First off, let me say that I am not a doctor or medical professional. Everything you read should be taken with a grain of salt. That being said, I’m not clueless to sports injuries. I am a fourth year Kinesiology student who takes a passion in sports injuries, especially hockey related. After my undergrad program, I plan to eventually pursue Athletic Therapy dealing with athletes (fingers crossed it’s hockey players). In my blogs, I plan to take the knowledge I have learned throughout my degree as well as further research to explain hockey injuries to the public. I think it is important to be educated but even more important to share your education with the audience that wants to learn.
So before we get into the actual injury of Andrej Sekera’s, I wanted to bring everyone up to speed with the Achilles tendon. The Achilles tendon is located in the posterior (backside) of the ankle. The tendon is the bottom portion of the Gastrocnemius muscle in the leg, this is what is most commonly referred to as the calf muscle (including the soleus but that’s not important) and is the most superficial (closest to the skin) in the back of your leg.
(Retrieved From: https://www.pinterest.co.uk/pin/541346817700210464/)
The Achilles tendon connects the gastrocnemius to the calcaneus (The heel bone) and is noted to be the strongest tendon in the human body. The tendon has a large role in plantar flexion of the foot (jumping, “tippy toes” or ballerina stance).
Achilles Tendon Ruptures
So now that you’re up to speed on the Achilles tendon, now we’ll learn what happens when the tendon ruptures. When the Achilles tendon ruptures, the athlete will usually hear a popping sound and immediately be in severe pain near the back of the ankle. The athlete will be unable to point their foot downward and walking may be a challenge. The rupture occurs approximately 5 cm above the insertion point on the heel and when the rupture occurs, the athlete may feel like the tendon is rolling up their leg.
Although I am unsure of Sekera’s condition, his Achilles tendon injury could’ve been a partial tear or a complete rupture. Either way a partial tear could progress to a rupture with use of the tendon. Sekera has already undergone surgery for his Achilles tendon which leads me to believe that the injury was significant.
(Here’s where my knowledge is lacking as I’m not a surgeon. I don’t know the first thing about surgery so bear with me).
The two most common techniques for surgery are open technique and percutaneous technique. Open technique involves a larger incision where percutaneous technique involves more smaller incisions.
Athletes recovering from an Achilles tendon rupture will spend 6-12 weeks in a cast/boot. The athlete should be working with a physiotherapist (PT)/Athletic therapist (AT) while in the boot to rehabilitate and recover. PTs and ATs will monitor the athlete on a daily/weekly schedule to make sure the athlete is recovering on pace for a return to play (RTP). PTs/ATs do not want to rush an athlete to RTP as this can cause more stress on the athlete and often times the athlete will re-injure themselves by speeding up their RTP.
PT/AT will start off small and make improvements on a weekly basis, this might start with something simple as putting on a shoe and eventually progress to a weight baring activity such as walking.
2-4 weeks after surgery the athlete should be working on moving the foot from dorsiflexion to a neutral position (Bringing your foot from pointing all the way up toward your shin to where it sits normally).
At 6-8 weeks post surgery the athlete should slowly be working to stand without the boot. Athletes may work on something such as standing on one leg for 5-10 seconds in order to regain balance. Athletes should also be working on an active range of motion of the ankle (Moving the ankle for themselves, bringing the toes down to the floor and then up to their shin while sitting). Stretching is often used on the calf muscles and balance drills where the athlete is confined to one space. Utilization of a pool is also a great way to recover as the athlete as a pool helps with weight bearing exercises so the strain is less of a factor on the tendon (If you don’t understand what I mean, have you ever tried to lift your friend normally and then try and lift them in the pool? The pool is a lot easier).
From 8 weeks onward you want to continue to push the athlete while avoiding forceful impact of the ankle. Squats and lunges can probably be implemented, and there should be no pain of the functional movements of the ankle. Pool activity can be continued, stationary bike is a useful tool.
At 4 months and onward you want to allow the athlete to practice sport specific movement. Activities such as cuts, jumps, using the floor/agility ladder is perfect. Doing anything to replicate the movements used in hockey is great for recovery. There should no longer be any pain or swelling. Remembering to stretch is also important. Fully recovery from an Achilles tendon rupture is 6 months or more depending on the situation, physio, cooperation from the athlete, etc.
An example of some exercises that may be used in this stage of recovery.
(Thanks to UW Sports Rehabilitation for some help with the recovery and rehab portion, PDF can be found here: https://www.uwhealth.org/files/uwhealth/docs/sportsmed/SM-143151_Achilles_Tendon_Rehab_final.pdf)
With at least half a year of recovery, I think it’s fairly safe to say that Sekera won’t be making an appearance in the 2018/19 NHL season. The Oilers will take their time with him and monitor his activity for RTP. There is no point into rushing him to play at the end of the season (in my mind).