Achilles tendon rupture (trainer stitch)
Rupture of the Achilles tendon is a major accident at the sports site. Consulting a specialized sports doctor and receiving appropriate treatment according to the type and level of the sport and age would be recommended rather than hurriedly having the patient transported by ambulance to hospital for surgery.
The idea that a flexible Achilles tendon is less likely to rupture leads to a stretching and balancing menu being prescribed for prophylactic conditioning. The basic stretching of the ankle is dorsiflexion but stretching can be classified into several groups according to the condition of the knee. Stretching with the instruments such as step stretching (see Photos 1 and 2) is also effective. Step stretching, which is characterized by simultaneously doing Achilles tendon stretching and plantar lengthening, may relieve considerably heel and Achilles tendon pain when used correctly.
On-site evaluation and first aid
Rupture of the Achilles tendon occurs suddenly, making the person surprised. It is characterized by kicking (hitting) impact from the back, as described in many text books, but the absence of severe pain, which the person feels such as in sprains, is an "unexpected" feature. The person may not know what happened and may stand up, but then he/she may fall if the Achilles tendon is completely ruptured. Anyone at any level is at risk of Achilles tendon injury when moving suddenly from resting state. Even leading players may be injured in many cases, because other factors, such as the accumulation of fatigue and physical condition, are intricately intertwined. Achilles tendon injuries are often seen among many middle-aged players probably because they forcibly try to move while recalling the past days without realizing weak muscles or tendons.
The starting timing of rehabilitation right after the injury depends on treatment methods: conservative or surgical. Therefore, make sure to follow the instructions given by the physician or physical therapist. Even after you go to the sports scenes, you will be prescribed training that is close to the actual movement while continuing the basic treatment menu. In hospitals, strengthening of the muscles around the body may be done with PNF (proprioceptive neuromuscular facilitation), isokinetic exercises, or other techniques.
A. During fixation
Achilles tendon rupture need to be secured with a cast regardless of, conservative treatment, or a surgery. Originally, this is the period of time when a physical therapist provides a prescription for rehabilitation in a hospital, but there is time to stay on the scene. During this period, the affected side should conduct mainly SLR with a cast and the unaffected side should conduct conditioning such as weight training or reinforcing exercises. If the patient has a doctor’s prescription, he/she can electrically contract the muscles using an EMS in this period. Plantar dorsiflexion of the toes also begins in this period to maintain the activity of the muscles adjacent to the affected area.
B. During wearing a simple cast or walker
For some time after the cast is removed, a patient should wear a simple cast or walker that is removable and stronger than an ankle brace or other sports orthosis. The first 2-3 weeks after the cast has been removed are said to be the time of the greatest risk of re-rupture, and careful recondition is required during this period. Basically, it is recommend to visit the hospital and receive direct guidance from physical therapists. To restore range of joint motion and muscle strength around the ankle, manual resistance exercises using machines such as plantar dorsiflexion, PNF, and isokinetic is prescribed.
C. After walking is allowed
Careful rehabilitation should be carried out under the doctor’s instructions, but a home menu is prescribed when calf raise can be done with hands on a desk. For athletes, walking exercises are performed in water. They may walk at a slow pace, walk on the toes, or walk on the heels. Be careful not to slide on around the swimming pool.
Walking exercises can be performed on land when the patient is able to do calf raise with hands on the walls. In addition to the usual walking, he/she may walk on tiptoe or on the heel. Then he/she gradually increases the length of stride. If he/she is able to do calf raise with getting hands off, shucking is allowed. Shucking is a slow jogging in which one foot is always on the ground.
D. After one-leg calf raise can be performed
Perform an ankle bounce not being away from the floor. An ankle bounce is an in situ jump with the ankle. In the early stages, do it rhythmically while not to leave the floor. As the patient gets used to it, raise the leg gradually.
Starting jogging is encouraged at this stage. Be aware of arm swing and posture, and keep balance as much as possible so that the right and left tempos are the equal. Adjust the speed and distance according to the level of recovery.
E. Hopping with the one leg can be performed
Carry out exercises and reinforcements to restore coordination, by employing instruments such as sliding boards, balance boards and boss systems. In addition to jogging, driving exercises include side-steps, skipping, cross-steps, and back-crossing. As recovery continues, the menu also includes turns and directions, but the most dangerous thing is to suddenly changing in direction from running backwards. It is also recommended to do the China Step at this time.
Return to game
Do not forget to perform a restart test for the basic movement before returning to full game. Careful conditioning and after-care to prevent relapses is absolutely essential for the case of Achilles tendon ruptures, as they have a high rate of relapse.