Achilles Tendon Rupture…Not Just for Athletes
No, I’m not Kobe Bryant, I’m not LeBron James, and I’m certainly not tall enough to be Shaq. However, I still love to play basketball.
Basketball keeps my endorphins up and helps me maintain a healthy dose of competition.
About two weeks ago on a Wednesday night, after playing four games, I should have listened to my body. I was already feeling fatigued but it was a competitive match. I suddenly went for a ball, stepped off my right foot, and then I felt and heard a pop. It sounded just like a gun shot. I knew exactly what it was.
I reached down to my right ankle and felt nothing. My Achilles tendon was gone. I had an Achilles tendon rupture.
Initially, and like normal, I didn’t feel any pain. However, after 30 minutes and after the adrenaline levels subsided, my pain quadrupled and remained at its peak until even after my surgery.
While I couldn’t plan for that exact moment, I realized my actions leading up to it could have been altered.
A few weeks prior to the game I went on a snowboarding trip which may have been the culprit of some micro-tearing. Without the threat of micro-tears, there’s no threat of an Achilles tendon rupture. I stretched and planned quite a lot before that trip, however, despite my best efforts, it may not have been enough to defer the threat of micro-tears.
When your physicians becomes the patient.
We are only as strong as our mind and body. When we see athletes fall to ailments we are humbled by how impeccable their bodies are but unsurprised due to their daily strain.
But what about our doctors?
We trust them with our bodies, our health, and easing our mind when we jump to conclusions from WebMD. However, in medicine, we are always comforted by the notion of “you are not alone”. Knowing that someone somewhere else out there has experienced where you currently are. That acknowledgment may be the first step towards accepting recovery.
Would you think the same if your doctor was that someone?
Normally, I’m a physician before I am an athlete. But when I had an unexpected Achilles tendon rupture, I became the patient. Being on the other side of the stethoscope gave me new understanding of the recovery process. I was no longer guiding a patient through recovery. I was learning to guide myself, and it was a challenge.
Now, I actually feel like I can give more to my patients. Now, I can give them that extra level of care. I can now offer genuine, empathetic guidance in recovery.
How do you know if you have an Achilles tendon rupture?
Diagnosis of an Achilles tendon rupture is usually done through a simple physical exam. Mine was diagnosed officially the next day without an MRI by our trusted orthopedic surgeon. A simple bedside clinical exam called The Thompson Test was administered; when the tendon is intact, and the calf is squeezed, the ankle will Plantar Flex. Mine was tested positive.
It was determined to be a complete tear. The initial tear feels like a pop and causes a loss in the ability to bear weight on the affected leg. After a tear, extending and flexing your leg and ankle is not possible. An x-ray was done later to rule out any other possible fractures.
An incomplete tear is said to be more painful than a complete one. The reason for this is that the tissue between your foot and ankle is still able to function to a small degree, thus inciting more pain on the injured location. Otherwise, the physical indications of an Achilles tear is swelling and bruising around the back of the ankle.
What exactly causes an Achilles tendon rupture?
While many risk factors are associated with an Achilles tendon tear, like disease and gender, the degenerative and mechanical theories are the most common. The degenerative theory suggest that ruptures occur from strain put on the tendon in adults (typically active males) over the age of 35.
The mechanical theory suggests that a tear occurs after a series of “micro-trauma” without adequate time to heal itself. Micro-traumas can occur when we stretch the Achilles tendon more than 8% of its own length. After too many repetitions of this stretching it creates “micro-tears” which leads to the micro-traumas.
Being a male at my age were factors in my own injury. However, I believe I may have had micro-tears in my Achilles tendon from a month prior to it tearing. I had gone snowboarding and I had a lot of wear and tear during that trip even though I didn’t feel much pain. So I may have unknowingly expanded on preexisting tears while snowboarding.
When this happens, sometimes the tears aren’t even large enough for your body to respond with inflammation, indicating healing is needed. When we aren’t alerted with inflammation in the area, we continue to exert force on the tendon which can lead to the either complete or incomplete tear.
We risk ruptures by adding too much pressure to our Achilles tendon too quickly: Are you not stretching enough before sprint training? Did you switch from concrete to grass training grounds? Even walking in high heels too regularly puts strain on your Achilles and can wear down its tolerance.
About three weeks prior I had severe bronchitis and was prescribed one of the Floraquinolone antibiotics. The black box warning on the antibiotic said that it could be associated with tendonitis, tendon rupture, peripheral neuropathy, and CNS effects. The threat of tendonitis or a tendon rupture may occur during treatment or even months after discontinuing.
However, I was already familiar with the drug and its possible side effects, so I was cautious with my exercise. For three weeks, I avoided playing any sports or engaging in too much physical activity; sometimes you just need to allow your body to heal. Nevertheless, a rupture occurred. I’m not saying that is what caused my rupture, but it certainly could have been a factor in the injury.
Treatment and Adjusting to Recovery:
An Achilles tendon rupture can be treated surgically or noninvasively. Nonsurgical solutions are better for those willing to undergo a longer recovery time or those prone to surgical complications. Patients will be wrapped in a cast or splint with longer a longer time to rehabilitate. Both options are effective but meant for different types of candidates.
Typically surgery is the choice of young athletes because it cuts the risk of a tear in the future. The surgery consists of opening the skin, exposing the torn tendon, and sewing back together the separated strands.
