Bodyworks: Achilles Rupture

How to recognise it, how to overcome it


Posted: 5 June 2000
by Patrick Milroy

Symptoms
It’s hard to miss a rupture or break of the Achilles tendon (TA). You’ll feel an acute pain, possibly hear a noise as loud as a gunshot, feel faint and a little clammy and find that you cannot stand properly on your toes.

Signs
You’ll probably find that the area swells or has visible blood under the skin, and that a Thompson’s Test (in which the doctor squeezes your calf while you lie face-down with your lower leg hanging off the couch) won’t produce foot movement. The break in your tendon may fill with blood, so it may be harder to feel than you might expect.

Medical investigations
A soft-tissue X-ray or ultrasound scan will confirm the break in the tendon.

What else could it be?
There is no real alternative diagnosis.

Self-treatment
Don’t even try!

Medical treatment
There is debate as to whether surgical repair is preferable to encasing your lower leg in plaster of Paris, which allows fibrous healing of the tendon to occur before rehabilitating it. The answer lies in the personal preference and experience of your doctor.

Can you run through it?
Not a hope, though some lightweight plaster and special boots may allow a little walking.

Recovery time
At least six weeks in plaster and probably a minimum of four months to rehabilitation and a return to normal training. However, the process can sometimes take years rather than months.


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Does anyone have experience of Achilles injury? This time last week I started to experience a slight twinge in my left leg. I took it easy for 4 days and then returned to running last night but to no avail and I had to abandon a Long Run due to the pain. Incidentally my trainers have done about 300 miles and I tend to run on my toes a bit when running (so others tell me anyway).

Now I know the advice is to rest but I'm trying to get ready for my first marathon in 2 months and I'm just annoyed that I've got injured again all of a sudden.

Does anyone have an idea as to how long the recommended lay off should be?
Also are there any particular exercises that may help recovery?

Any help will be greatly appreciated.

PPB.
Posted: 28/07/2003 at 16:40

Try stretching - stand facing wall with leg straight behind you, and turn foot slightly outwards to increase the stretch in the achilles. My physio got me doing this 3 times, holding for 10secs - every 3hours hours for the first week, and then twice or 3 times a day afterwards.

I also found that warming the area up before a run helped lower the chances of it starting to hurt (just rubbing it for a while with my hand). Also icing the area afterwards was effective too.

My physio also gave me really small heel lifts (the highest part only about 5mm) to put in my shoes and trainers, and this really made a huge difference.

Good luck with it and hope it sorts itself out so that you're able to do your marathon.

Posted: 28/07/2003 at 16:57

When my husband damaged his achilles he did as MT says as above...the phsyio also said that dehydration was a factor...so on that basis try drinking more fluids if you aren't already
Posted: 28/07/2003 at 17:00

Hi there, don't want to rain on your parade but I have only just returned from an achilles problem having been out for four months.. yours may not be as bad as I have had it and although you must really want to run in your marathon don't risk causing more damage.. there are other races!

I damaged mine by doing aerobics on my lounge floor with no trainers on (it was 6:15 in the morning!) but I have paid for it.. missed the whole summer of evening runs and races - I last raced in March!

All the suggestions above are excellent, stretching, ice and staying off it for a while, elevating where you can. Is it possible to do some cross-training for two weeks? Non-impact stuff like biking and weights in the gym, then you're not losing fitness and you are increasing muscle mass but not making the injury worse.It has really helped me now I'm running again, I'm much stronger through the work in the gym.

Only you know how bad it is but don't run on it just because of the maraton - I kept training for two weeks after it first occurred (just ignored the excruciating pain)and only made it worse.
Sorry to be a bringer of doom! Good luck!!
Posted: 28/07/2003 at 18:25

oh, and also, buy some new shoes! Go to a proper running shop and get an expert to check your gait and which bits of your feet you put most pressure on. It could be that your shoes are causing some of the trouble.. :-)
Posted: 28/07/2003 at 18:27

Yep, I carried on training for a while when mine went, thinking that it was just a calf strain of something and would be fine... that probably made mine worse too.

Cross-training, as Louise said, is a really good idea - keeps you sane when you can't run. I found both cycling and swimming to be fine - especially the cycling as it meant that I could do get out and about so it's as close to a run as you can get... only sitting down!
Posted: 29/07/2003 at 08:27


Thanks for the advice everyone. Interestingly I do have proper running shoes bought from a running shop. My local running shop (and we only have one in Aberdeen) doesn't do gait analysis. I was blaming some new Nike Pegasus shoes bnought recently for possibly causing the injury but I doubt this is actually the case.

