was having next week.
I am 27 years old. I have been playing basketball for at least twice a week since high school. Thinking back upon it, I had a pain in my left calf in the earlier game. I have always had aches and pains playing basketball, but I should have stopped right then and there. Coulda, Woulda, Shoulda. At least it was not my right Achilles tendon. I feel sorry for the person that can’t drive around.
Another surgery. I recently had an emergency appendectomy earlier this year. Acute appendicitis is no fun. The difference with the Achilles tendon surgery is you have time to think about all the horrible things that can go wrong. The appendicitis happened so fast and I was in so much pain I wanted that bugger outta there.
I can into the out-patient surgery wing of the hospital at 7:15 A.M. My Surgery was schedule for 8:45 A.M. I was checked into a small room and changed into the gown they gave me. The nurse put in an I.V. The anesthesiologist came in to talk to me about the procedure. He asked a couple of questions about my prior surgery and how I did with the general anesthesia. I was asking him I bunch of questions but I could not understand him, I believe he was from Croatia. His accent was heavy. I told him I felt no ill effects before. He asked me if I wanted general anesthesia or a spinal shot. I elected to have general anesthesia. I didn’t have to wear a catheter. Hurray, No Catheter!
They rolled me into the pre-op room where I met with another nurse the Croatian anesthesiologist and another anesthesiologist and the surgeon. They told me they made a last minute decision to give me a nerve block. They inject a numbing agent into the nerve of my leg. It is done to help the patient with post op. pain. I rolled onto my stomach and could hear the Croatian explaining to the other anesthesiologist where to inject the needle into my nerve. And then…..Darkness.
Awake…I was in the post op. room on my back with a cast on my leg and a bag of ice underneath. The nurse said the operation only lasted 45 minutes. If this is going to your first time going under it is a trip. I couldn’t feel a thing in my left leg. I went to the bathroom, put on my clothes and went home.
Fast forward roughly 24 hours later when the nerve block wore off. Holy Christ was I in Pain. The pain hit in a matter of minutes. It was painful. It eventually wore off, and I was only on painkillers for a couple of days.
Just a side note they give you a lot of antibiotics to take after the surgery. The biggest problem post operation is an infection of the wound. At the time of writing this I am four weeks post op. and have had not problems.
I am 27 years old. I have been playing basketball for at least twice a week since high school. Thinking back upon it, I had a pain in my left calf in the earlier game. I have always had aches and pains playing basketball, but I should have stopped right then and there. Coulda, Woulda, Shoulda. At least it was not my right Achilles tendon. I feel sorry for the person that can’t drive around.
Another surgery. I recently had an emergency appendectomy earlier this year. Acute appendicitis is no fun. The difference with the Achilles tendon surgery is you have time to think about all the horrible things that can go wrong. The appendicitis happened so fast and I was in so much pain I wanted that bugger outta there.
I can into the out-patient surgery wing of the hospital at 7:15 A.M. My Surgery was schedule for 8:45 A.M. I was checked into a small room and changed into the gown they gave me. The nurse put in an I.V. The anesthesiologist came in to talk to me about the procedure. He asked a couple of questions about my prior surgery and how I did with the general anesthesia. I was asking him I bunch of questions but I could not understand him, I believe he was from Croatia. His accent was heavy. I told him I felt no ill effects before. He asked me if I wanted general anesthesia or a spinal shot. I elected to have general anesthesia. I didn’t have to wear a catheter. Hurray, No Catheter!
They rolled me into the pre-op room where I met with another nurse the Croatian anesthesiologist and another anesthesiologist and the surgeon. They told me they made a last minute decision to give me a nerve block. They inject a numbing agent into the nerve of my leg. It is done to help the patient with post op. pain. I rolled onto my stomach and could hear the Croatian explaining to the other anesthesiologist where to inject the needle into my nerve. And then…..Darkness.
Awake…I was in the post op. room on my back with a cast on my leg and a bag of ice underneath. The nurse said the operation only lasted 45 minutes. If this is going to your first time going under it is a trip. I couldn’t feel a thing in my left leg. I went to the bathroom, put on my clothes and went home.
Fast forward roughly 24 hours later when the nerve block wore off. Holy Christ was I in Pain. The pain hit in a matter of minutes. It was painful. It eventually wore off, and I was only on painkillers for a couple of days.
Just a side note they give you a lot of antibiotics to take after the surgery. The biggest problem post operation is an infection of the wound. At the time of writing this I am four weeks post op. and have had not problems.
Sunday, January 6, 2008
Take your medicine, son.
Prevention can help you avoid this injury.
To help prevent an Achilles tendon injury, 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.
-Maintain a healthy weight.
-Wear well-fitting athletic shoes with proper cushioning in the heels.
Strengthening your calf muscles also can help prevent injury to your Achilles tendon.
To strengthen your calf muscles, practice toe raises:
-Stand flat, 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.
To avoid a recurrence of an Achilles tendon injury, follow these guidelines:
-Use warm-up and cool-down exercises and calf-strengthening exercises.
-Apply ice to your Achilles tendon after exercise.
-Alternate high impact sports with low impact sports, so as not to overwork your Achilles tendons.
To help prevent an Achilles tendon injury, 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.
-Maintain a healthy weight.
-Wear well-fitting athletic shoes with proper cushioning in the heels.
Strengthening your calf muscles also can help prevent injury to your Achilles tendon.
To strengthen your calf muscles, practice toe raises:
-Stand flat, 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.
To avoid a recurrence of an Achilles tendon injury, follow these guidelines:
-Use warm-up and cool-down exercises and calf-strengthening exercises.
-Apply ice to your Achilles tendon after exercise.
-Alternate high impact sports with low impact sports, so as not to overwork your Achilles tendons.
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