A one-legged sojourn

My veterinarian friend said that if I were a horse, she'd probably shoot me. I was in her car in the first week of recovery from a complete Achilles' tendon tear and was keen to hear about the equine approach to this injury. Mine was a result of being over competitive and middle-aged on a netball court.

The Achilles' tendon at the back of the ankle is the strongest one in the body. It is impossible to win a leg/arm wrestle with a healthy one. Hence its association with Achilles. His mother, Thetis, dipped him in the River Styx to make him invulnerable, hoping to delay his predicted early death. Sadly he remained weak at the place where she'd held him by the ankles at the dunking. We all know about the poisoned dart that ended this young celebrity's story.

I was felled as if a metal frisbee had been flung at my lower leg and wondered momentarily if my opponent had aimed a sneaky kick! A common phenomenon in A and E is that of the twin injuries of an Achilles rupture and a black eye. The latter is often sported by the opponent of the one with the injured leg!

Given this tendon is the superstar of the body, I marvel at its capacity to rejoin. When it's split and flaccid, surgeons describe it resembling cooked pasta. I wore a boot day and night for nine weeks to contain the great mass of blood, swelling, and debris produced from the tear. My body has magically grown working tendon. I have added nothing but patience to this process.

Like a well-choreographed military mission, cells migrate in to manufacture and build collagen. Sculpting begins once the boot is removed, and the muscle is required to work more. New blood vessels grow into the area; these are highways that deliver FedEx parcels of oxygen and packets of light and sound to power the cells.

Now I need to devote time and effort to ensure good rehabilitation, and this should be done after any injury. The foundation of this will be a healthy environment at the cellular level, deep and steady input of oxygen, and output of waste. The blood also returns information to the heart detailing the needs of the cell. Puddles of swelling hinder all this and can be cleared with self-massage and stretching. The muscles must be challenged to strengthen in all directions. I will need to restore good gliding between the layers of fascia and muscle; otherwise, lingering stickiness might lead to re-injury. I must regain the length of the tendon and keep the adjacent joints mobile from their months of relative stillness. Specific balancing exercises will restore the fine-tuning of position sense.

My right leg's push-off may never match the strength of the left. Current research is investigating putting growth factors into injured tendons via gene therapy. This intelligent healing would ensure a much more robust finished product, akin to tendon growth in the embryo.

Stem cell injections are a popular choice of treatment for athletes with tendon injuries. In the early days, animal stem cells were used on sportspeople. Now cells can be filtered from someone's blood and injected into their injury to accelerate healing. Recent articles, however, urge caution as the well-publicised stories of professionals returning to their sports may camouflage the lack of scientific testing.

I rather fancied a few horsey stem cells in my Achilles. It would have improved my netball no end.

References:

British Journal of Sports Medicine vol 36 issue 5 Tendon healing: can it be optimised? N.Maffulli, H.Moller, C.Evans

Adventures in last year of Trojan War

SportMedBC

Does the evidence support traditional concepts of Achilles Tendon Rupture Aetiology and Repair. Podiatry today vol 31. Issue 5. May 2018.