I think I'll try and get the gait analysis done next time I'm in a town with it. I think a running shop in Edinburgh do analyse running style.

I'll follow the advice provided. I think Louise has hit the nail on the head. It's better to rest for a couple of weeks with cross training than try and run through niggling pain that only gets worse as my distances increase. I'm fortunate that ther is a gym next to my work so I can cross train and go swimming at little cost. So I think I'll do that for the next 2 weeks then slowly try and return to the running. If the injury hasn't improved enought then I may just have to abandon the marathon run for this year and work towards one for next year instead.

Thanks again

PPB.

Posted: 29/07/2003 at 08:28

I hope the cross training works - I feel sad for you now if you have to postpone the marathon.

P.S. If the shoes are relatively new and/or you've changed shoe style/brand it could be them.. do they have high backs (don't know what that bit is called!) that sit on your achilles? If so they could be rubbing and causing the trouble - even if they don't feel as though they are. A suggested remedy is to attack your shoes with some scissors and cut the very top bits off so the shoe fits lower around your achilles. I've never done this and you do effectively ruin a lovely pair of shoes but if it stops the pain.. might be worth a try if you don't see an improvement in a couple of weeks.

Good luck!!
Posted: 29/07/2003 at 09:34

I've had Achilles tendonitis in my right leg for about a year now. I believe it has become chronic. However, there is very little risk of the AChilles tendon snapping if you carry on training; so if you can take the pain, you could carry on running till your marathon, and use the lay off period after that to let it heal.
A few additions to what people have suggested: if you have a lay off, do not try stretching straight away (you'll do more damage). Give the pain time to receed. Avoid running uphill or in sand; avoid plyometrics, especially exercises such as bounds and hops. You can try cutting or burning off the top back of the heels of your running shoes to ease the pressure on your tendon (the pain is caused by the swelling around the tendon which causes it to stick ti its sheath. Finally alternate cold therapy (ice) with warming the area, which increases the blood flow to the area.

The pain in my achilles is still very much accute at the moment, but I had similar problems with chronic plantar fascitiis (for over a year) and refused to let it stop me, using natural lay off periods such as after a marathon to give it a chance to heal and, eventually, it did go.

I know this doesn't sound like very sensible advice, but I have long ago refused to let every niggle (and they are many!) stop me...
Posted: 29/07/2003 at 09:51

hurrah! someone 'sensible'! run through the pain (unless you can't move at all) I reckon!
Posted: 29/07/2003 at 10:20

Interestingly controversial adice Nick J. I'm sure some medics would love you.

Thanks though Louise & Nick. I'm tempted by the "cut up the trainers" solution as I reckon the Nike Pegasus' do have high backs and this could be affecting the injury. But I think I will follow what I suggested earlier and rest / cross train for a week or two and then return slowly to see if the injury is healing.

While on the Long Run on Sunday I know I could have kept going and ran through the pain, the mistake I made was stopping and walking at one point (my mate nutcases fault as he wanted to stop for a p*ss).
So if I was in a marathon I would most likely be able to keep going until the end and deal with the injury consequences subsequently. Not a bad time to get injured though if it was the end of Septmeber as I've no planned races after Loch Ness Marathon anyway until next year.

Cheers again.
Posted: 29/07/2003 at 11:53

Rather interestingly, it's advice I got off my physio while preparing for FLM, after I'd told him I really did not want to rest...
Posted: 29/07/2003 at 12:17

In response to Nick J I feel that AT is an injury that has to be considered more seriously than just a niggle and would certainly not consider running a marathon with any kind of achilles problem.
I had an AT injury several years ago that I initially tried to ignore but in the end in became chronic and I needed an operation. The operation was no walk in the park and I needed several sessions of very painful cross frictional massage from the physio before I fully recovered. In all I think I lost nearly 2 years but did recover eventually. I just wish I had been patient immediately.
I currently have a slight strain in the other achilles (due to the hard ground with the recent heatwave I think) but I have sought treatment straight away and am confident with the correct therapy ( massage, ultrasound) and stretching I can limit the lay off to 6 weeks. However I will only test when I am sure. You can't mess around with an AT injury in my opinion or the problem will haunt you for months or worse.
Good luck everyone.
Posted: 29/07/2003 at 14:18

Good article and exercises here,

http://www.pponline.co.uk/encyc/0031.htm

I have had chronic Achilles pain in the past, and normal stretching/nsaid/rice didn't seem to work. However the strengthening methods outlined at the above link have worked for me.

I have also cut the back of my trainers so that there is no rubbing, although I have just bought a pair of low backed ones to see how I get on with this type (Adidas calibrate).

Have a look and good luck with your recovery.

