On April 12, 2013, Los Angeles Lakers superstar Kobe Bryant tore his Achilles tendon late in the 4th quarter against the Golden State Warriors. Bryant is 34 years old and has been in the NBA for 16 years. His projected return to play ranges from 9 months to a year. This is a substantial amount of time for anyone and a long rehabilitation process.
The Achilles tendon connects your calf muscle to the back of your heel and enables one to stand on their toes, jump, and walk properly. If the Achilles tendon is ruptured (torn), all activities involving one’s lower extremity are made very difficulty, even impossible, until the tendon is surgically repaired or given proper time to heal.
A rupture of the Achilles tendon is a common injury amongst men ages 30-45 that participate in recreational activities on the weekends. This is not to say that people who do not meet this criteria cannot tear their Achilles, this is just the most common demographic.
The most common ways to tear your Achilles tendon are to land from a jump or change directions quickly, as Kobe Bryant did. Some factors that may make you more susceptible to tearing your Achilles are decreased flexibility of your Achilles tendon or a history of tendinitis. What happens when you tear your Achilles tendon? When someone tears their Achilles tendon it is common for them to describe the sensation of the injury as if they were shot. It is also likely that they heard and felt a ‘pop’ in the location of their Achilles tendon. After the tendon is ruptured one will exhibit extreme weakness in their lower leg, swelling, a defect in the tendon that can be felt, and pain. Tearing one’s Achilles tendon is considered one of the more painful injuries that someone can sustain. To assess the rupture, medical professionals use what is called the Thompson test. The calf is squeezed and if the foot does not move into a pointed toe (plantarflexed) position, as it should, the Achilles tendon is torn.
For more information on physical therapy services head to www.totalperformancept.com.
Physical Therapy and Recovery
Once the tendon is ruptured that are two options in terms of repairing the torn tendon. The first option applies more so to the older, less active population, this is the non-surgical option. The individual’s foot is placed in a cast or boot in the toe pointed position for 8 weeks. This allows the body to naturally heal the tendon on its own by forming scar tissue to reconnect the tendon. Every 2 weeks while in the boot the foot is gradually moved to the 90-degree position as one would exhibit in a standing position. One of the negative side effects of this option is a significant loss of strength, which is why this option is used for older, less active people who would not need such strength to perform their everyday activities.
The second option, the one Kobe Bryant did, is the surgical option. The surgeon reconnects the two parts of the tendon that were disconnected and torn. Then the individual must remain in a boot or uses crutches for 6 weeks to allow the tendon to properly heal.
Patients with this injury come to physical therapy so they can return to their previous activities they were involved with prior to their injury occurring. The issues addressed in physical therapy are strength, range of motion, balance, and gait. People with Achilles tendon tears have deficits in these areas.
Early on in the rehabilitation process it is important to not over stretch the Achilles tendon. This could possibly lead to re-rupture or an over lengthening that will compromise strength later on down the line. Another guideline to not rupture or over lengthen the tendon is to hold off on strengthening the muscle until 12 weeks post-op. You can already see why this is such a long rehab process, even for someone like Kobe Bryant. Patients cannot be pushed too hard, too fast otherwise the tendon could re-rupture and then it’s right back to square one.
Let me briefly discuss some of the strategies that physical therapists use to address the deficits that patients present with after an Achilles tendon rupture. For greater detail, you can visit Total Performance Physical Therapy.
Physical therapists will start patients on partial weight bearing ambulation either through aquatic therapy or a support system on the treadmill. This allows the patient to address strength, ROM, balance, and ambulation all at once without compromising the healing tendon. Another strategy used is through backward walking. This decreases the demand on the healing tendon while addressing the patient’s impairments. Also, the rehab process is longer (about 9 months for Bryant) since the patient begins jogging slowly before going right to running. This is because with running a person is usually on their toes more often, which puts a greater demand on the tendon. Physical therapists use many other tools such as therapeutic exercise, manual therapy, balance training, etc. to return patients to functional activity. Listed above are just a few examples of what a patient will do in physical therapy, for more visit Total Performance Physical Therapy.
As you can see the therapy process is a delicate balance between addressing a patient’s deficits and progressing them, but not progressing them too fast as to compromise the healing tendon.
For more information on physical therapy services head to www.totalperformancept.com.
