Thursday, November 28, 2002

My Achilles Rupture

Thursday, November 28, 2002

Back in the Game
by Carolyn La Duca Torella
For the Poughkeepsie Journal

I wish I could capture on film all of the faces that people make when I tell them about my Achilles tendon rupture. I get a variety of sympathetic gasps and grimaces, but the words are invariably the same: "Oh MAN, that must’ve HURT!!" Then I show them the scar and I get a few more cringes. I know it’s cruel, but when it comes to Achilles injuries, you have to get the laughs in when you can.

I certainly wasn’t laughing the night I injured it. I doubt that NY Giants rookie wide-receiver, Tim Carter or Giants tackle, Keith Hamilton were laughing when they ruptured their Achilles’ this season, nor did Vinny Testaverde or Patrick Ewing when they were injured during their careers. While the pain subsides relatively quickly, the gravity of the situation does not. The Achilles tendon rupture is a potentially career ending injury for a professional athlete as well as the weekend warrior.

I guess you could say that this was my first, official "weekend warrior" injury. I made it all the way to the age of 36 without one, lucky me. I’ve been playing volleyball every year since high school and I never missed a game due to injury. It was a pretty good run, too, until I ruptured my Achilles tendon in March.

The injury:
I agreed to be a last minute substitute for my friend’s men’s volleyball team at the Casperkill Country Club. My women’s league there had ended a few weeks prior, so I was happy to play again.

I arrived a few minutes before the game started and tossed the ball around briefly with a friend as our pre-game "warm-up." The first game went by without incident (ok, we lost). A few points into the second game, I found myself in the back row ready to receive serve.

All I did was move to lunge forward, like I had done a hundred times before this season and quite a few times that night. I pushed off on my toes to dive for a hard hit jump-serve and that, as they say, was all she wrote.

I don’t remember the ball coming over the net or even falling down. I just remember feeling an explosive, burning pain in my calf, rolling over and asking the tell-tale Achilles rupture question: "Who kicked me in the leg?!" Of course, no one had.

I screamed, "I think I just ruptured my Achilles tendon!" My teammates carried me off the court where I sat, stunned and immobile until the ambulance came.

I knew mine had ruptured as soon as it happened. Just like I knew when I saw Giants wide receiver, Tim Carter go down during their game against the Vikings. I knew. There was no one near him. Half a step off the line of scrimmage and he went down hard. Achilles.

I had taken an Athletic Training course in college and I remember that section, because I was the "mannequin" the day in class. "The athlete often says that it feels like someone just kicked them in the calf," my professor’s words came back to me in a flash, "The explosive pain is a result of the tendon ripping away from the bone or being completely severed above the bone. The athlete will be unable to move the foot in the downward (plantar) direction."

"The Thompson Test is a clear indicator of a complete rupture," he said. I was lying face down on the desk, with my leg straight and foot hanging off the edge. Then he squeezed my calf muscle (essentially contracting the muscle manually), "If Carolyn’s tendon was really ruptured, the foot would not move."

Like it didn’t move in the emergency room that night. Nothing.

Maybe it was bad karma. Maybe someone else should have been the mannequin that day. Maybe I should’ve just let the guy next to me take that serve. Whatever the reason, what’s done is done. And my Achilles tendon was done. That’s what the ER doctor said. That’s what my Orthopedic Surgeon said, "You’re done for six months."

Trouble with tendons:
Named for the mythic hero, Achilles, whose only weakness, was, you guessed it, his heel, the Achilles is the largest tendon in the human body. It attaches the calf muscle to the heel, allowing a person to rise up on the toes and point the foot. It is necessary for jumping and pushing off.

A rupture of this tendon is often compared to the fraying and eventual breaking of a rope. The tendon is made of bundles of fibers. The tendon fibers become weak over time and can break, weakening the whole tendon. In some athletes, the tendon can completely snap in two, or rupture. It can be caused by trauma like being hit by a stick in lacrosse or being kicked in the calf in soccer. Or the injury can occur without contact, by simply pushing off on the toes, as in the case of Jets QB, Vinny Testaverde’s season ending injury in 1999.

This "non-contact" type of Achilles injury is most common in the over-30 age group. Over time, tendons can suffer repeated micro-tears and become weakened. Poor conditioning can result in a decrease in flexibility, strength and resilience in the tendon. Inadequate blood circulation to the area, due to age and inactivity, excessive exercise on steep inclines and carrying excessive weight, have also been linked to Achilles’ ruptures.

Injuries to the Achilles tendon in people over 30 years old are becoming more and more common. "Weekend warrior" types, ala yours truly, who don’t exercise regularly, are poorly conditioned, fail to properly stretch out and then play aggressively during one or two days of activity are highly susceptible to this type of injury. In a recent study of patients who had Achilles tendon ruptures, the average patient was 37.9 years old, and 83% of the patients were male. Nearly 75% of all Achilles ruptures are sports-related.