Cha
Posted: 29/07/2003 at 14:59

ok ok ping pong boy, so you're also into AT.
here i am 50 years old running 10 k runs 2 times a week. i developed AT this feb but i keep running through. i've cut down my frequency from 4 times a week to 2. but i feel better if i keep running. at times when the gap exceeds 4 days, the pain just increases. listen to your body and your heart. just keep going.
Posted: 29/07/2003 at 15:39

I'm with NickJ and Sameer on this one, I reckon I've had AT for about 18 months. If I stop running or restrict my running to treadmills then the AT symptoms seem to stay away. As soon as I run any distance, 10K+, on grass, tarmac, shale ... whatever the the symptoms reappear.
Remedy ..
- never run on consecutive days,
- give myself 48, or preferably 72, hours between runs,
- don't engage in heavy stretching when you can still feel pain in particular avoid the calf extension with ball of foot on a step a great stretch normally but not with an inflamed AT,
- ice it rest it between runs,
- regular (monthly) sports massage legs obviously,
- cross training swimming particularly,
- careful shoe selection.
My symptoms are less severe than those described above, I don't get pain when I am running, only afterwards. I'm 56 and I suspect that if I continue to run I'm never going to get rid of AT completely so find yourself a regime that enables you to live with it

Only you know how bad, tolerable the pain is.
Posted: 06/08/2003 at 14:00

Cheers Again. I've decided to rest for a couple of weeks and just cross train. I'm going to start back the weekend after next with my training. As many say, the pain isn't so bad that I can't run through it, it's just probably not the wisest move long term.

When I return after the 2 week lay off I'll drop the runs from 5 before down to 3(Long, Tempo and possibly a little speed) and keep cross training with hard cardio on the other days. I was aiming for a 3.50 marathon but 4 Hours will now be the target.

PPB.
Posted: 06/08/2003 at 15:26

I did some strides on the beach yesterday, running barefoot in the sand. Rather unsurprisingly my right achilles was killing me this morning and I could hardly walk. 'Have been limping all day, but I manage to go through a 10M session without too much trouble (once I had warmed up).

I feel tempted to rest it, but I know from experience it isn't the answer (I could rest for 3 months, and the pain will still be here when I start running again). 'Wish there was a miracle cure but, failing that, will pretend I'm allright and carry on training as usual...

(sorry, I'm just venting off my frustration here, as the bloody thing is preventing me from doing plyometrics & hills, which I feel could really benefit my running at the moment)
Posted: 06/08/2003 at 23:26

I did some strides on the beach yesterday, running barefoot in the sand. Rather unsurprisingly my right achilles was killing me this morning and I could hardly walk. 'Have been limping all day, but I manage to go through a 10M session without too much trouble (once I had warmed up).

I feel tempted to rest it, but I know from experience it isn't the answer (I could rest for 3 months, and the pain will still be here when I start running again). 'Wish there was a miracle cure but, failing that, will pretend I'm allright and carry on training as usual...

(sorry, I'm just venting my frustration here, as the bloody thing is preventing me from doing plyometrics & hills, which I feel could really benefit my running at the moment)
Posted: 06/08/2003 at 23:26

Ooops
Posted: 06/08/2003 at 23:27

Your frustration shows NickJ!!

The Peak Performance sports injury bulletin webpage, which chamac directed us to, looks very interesting and definitely worth trying. My sports massage person (is masseuse sexist?) had told me about these exercises and I got the impression that a lot of people involved in the treatment of sports injuries think this approach really is the business as far as AT is concerned.

Maybe I'll take her advice and actually do them for an extended period!
Posted: 07/08/2003 at 08:41

Re-reading this thread, there seems to be a misunderstanding or misuse of the term "chronic".
My understanding (I'm sure one of the medics who browse this site will slap me down if I'm wrong) is that when used to describe an injury or medical condition then it means long-term, persistent something like that. It does not mean severe or serious; the term used to describe that is "acute".
I realise this could win me pedant of the day but it can be important when discussing these things.
Posted: 07/08/2003 at 12:38

'pretty sure 18 or so months qualifies as chronic....
Posted: 07/08/2003 at 13:08

Ooops .. apologies NJ, it must have been on another thread to do with Achilles problems ... it's the heat you know!!
Posted: 07/08/2003 at 13:39

no worries (he says, still foaming at the mouth).

My achilles is still hurting (again I couldn't walk this morning), and I have a speed session planned tonight...
It's as bad as it's ever been recently and, yes, I am getting frustrated. I don't really have the patience for the exercises describes in the afore-mentionned article, but I guess, eventually, I'm going to need to make the time.
Posted: 07/08/2003 at 16:18


FAJ
I've just read this whole thread through and found it very interesting. My achilles get pretty sore too and I'm convinced I have a touch of plantar faciitis (sp?), especially in my left foot. If I get up to go to the loo in the night then I have to tippy-toe on my left foot. Despite being generally pretty flexible, I do seem to have tight calfs.

