Note: This article is not intended to replace the advice of a qualified medical professional. Please follow your medical professional’s advice in order to maximize the effectiveness of recovery from any injury.
Last month, we were as shocked as anyone when Alethea Boon came in third place worldwide in 17.2 CrossFit Open workout. Not because we don’t think she’s an extraordinary athlete, but because she did so seven months after tearing her Achilles tendon.
17.2 was a serious lower body workout to boot, requiring athletes to perform front rack weighted walking lunges for four hundred feet in total. We never would have thought it possible so soon after an Achilles tear, so we had to ask the question: why do some people recover so much faster than others?
The largest and strongest tendon in the body, the Achilles connects the calf muscles (technically the gastrocnemius and soleus muscles) to the heel bone. Tears can be partial or total, but here we’re talking about complete ruptures, which usually occur during recreational sport. (Boon’s was a result of box jumps.)
“Early on you’re looking for pain management, swelling reduction, and mobility,” says Joseph LaVacca, DPT, CFSC, FMT-C, SFMA, an orthopedic physical therapist based in New York City. “In the second phase, four to six weeks after the injury, you’re looking to build stability in specific ranges, that’s where your isometrics and eccentric exercises come in. In your third phase that’s when you’re looking for the explosive power the strength output.”
Typically, recovering from a tear takes at least six to eight months, and for most people it’s more like ten to twelve months. There are a few things you can focus on that will help to minimize the recovery time.
Firstly, you’re more likely to recover quickly if you’re fit and active before it takes place, so that’s one more reason to be consistent with your workouts: a strong, mobile body will recover better from an injury.
The same rule applies after an injury, and that’s where most people get tripped up.
“One of the biggest things I see with Achilles tears or any injury is people telling me they’re not doing anything in the gym because they thought they couldn’t work out,” says LaVacca. “And that is so far beyond the truth. You just maybe can’t do running, squatting, and jumping, but you can definitely be doing things in modified positions to keep your other systems intact, and I think that’s a huge opportunity that people often miss out on. “
Usually, people are put in a “boot” for a period of time (sometimes weeks) before surgery is performed to repair or reconstruct the Achilles. Even before surgery takes place, it’s smart to remain active.
“If you’re going to be casted for a long period of time before the surgery, you can’t lose that time by not strengthening quadriceps, hip stabilizers, core, and finding some way to regress your workouts that you can still stay in shape,” says LaVacca. “So if you’re in a boot, you can still be doing things in a kneeling position. You can still do medicine ball throws, plyometrics, battle ropes, you can be doing kettlebells, you can do lots of things from a modified kneeling position.”
Days after her injury, Alethea Boon was back in the gym. Her first workout was a hundred strict pull-ups, and a few days afterward she was incorporating single leg wall balls into her workouts.
After Julie Foucher busted her Achilles at the 2015 Reebok CrossFit® Games , her first workout was was a 21-15-9 workout on the rower, strict pull-ups, one-legged push-ups, strict ring dips, and strict handstand push-ups.
For some folks this might look extreme, but it’s important to make sure that the hip and the lumbar pelvic complex stays in tact in terms of stability. A lot of the time, athletes will shy away from loading their injured leg — which is fair enough — but that’s no reason to avoid movement or avoid an entire half of your body.
“You want to make sure your proximal muscles are engaged, the obliques, the glutes, the abdominals, the erector spinae, all the adductors, all those muscles,” says LaVacca. “As long as you keep them in sequence through half-kneeling plyometrics, half-kneeling chopping exercises, pushes, presses, you name it, that’ll stimulate loading through the hip and at least keep those proximal structures in tact so when you get out of the boot, you’ll be much more likely to start loading that side again and potentially have a little less pain and fatigue.”
The main rule here is to stay active in a way that supports your recovery. But as far as mobility goes, it’s also a good idea to have a clear picture of what you’re trying to attain.
When you think Achilles tendon, most people think of dorsiflexion and that’s what they focus their recovery on. But the tendon is also involved in plantar flexion (pointing the toe) and eversion and inversion (moving the foot from side to side.)
“I do find a lot of times when patients come in with an old Achilles injury they’ve got plenty of dorsiflexion, but ask them to point their toes and they’re lacking,” says LaVacca. “So if they lack that full mobility in order to get into plantar flexion and stimulate the calf muscles, they’re probably going be robbed of a lot of power because they won’t be able to use the full range of motion at the ankle.”
He strongly cautions against prolonged stretching of the Achilles early on, and suggests instead working with your physical therapist on light, repeated mobilizations to get the dorsiflexion back while you work on other physiological motions like the plantar flexion, inversion and eversion.
So, with the right approach and the right attitude, it’s possible to recover relatively quickly from an Achilles tear, but it’s probably not a great idea to expect a lightning fast, Boon-level recovery.
“What she did was remarkable, but that shouldn’t necessarily be the expectation for everyone, because then it’s easy to become defeated in your rehab, and that’s when you need the most positive outlook possible,” says LaVacca. “For the normal desk worker, they’re probably not coming back so fast. And that’s OK! You just need slightly different goals, that’s all.”
It goes without saying that you should talk to an awesome physical therapist before you embark on any kind of physical rehab, but we hope that the tips above might help you avoid some of the more common mistakes — and get you back performing front rack walking lunges as soon as possible.
Featured image via @reannajphotography and @alethea_boon on Instagram.