In my case, I had a lot going against me. I played volleyball, an aggressive stop and start game, for 20 years, which, my surgeon said, took a toll on my tendon. I was power walking up steep inclines for a 6-month period just prior to my injury. And, up until I lost the weight by walking up those hills, I did carry around extra (let’s call them child-bearing) pounds. That last push-off was the final insult to the tendon.

I was admitted to the hospital that night. That morning, my orthopedic surgeon, Dr. Spyros Panos, Mid-Hudson Medical Group, briefly, but thoroughly explained the reasons why I would elect for surgery as opposed to more conservative, non-surgical options. He said that due to my age and desire to compete again, surgery was the better option. Although both options would take the same amount of time to heal, surgery would repair the tendon, to nearly full strength, where non-surgical repair would most likely not and would have a higher possibility of re-rupture.

Dr. Panos said that I had a complete rupture, not a partial tear, about halfway up the length of the tendon, a very common place to rupture and easiest to repair since the heel bone wasn’t involved. He would make an incision just to the side of the tendon, a few inches long and re-connect the tendon with one stitch and then close the incision with surgical staples. The whole procedure would take about 45 minutes. I would be put into a hard cast from just below the knee to the ball of my foot for six weeks, he said, and then I would have some rehab without "aggressive" activity for up to 4 months.

Later that afternoon, I was off to surgery. One injection into the IV and two breaths into the oxygen mask later, I was out. I groggily awoke to a bouquet of flowers and apologetic cards from my teammates and family visits. The "get well" phone calls came. I had a cast, some flowers, SportsCenter on TV, sole possession of the remote control and painkillers. All went well, until the drugs wore off and I had time to consider the calendar.

As the surgeon explained, there was only one stitch holding my little tendon together. After removal of the cast, there would be no hopping, jumping, darting, sprinting or otherwise "aggressive activity" involving my left foot for at least four months. Okay. So six weeks in a cast. That’s mid-May. Four months from there…mid-September. So there goes the entire spring and summer. Two seasons. It hit me, "I am out of commission for a half a year." Pass the Kleenex, please.

Recovery and rehab:
I was in the hospital for two days, in a non-weight bearing cast for six weeks and a total of eight weeks on crutches (seven of which my children said, "Can you pick me up this week, Mommy?"). My foot was cast with the toe pointed down to put the least amount of strain on the repairing tendon. After the first four weeks, and every two weeks after, my cast was removed and recast so as gradually stretch the tendon.

When my cast was finally removed, the calf muscle in my injured leg suffered from severe atrophy, and was nearly half the size of my healthy one. The tendon had repaired itself, but the area was much thicker than before, which is normal but challenging when you’re trying to find shoes that fit, even after seven months. I had no range of motion in the ankle area as a result of six weeks in a cast and let’s not forgot that lovely scar from the incision and 13 staples. I needed rehab.

The goal of rehab was simple: to regain range of motion in the tendon and strengthen the calf muscle. I started rehabilitation two weeks after my cast came off. My therapist started out by measuring my range of motion post surgery. The tightness in my tendon prevented me from even bringing my foot to a 90-degree angle to my leg. We started out slowly with heat therapy, electro-stimulation, stretching and massage. We progressed to increasing my range of motion and balance on the "Baps" board (a round, tilting board like a wide skateboard without wheels). I eventually graduated to weights, wall stretching and toe raises on both feet then on one. It was slow and painful, but my mobility improved with each visit.

I was in rehab for six weeks in the office and I continued with two months of rehab on my own. I spent the summer walking, swimming, stretching and strengthening. And exactly six months from my surgery, my surgeon gave me the green light to play again.

Back in the game:

I am, as recommended, taking it easy at first, until I regain full strength in my calf muscle. Right now, my game isn’t what it used to be. I have trouble moving left quickly, my defensive range is decreased and I am not jumping as high as before. Be the reason mental or physical, I still have not attempted a forward lunging dive. But my reduced mobility has helped me to anticipate the other team’s moves because I know I can’t get there at the last minute.

My fellow wounded weekend warriors tell me there won’t be a Nor’easter or low-pressure system that I can’t predict and I am reminded every morning by a stiff tendon that I should stretch.

And I do. Before every game, I walk or bike to warm-up and then I stretch. And so do my teammates. All I have to do is show them the scar.

Note: This story was written in 2002. Things have come a long way since then in terms of rehab and post-surgical treatment. My friend had surgery for his rupture recently and he was out of the cast in 3 weeks, then into a walking boot. The walking boot helps maintain muscle tone in the leg - unlike how I had experienced recovery - 6 weeks in a non-weight bearing cast. So...when the next one goes, at least I know it won't be as bad! = )