I chose to have the surgery. My surgeon, Dr. Reed, has been the best orthopedic surgeon in Central Florida and Volusia County for about 30 years now. I knew him not only from childhood injuries but also from him operating on my brother’s basketball-induced Achilles tendon rupture. He has become our own, trusted family orthopedic surgeon.
The whole procedure took about an hour and a half. Prior to being put under general anesthesia by the anesthesiologist, Dr. Lenox, he gave me a popliteal nerve block (for which I am eternally grateful for). I was actually given another one post-surgery because the pain during the transition home from surgery was so severe.
I was prescribed different narcotics for pain relievers and anti-inflammatories. I know the side effects associated with these prescriptions so I had to really choose my battles.
Did I want nausea? Did I want severe constipation? Did I want the inability to focus when walking across the hall to the bathroom when it already took two people?
Being cautiously restrictive of how much of a narcotic you take means experiencing various levels of pain. I would try to take my mind off the pain by focusing my attention elsewhere.
With that said, by choosing to deal with my pain primarily away from narcotics, it allowed me to focus on my own holistic healing.
Yes, I am a medical doctor but when I treat a patient as a whole and their bodies as a whole, we can see the influence of each interdependent part on the others. Which part is affecting the ability of another? Where are the imbalances and therefore destructions?
Treatment comes in the form of physical, emotional, and spiritual healing.
Having this experience, I realized that the medical aspect of my healing had been completed. I had already had my surgery. The only thing left for me to do was heal.
Psychologically I had to prepare myself in allowing my body to just focus on itself. I found that focus in meditation and spirituality.
In fact my spirituality took the primary form as my pain reliever. I reminded myself about the time when Job called to the Lord and said, “Adversity has touched me, and you (the Lord) are the most merciful of the merciful.” – Verse 21:83.
The Healing Process:
I knew the healing process would be difficult on me and my body; moreover, this type of injury requires the assistance of others, especially your loved ones. In my case, my wife was impacted the most. Since the first day my wife and I got married, I have been blessed to have her in my life, but this injury has put my admiration for her to another level.
Finding support not only in your physicians but in those in your life is a genuine component in successful recovery. Obviously, the biggest support I had was my wife and family. I couldn’t drive, I couldn’t go to work, I mean, I couldn’t even get out of bed without someone to lean on! My wife, my best friend, and my strongest motivation was my selfless support in my recovery.
As this was an unexpected injury and surgery, it was a true challenge adjusting my life around making my body better. Medically monitored rehabilitation from this kind of injury varies. In fact, some athletes may not be able to return to the full rigor of their sport.
- The first three weeks is reserved for minor exercises: weight training, swimming (if operated area is allowed to be exposed to water), toe curls, knee extensions and flexing.
- By month two, patients should continue strength and weight training and transitioning off crutches.
- By month four, patients may be able to take their protective boot off and should have full range of motion in their affected ankle.
- By month six, more extensive weights and therefore pressure is encouraged to be put on your affected ankle; squats, lunges, calve raises, and monitored cardio like jogging.
- By month eight, patients should feel more confident in their Achilles healing. However, lingering effects may prohibit too much regular, intense sports.
The most common action that produces a tear is lunging upward with the knee extended. Of the 70% of sports-related Achilles injuries, half of them belong to basketball players.
Achilles injuries have plagued many NBA players to the extent it ruined careers. An Achilles injury in basketball is like an arrow in Achilles heel; it’s done for.
One of the most notable NBA Achilles injuries belongs to Kobe Bryant. At a game on April 12th, 2013, Kobe fell to the ground, thinking a player had kicked him. By the next day he was in surgery.
By August Kobe was running on an antigravity treadmill, perhaps giving himself more hope of a future in the NBA than the rest of the organization.
By November 18th, 2013, Kobe received the greenlight to resume his historical basketball career with The Lakers. As of December 8th, 2013, Kobe cemented his return to the court.
Kobe’s eight month return from an Achilles tendon rupture is nothing short of amazing. What’s even more amazing is that he played for two whole seasons after that!
Not everyone is Kobe Bryant or a doctor but everyone has the means to recover on their terms.
I want my patients to know how or why something has happened to their body and how it has the potential of happening to anyone.
I pride myself of practicing holistic medicine. It is important to consider the complete person: physically, psychologically, socially, and spiritually, in the management and prevention of ailments and diseases.
When an ailment occurs, recovery is dependent upon both your physician and you as the patient.
No matter what, recovery is a challenge but it is up to you to make it challenge you look forward to. Setting an ending goal for recovery is nice but setting daily goals will make the recovery a more bearable journey.
As a physician it’s exciting to be able to relate to patients on a different level, with a new perspective. It humanizes the process for anyone who may be struggling with a seemingly long recovery.
Disclaimer: MultiCare Physicians provides the [www.multicaredocs.com] Website as a service to the public and Web site owners.
MultiCare Physicians is not responsible for, and expressly disclaims all liability for, damages of any kind arising out of use, reference to, or reliance on any information contained within the site. While the information contained within the site is periodically updated, no guarantee is given that the information provided on this Website is correct, complete, and up-to-date.
Although the MultiCare Physicians Website may include links providing direct access to other Internet resources, including Websites, MultiCare Physicians is not responsible for the accuracy or content of information contained in these sites.
Links from MultiCare Physicians to third-party sites do not constitute an endorsement by MultiCare Physicians of the parties or their products and services. The appearance on the Web site of advertisements and product or service information does not constitute an endorsement by MultiCare Physicians, and MultiCare Physicians has not investigated the claims made by any advertiser. Product information is based solely on material received from suppliers.