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Step into sports activity slowly
By Robin Frank
Wednesday, August 6, 2008 6:09 PM EDT

The summer months are prime time to get out and participate in sports. But the warmer months are also peak season for Achilles tendon injuries, according to Dr. John Kennedy, an orthopedic surgeon specializing in sports injuries of the foot and ankle at Hospital for Special Surgery (HSS) in Manhattan.

“As the weather gets nicer, people want to be out and about and involved in their sports. Sometimes, though, they haven’t been so active in the winter or spring, and launching straight into activity without a gentle build-up or flexibility exercises can place them at higher risk of injuries such as Achilles tendonitis or rupture,” Kennedy said. “These are most often the ‘weekend warriors’ who are busy at work most of the week and dive into sports on weekends.” Running on the beach is particularly problematic as this places a greater load on the Achilles tendon than running on a flat, stable surface, according to Kennedy.

An Achilles injury can stop you in your tracks. Just ask Doug Escher, an elite runner who first went to see Kennedy in 2006. A retired police detective, Escher came in with Achilles tendonitis and an amazing record as a marathon runner. Orthopedic surgeons at HSS are accustomed to treating professional athletes, but Kennedy and his colleagues marveled at Escher’s accomplishments.

A former elite runner, at age 38 he ranked 47th nationally. He had been running marathons on and off for about 30 years. At one time, he could run a mile in 5 minutes and 44 seconds. At age 60, he ran a 26-mile marathon in 3 hours and 10 minutes, which many younger athletes would struggle to match. He continued running until age 61, when Achilles tendonitis put him on the sidelines. “It was very painful,” he says. “I knew it was a condition that often affects runners, and I wanted the best care possible.”

The Achilles tendon is the largest and strongest tendon in the human body, connecting the calf muscles to the heel bone. Remember Achilles, the hero in Greek mythology who was only vulnerable at his heel?

The tendon can withstand forces of 1,000 pounds or more, but it is also the most frequently ruptured tendon in the body. Achilles tendonitis is a common overuse injury that causes pain and inflammation.

As is the case for many runners, Escher’s tendon had degenerated from wear and tear. After his doctor visit, he went home with a prescription for physical therapy, orthotics and medication to reduce the inflammation. He also took it easy for a while and was hoping to get back to running. Then he ruptured his tendon in a freak accident. One day when he was out with his dog, his pet suddenly dashed over to another animal. When Escher jumped up to go after him, his already weakened tendon snapped like a rubber band.

“Escher’s tendon was compromised to begin with, and that type of sprinting action is often the final blow that causes a rupture,” Kennedy says. “Many people who rupture their Achilles tendon say it feels like someone has kicked them in the back of their leg. They may be able to walk after, but they could not stand on their toes or engage in athletic activities.”

This time, Escher needed surgery. Kennedy repaired the tendon by suturing it back together. Recovery after such an operation is generally slow, requiring a cast and rehabilitation to build back muscle strength, but Escher was willing to do what was necessary to get back to running.

“We see a lot of elite runners, but we were particularly impressed by Escher,” says Dr. Padhraig O’Loughlin, an orthopedic research fellow who works with Kennedy, and a marathon runner himself. “The most impressive thing about Escher is he’s always so positive, nothing gets him down. The whole office is rooting for him.” The doctors expect Escher to get back to running this summer.

People who are not elite athletes are at just as much risk of a rupture resulting from tendonitis, especially if they do not pay attention to their symptoms and take it easy, according to Dr. Kennedy. “Some patients will play through it, hoping that it’s a minor injury and will go away. However, it simply gets worse and can lead to rupture.”

To avoid tendon problems, Dr. Kennedy advises that people warm up before exercise and build up gradually with training. They should never run through the pain.