What it Takes to Recover From an Achilles Injury
May 9, 2013 | Mo Skelton
One injury that consistently makes athletes cringe is an Achilles tear—and rightfully so. Achilles injuries are no joke. Just ask Kobe Bryant for his thoughts on this potentially "career ending" injury. According to his doctor, Dr. Neal ElAttrache, Bryant's surgery (performed on April 13) went well. However, repairing a tendon is nothing like replacing a ligament. "They usually tear in a little bit of a shredded fashion, like two ends of a mop," Dr. ElAttrache told the LA Times. (Learn how to prevent an Achilles injury.)
Due to the complexity of an Achilles injury, recovery is a slow and tenuous process. Many reports say that Bryant will be able to return in six to nine months, but full recovery in normal circumstances takes closer to a year. In fact, a study by Dr. Rohit Garg, presented at a recent meeting of the American Academy of Orthopedic Surgeons, noted that 40% of NBA players do not return from this injury, and those who do exhibit inferior performance and play fewer minutes per game.
The Achilles is a unique structure in the body. According to the Hospital for Joint Diseases, it's the largest tendon in the body, attaching the calf muscles to the heel of the foot. Achilles injuries most commonly happen to men in their thirties and forties (Bryant is 35) who play sports occasionally.
Overuse or repetitive use can cause micro-trauma within the tendon, gradually weakening the tissue. It encounters extreme forces during jumping, sprinting and decelerating, so there are many opportunities for an injury to occur.
Road to Recovery
Recovering from an Achilles tendon tear and subsequent surgery takes patience and dedication. It's not like an ACL rehab (not to discount the difficulty of an ACL rehab). It cannot be rushed due to the location of the tissue, the risk of complications and the limited amount of weight bearing permitted in the early phase of recovery. It is common to remain on crutches and in a boot for up to six weeks.
Once the boot comes off, the focus turns to soft-tissue remodeling, which is the process of converting scar tissue to fully functional and mobile tissue. To regain mobility and loosen scar tissue, it's crucial to receive a high level of care from someone who understands soft tissue injuries and has skilled hands.
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Restoration of Activity
Early weight-bearing activity is best performed in an aquatic environment using a Hydroworx pool, or on an anti-gravity treadmill such as the AlterG.
Mobility can be improved by modifying "normal" exercises, such as Leg Presses, by placing wedges under the heels to limit tension. As mobility improves, the wedge can be placed under the ball of the foot to increase dorsiflexion to stretch the Achilles.
Balance must also be restored. Simply balancing on one leg at a time is a good starting point. Once this is mastered, it's common to progress to instability exercises using a BOSU ball, Theradisc or Biodex Balance Trainer. It's possible to bowl, play tennis or even play Nintendo Wii while standing on a foam pad to enhance the balance challenge.
Strengthening begins with stable two-leg exercises. However, it's critical to progress to single-leg exercises. One leg has been virtually immobile for over a month, so strength needs to be developed on each side separately to eliminate imbalances. Effective exercises include Bulgarian Split-Squats, Single-Leg RDLs and Single-Leg Goodmornings.
Plyometrics place a great deal of tension on the Achilles, so proper care must be taken when reintroducing them into a rehab program. Start with stationary two-leg activities, such as two-leg hops and jumping rope. Progress to Box Jumps, Ladder Drills, single-leg drills and lateral movements. (Try Paul Rabil's Hurdle Hops.)
The final step in the recovery process is to re-teach the central nervous system to properly fire all large and small muscle groups. Do a heavy exercise, such as a Squat or Deadlift, and immediately follow it with a max effort plyometric movement with the same movement pattern. This will help restore normal strength, power and quickness. (Learn more about complex training.)