ACHILLIES TENDON INJURIES

Darragh Hanratty & Aisling O’ ConnorK00201178 & K00193124Sports Injuries

OVERVIEW Anatomy & Function Research & Findings on Achillies injuries Case Studies of athletes Recovery & Treatment Methods Rehabilitation Programs

ANATOMY & FUNCTION Posterior leg tendon. Biggest & strongest tendon within

the body. Strong fibrous chord which

connects the gastrocnemius & Soleus muscles to the calcaneal tuberosity.

Does not have true tendon sheath – paratenon which is areolar connective tissue supplies blood

Posterior tibial artery & peroneal artery

Blood vascularity is weakest at achillies heel connection (2-6cm)

Enables us to not only play sport but run and jump.

TYPES OF ACHILLIES TENDON INJURIES

ACHILLIES TENDONOPATHY ACHILLIES TENDON RUPTURE

Overuse injury Painful and debilitating Chronic Inflammation Swollen Micro-tears Findings – Due to

degeneration of tendon in older athletes

Partial or complete Can be a result of

tendonopathy Athlete hears a ‘Pop’

sound Sharp pain in ankle Can be floppy and weak

THE THOMPSON TEST

FINDINGS Majority of injuries occur in

males due to higher rates of participation in sport

The achillies tendon is able to withhold the stress of about four times a persons body weight while running and just above insertion it is only 4cm thick. (Healthline Editorial Team, 2015)

Account for 5-12% of all running injuries (Davis, 2002)

A study done in Finland showed 75% of total & majority of partial ruptures are related to sports activities involving repetitive jumping & sprinting movements (Kvist.M, 1994)

COMMON SPORTS

CASE STUDIES Dominique Wilkons suffered a

ruptured achillies in 1992 aged 32 and went through 9 months of rehab

Elton Brand ruptured his left achillies aged 28 previous trouble before & got a corticosteroids injection for pain relief. Studies show side effects can lead to rupture of tendon taking away integrity of tendon.(Nepple et al,2009) 8 month rehab process.

Kobe Bryant suffered a third degree tear and was out for a year

70-90% of athletes have a successful comeback post surgery (Kvist.M,1994)

Led to shaquille O Neals early retirement.

FACTORSINTRINSIC EXTRINSIC

Age Gender Bodyweight Vascularity of Tendon Weak or tight calf

muscles Ankle Instability

Previous or reoccuring injuries

Sudden increase in activity levels

Footwear Poor running mechanics

RECOVERY & TREATMENT METHODS Rest Ice for acute injuries Heat for chronic

injuries Orthotics (Raise heel) Physical Therapy Low impact exercises Cross Fibre friction

massage (heal strong, fibres line up right)more blow flow

Stretching Strengthening

exercises Medication -NSAI

ibuprofen,naproxen Cortisone Injections

REHABILITATION 0-3 weeks - non weight bearing exercises for 3 weeks Pain control (Cryotheraphy, electro stim, soft tissue treatment) Toe curls, toe spreads, straight leg raises, knee flexion,extension& swimming 3-8 weeks Gradual increase in weight bearing exercises After 6 weeks progress to full weight bearing exercises Isometrics & passive range of motion and stretch in achillies Proprioception 8-12 weeks Full weight bearing and gait training Increase active and resisted exercises (Theraband) cycling 3-6 months Controlled squats, lunges, bilateral calf raises, progress to unilateral slow eccentrics 6 Months Progress with training jogging, running jumping and eccentric loading. Non competitive

sporting activities 8-9 Months RETURN TO PLAY (Stone, 2014)

CONCLUSION Strong, powerful tendon that allows us to engage in many sporting

activities Very susceptible to injury due to high amounts of stress Tendonopathy is related to degeneration of fibers in the tendon as well

as repetitive overload as a result can lead to a total rupture of the achillies

Athletes who participate in Sports that involve running or jumping are more prone to achillies injuries

Intrinsic & Extrinsic Factors like age, gender, poor running mechanics Found that eccentric training is the gold standard for recovery, rehab

and prevention

REFERENCES Dr.Steven M. Raikin. (2015). Read and Recover: An athletes guide to Achilles tendon

injuries. Available: http://www.si.com/edge/2015/04/16/rothman-sports-medicine-achilles-injuries-kobe-bryant. Last accessed 23rd March 2016.

Jeffrey J. Nepple, MD Matthew J. Matava, MD. (2009). Soft Tissue Injections in the Athlete. Sports Health. 1 (5), p396-404.

Healthline Editorial Team. (2015). Calcaneal tendon. Available: http://www.healthline.com/human-body-maps/achilles-tendon. Last accessed 23rd March 2015.

John Davis. (2002). The Ultimate Runner’s Guide to Achilles Tendon Injuries. Available: http://runnersconnect.net/running-injury-prevention/achilles-tendonitis-and-insertional-achilles-tendinopathy-in-runners/. Last accessed 23rd March 2016.

Kvist.M. (1994). Achilles tendon injuries in athletes. Sports Medicine. 18 (3), p173-201.

REFERENCES CONTINUED… Jonathan Cluett, MD. (2016). Thompson Test. Available:

http://orthopedics.about.com/od/findingthecaus1/g/Thompson-Test.htm. Last accessed 25th March 2016.

Dr.Kevin Stone. (2014). Achilles tendon repair rehab protocol. Available: http://www.stoneclinic.com/achilles-tendon-repair-rehab-protocol. Last accessed 25th March 2016.