Athletic Development for Injured Athletes: Part 4 – Achilles Rupture


In the final installment in this series on training injured athletes I’m going to take a look at an athlete who I’ve written about before on this blog and who many of you have helped out through financial donations or kind words. I am of course writing of Jade Ellis who now has the dubious distinction of having ruptured both Achilles tendons, with the left one being the most recent injury only 5 months ago. In the 2 months following the injury we sat in limbo as we waited to find a medical solution that would fit Jade’s situation. He was in a boot and we didn’t do much training at all. Things seemed to drag on forever. For a long time we were waiting for an MRI, then it was a diagnosis from the MRI, then a second opinion on the diagnosis. In the end, both doctors believed Jade could forgo surgery. Apparently, so much time had passed between the injury and the diagnosis that surgery wouldn’t be the best option and some healing of the tendon was observed. Instead of surgery, Jade underwent two platelet rich plasma (PRP) injection treatments spaced by about a month. PRP has been around for quite a while but is really only just recently gaining popularity as a means of accelerating tissue recovery from tendinopathies and traumatic acute injuries. Although research evidence on PRP is still somewhat mixed, I’ve now worked with 3 athletes who’ve had it and in all cases the results were very good.

So that brings us up to 2 months ago…just prior to the first PRP treatment. Around that time, 3 months following the injury, Jade started training again. He was able to walk with a noticeable limp, had compromised dorsiflexion in the injured ankle, and the Gastrocnemius on the affected side had atrophied and had lost about 90% volitional contraction capacity. The latter issue was a little concerning because even if the Achilles healed completely, if the Gastroc was unable to contract normally, the elastic properties of the Achilles would be lost…not to mention we would be unable to really bring the Achilles back to full strength because we wouldn’t be able to apply tension on it.

We started with primarily just strengthening activities. Deadlifts with light loads and higher reps, single leg bench squats starting at higher box heights and progressing towards squatting to the height of a weight bench as Achilles mobility increased, double leg calf raises, etc. Some light walking and jogging was added in as tolerated. At around this point, Jade had his first PRP treatment which kept him out of training for about a week.

When he returned, we started with 15 minute easy walk- jogs performed Fartlek style as tolerated. Sprint drills on grass were slowly added in. Then on a track. Jade favored the non-injured leg for weight bearing and almost all contacts on the injured leg were heel first instead of the usual mid-foot strike. After a little while, we started doing some very low level plyometric activities. At first, we were doing a routine that is all double foot contacts and so low amplitude that I typically reserve it as a form of cool-down. Then we progressed to doing multi-jumps barefoot in the sand pit. By the time we got to these, Jade was beginning to look springy again…to the point that on certain activities you couldn’t tell he was injured. Not coincidentally, around this time you could also see the Gastroc was starting to fire correctly again. Prior to this point, the Gastroc acted ‘dead’ when you’d expect it to be contracting. The last big workout before his second PRP treatment was one which involved skipping for distance. The emphasis on distance minimized fast eccentric loading and doing skips rather than simply takeoffs meant longer contact times….things I assumed would be best for a Gastroc that clearly needed some motor re-education.

Jade then had his second PRP treatment. As before we took about a week off prior to training again. Somewhere in this time, Jade was out on a basketball court and got the urge to see if he could dunk. He could. A major milestone for sure but the Achilles has been a little tight since and the Gastroc seems to freeze up after a little work. As a result, we’ve been quite cautious. Almost all running and plyometric work has needed to be prescribed on a day-by-day basis depending on how the Achilles feels. I’ve been a little more ambitious with some of the strength training though.

As Jade won’t be competing this summer we have the luxury of being able to return to general fitness training. The goal is to have a full return by next outdoor season. Obviously there’s some big steps along the way but we’re going to go back to a lot of general fitness work in the weight room with metabolic conditioning circuits, bodybuilding style workouts, low amplitude jump circuits and lots of focus on strengthening the Gastroc and Achilles. So while most of my athletes are winding down there outdoor season and happily entering a transition phase of rest and unstructured training, Jade is going to be getting a jump on his general preparatory phase to make up for the conditioning lost to injury and better prepare for the more intense elastic work to come when the others return to training following the standard 3-5 weeks off I prescribe to most of my athletes.