Achilles Tendon Injury or Rupture

By

Mike Parent

April 4, 2003

This Injury Hits Home

The game of squash is demanding. It is one of the most demanding sports because it requires aerobic endurance combined with anaerobic power, quickness, strength and flexibility. In my experience playing around the league, I wish I saw more players conduct a proper warm-up and stretch prior to playing to help prevent this and other squash injuries from occurring. I hope this article helps you incorporate some simple exercises into your routine to help prevent this injury from occurring.

As you may know, we have unfortunately had a number of achilles tendon injuries and ruptures over the last couple of years. This injury has affected players at all levels and playing abilities. It is debilitating and can take 4-6 months to recover to normal activities. Why do they occur?

Why Do They Occur?

• Age: Lets start with the “uncontrollable” factor. Lets admit it; we can’t do much about growing older. The majority of achilles tendon injuries I have been made aware of in the league have occurred to players from age 30 to 50 but remember that they can happen at any age. As we age, the physiology of muscles and tendons begins to change. The muscles and tendon tissue becomes less pliable and will automatically increase our risk of injury. When we were younger, we had a greater margin of safety when we didn’t stretch because the physiology of the tissue was more forgiving. Also, you should be aware that we automatically lose muscle mass through aging (more on this factor below).

• Personal Differences: All of us are constructed differently and bring our own genetic predisposition to flexibility. Again, not much we can do about who our folks were, but if you know you’ve always been “tight” and you just turned 35, I suggest you read on and think about incorporating some specific exercises into your routine.

• Muscle/tendon weakness: As I mentioned, we lose muscle mass through aging, which means we lose strength. As we lose strength, we loss power to move around the court like we once did. If you are not doing some specific strengthening to maintain muscle strength and balance in the core, legs and hips, you will be at higher risk for injury. Remember that tendons are very course cords that attach our muscles to the bone. Their properties are similar to muscle and require strengthening and flexibility as well. The good news is that the exercises for improving muscle strength will also improve tendon strength.

• No Warm-up or stretch: Lets admit it, warming up and stretching is not enjoyable. Compounding the problem is that we’re all busy and many times show up at 5:55 pm for a 6:00 pm match. I’m hopeful that if you know the right exercises to perform, you’ll see the value of investing 15-20 minutes into a proper warm-up and stretching routine. You will reduce the likelihood of injuring your achilles tendon.

• Poor hydration or nutrition: A hydrated muscle will perform more efficiently than a dehydrated one. A nourished muscle will also perform better. As simple as it sounds, you should drink ample water during the day, before playing, during the match and after. In terms of overall nutrition, eat smaller, more frequent meals that are higher in complex carbohydrates (fruits, vegetables, pasta, etc.) and lower in saturated fats (red meat, deserts, etc.).

How does it occur?

The Achilles tendon is a large ropelike band of fibrous tissue in the back of the ankle that connects the powerful calf muscles to the heel bone. Sometimes called the heel cord, it is the largest tendon in the human body.

When the calf muscles contract, the achilles tendon is tightened, pulling the heel upwards. This allows you to point your foot and explode to retrieve a drop shot from the back of the court. It is vital to the game of squash.

The achilles tendon can grow weak and thin with age and lack of use. Then it becomes prone to injury or rupture. Certain illnesses (such as arthritis and diabetes) and medications (such as corticosteroids and some antibiotics) can also increase the risk of rupture.

Rupture most commonly occurs in the middle-aged male athlete. Injury often occurs during sports that require bursts of jumping, pivoting, and running. Most often these are tennis, squash, racquetball, basketball, and badminton.

The injury can most commonly happen in squash while you are toward the back of the court and suddenly want to push-off with your back foot to go to the frontcourt.

How do I prevent the injury?

• Prevention centers on appropriate pre-activity warm-up and daily achilles stretching.

• Try to dedicate yourself to a pre-match warm-up activity for 10 minutes. These activities can be riding a bike, stair machine, elliptical or running. The idea is to increase your core temperature and blood flow to the muscles and tendons of the legs. Ideally, you should be slightly sweating before you step on to the court and then make sure you make some quick movements, which mimic a game condition before you start the match.

• Perform the following stretches after your pre-activity warm-up (remember to hold each stretch for at least 20 seconds):
  
  
  

• Perform the following strengthening exercises 2-3 times per week (remember to execute 2-3 sets with 10-15 repetitions for each exercise):

• If at all possible, try to maintain a continuous level of play throughout the year or work up gradually to full participation if you have been out of squash for a period of time.

I hope this helps you improve your performance on the squash court and reduce the chances you will have an injury to the achilles tendon. If you have any questions, feel free to contact me at mparent@fitcorp.com . Good luck!