Do the 3 things go hand in hand? And what comes first? What I mean is, if I sorted out my tight calfs, would the other niggles even out too?

Posted: 12/08/2003 at 10:23

My symptoms are nothing like as severe as some of those described in this thread but I think it would be interesting to know (a survey perhaps?) how many of us regular runners suffer from these tight calves, sore-ish achilles type problems. I guess it's a fairly high proportion, if everybody were honest.
As a runner one gets used to various niggling aches and pains and one also tends to be dismissive of any remedy that prescribes extended periods of non-running for something that we don't perceive as particularly serious.
Posted: 12/08/2003 at 10:50

NickJ - those exercises posted by Chamac look seriously good. TAKE THE TIME TO DO THEM TWICE DAILY - thsi could really be the answer for you. Then you can bound and plyometric yourself all you like...
You have too much to lose not to do this...
Posted: 12/08/2003 at 11:54

is this the thread you are talking about pants?
Posted: 12/08/2003 at 11:56

Pantman,

You're the voice of reason... I guess I will. Thanks for that
Posted: 12/08/2003 at 13:45

Yes, DBSA, glad you found it! The article was posted by Chamac - it is brilliant stuff. Should allow you to do a LOT more mileage without injury if you have weak calves.
Posted: 12/08/2003 at 14:23

ill have to have a proper read later
Posted: 12/08/2003 at 14:28

After reading this started the Chamac exercices. Have had achilles problems for 3 months also after Nike Pegs! Maybe thats because theyre off road? I was only in Richmond Park though. Still the exercices really take out the morning aches am very hopeful, thanks a lot,
Posted: 14/08/2003 at 12:01

Hmm, much though I enjoy flattery, describing other people's research and expertise as the "Chamac execises" is possibly pushing it a little. All I did after all was point out where the info actually was.

Lets give the nice guys at Peak Performance the credit, and call them the Peak exercises.

Cha
Posted: 14/08/2003 at 13:39

But without you, Cha, we would be ignorant still - credit to you too!
This is what is so good about the internet - helping each other find the information we need.
Posted: 14/08/2003 at 15:31

I just thought I'd pop up again on this thread. What doesn't follow for me is I have very stong calf muscles (a genetic acomaly I think as I've always been that way). For me I wonder if it was just the Nike Pegasus' that have helped to cause my achilles injury.

I'm nearly at the end of my self imposed 2 week lay off. I'm returning to running on Sunday, easy does it...


Posted: 14/08/2003 at 16:24

quick update... I'm still not doing me exercises (naughty me), and I am still running everyday (or doubling). My achilles is feeling better at the moment (I can walk in the morning), and only seems to be aggravated by hills and sand (and speedwork to some extent), but never so painful that I couldn't run the next day... 'glad I haven't stopped...
Posted: 15/08/2003 at 12:18

quick update... I HAVE been doing the exercises! (naughty Nick!!!!) Legs got stiffer to start with (due to the extra work), but any inflammation seemed to go down. Now stiffness is starting to fade. And I can feel my legs are stronger already. I think the exercises (Wlat's SAS) are brilliant to just for lower legs, but hips , quads, gluts, etc as well. Basically it is strengthening ALL the muscles employed in the foot plant phase. Think EVERYONE should do them...

So now (4-5 days after starting) I am stronger and can feel a definite difference, but still stiff and sore. My only fear is that I may have found these too late and will need to slow my schedule down to allow them to take affect. Will decide over the next week or so. But I do wish I had known about them and done them from day 1...

NickJ - (warning rant approaching) you have talent that most of us would die for and your best marathon is still to come. When you put in the miles that you do, don't come unstuck when a few minutes of simple exercises a couple of times a day could have prevented it. You need the extra strength to do the plyo and bounding that you think you need. Many of us are competing vicariously "through" you. You represent us of the forum. Do the exercises and go kick ass! (rant over!)

Posted: 15/08/2003 at 15:28

Yep I'm a total fan too inspite of a bit of aching calves, well quite a lot really. But the achilles ache just goes and the other is just readjustment not injury. So ta to all, and I thought they were 'Chamac' exercises, LOL.
Posted: 16/08/2003 at 13:13

My word Pantman, you do talk a good game... Thanks really; 'appreciate it... (I'll go and do me exercises now).
Posted: 16/08/2003 at 19:16

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