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Squash Magazine Articles

Achilles Tendon

by Michael Schumacher, DPM, FACFAS

Preventive care is a key to avoiding injury

If you are over thirty and play squash, it would be surprising if you never thought about a ruptured Achilles tendon. If you have been fortunate enough to avoid this injury, surely you have heard about it happening to someone. The story is always the same: a player falls down, grabbing his/her ankle. The first words out of the players mouth (after #$%@#!) are directed at the opponent: "Why did you hit me in the leg with the racquet?!" After being assured there was no contact, the player limps off the court, not to return for the better part of a year. In this edition of the Training Room, I will explain about the Achilles Tendon and what it does, how to protect and strengthen it and what to do when you've injured it.

The Achilles tendon is a single tendon attached to two muscles (the gastrocnemius and the soleus). These two muscles make up the bulky part of your calf, and they become tendon below the calf. The other end of the tendon inserts on the back of your heel bone (the calcaneus).

The Achilles tendon enables you to move your ankle so that your toes point to the floor (plantarflexion), and it provides the main propulsive force in walking and running. About two to six inches above the insertion point at the heel bone is where the trouble usually lies. This is an area where there is poor blood supply (called avascularity) and is known as the watershed area. The watershed area, coupled with the tremendous force the tendon is often called upon to supply, is the underlying reason behind Achilles tendon trouble.

Stretching is of paramount importance in avoiding problems with the Achilles. If you are thirty years or older, even if you never have an ache or pain in your body, stretching must become an integral part of your squash game. This does not mean 15 seconds of leaning against the wall before you serve the first point. To properly stretch your Achilles tendon, as well as any part of your body, you must warm up first.

To warm up, you should get on the stationary bicycle for five minutes and break into a light sweat. By sweating, you are getting the blood pumping to your legs and arms, and you are letting your body know that a workout is on the way. Once you have loosened up by getting your body warm, you then begin to stretch. Instead of describing specific techniques, I would like to recommend an excellent book about stretching. "Stretching," by Bob Anderson and published by Shelton Publications, is an excellent book, and it contains many stretches for the Achilles. It is a must for both the casual and serious squash player. One last important comment about stretching: It should not hurt. If it does, you are probably being too aggressive or doing it improperly.

Besides stretching properly, another important part of Achilles tendon health is proper shoe gear. Make sure your squash shoes are not worn out. I have found from personal experience that if you play five times a week, you need to buy new shoes every 3-4 months. I am always amazed by the number of patients that come into the office with complaints of Achilles tendonitis who have been playing in the same pair of squash shoes for over one year! Never underestimate the importance that proper shoe gear plays on the health of your feet and legs.

How should you know you may be heading for trouble with your Achilles tendon? Occasionally, there are some warning signs that you are heading for a ruptured tendon. The most common sign is pain and a tight feeling along the back of the lower leg. Like any tendon, the Achilles is subject to overuse and strain.

When this happens, the first line of treatment is rest. If ignored, the symptoms can worsen into a chronic inflammation of the tendon, leading to Achilles Tendonitis (itis = inflammation) which can weaken the tendon to the point of rupture. If you have tendonitis, rest (again!) and ice therapy are called for. Your sports medicine specialist (who you should see right away if you suspect a problem in your Achilles tendon!) can also prescribe some anti-inflammatory medicine. One thing is for certain--do not ignore the symptoms, as they can lead to a rupture of the tendon.

If you think you have ruptured your Achilles tendon, please make an appointment with our office. The longer you delay treatment and continue to walk, the farther apart the two ends of the tendon get. This makes the surgery more difficult, and adds to the length of rehab time.

So, remember, STRETCH!! And visit our office so we can get you back to recreational activities.


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