The Pro sports blog
The material provided here is general information and individual advice should be obtained with an evaluation or assessment by an appropriate physical therapist
Marko Grzan S.P.T.
The Achilles tendon, or Calcaneal Tendon, is the largest and strongest tendon in the human body. It serves to connect the muscles of the posterior leg (Gastrocnemius and Soleus) to their insertion on the Calcaneus bone. These muscles are major components of walking and athletic activity such as sudden powerful movements including running and jumping.
The prevalence of Achilles tendon ruptures continues to rise annually with the occurrence rate reaching as high as 55 cases per 100,000 people. The rise in prevalence can most likely be attributed to an increasing number of older individuals participating in physical and athletic activity. Factors other than aging that contribute to Achilles tendon rupture include sudden changes or increases in activity type, tightness/weakness in the calf muscles, leg length discrepancies, use of corticosteroids, or the use of Fluoroquinolone antibiotics such as Cipro or Levaquin, which are commonly administered antibiotics. Achilles Tendon ruptures are most common among men between the ages of 30-40. Men are 10 times more likely to suffer the injury and is most common in the episodic athlete AKA the “weekend warrior”.
Acute ruptures are the most common type and occur when the ankle experiences a sudden and strong dorsiflexion moment (toes are pointed down and then suddenly point up as might occur when landing from a jump). In the United States basketball is the most common sport where the injury occurs, while soccer is the most common sport associated with the injury throughout the rest of the world.
There are several ways to test for Achilles tendon rupture. The Calf Squeeze test, or the Simmonds/Thompson test, is the gold standard. With the patient laying prone the calf muscle is squeezed. If the tendon is intact then plantar flexion of the ankle will occur. If the tendon is ruptured then no movement will occur.
Both Surgical and Non-Surgical repairs have been shown to be effective methods of recovery. Non-Surgical repair involves immediate bracing of the lower leg and often requires that the patient be non-weight bearing for a longer period of time. Surgery involves an open repair with the tendon being sutured back together. Surgery is the recommended method of repair for young athletes seeking return to sport.
Goals of rehabilitation include protection of the surgical site, return of a normal gait pattern, full range of motion of all ankle movement, reversal of atrophy, and full functional activity. The standard rehabilitation process is a multi-stage recovery that begins with protection of the wound site and progresses to weight bearing activities, range of motion activities, and strengthening exercises. While there are timelines attached to each stage of recovery, it can vary greatly from individual to individual.
U., & U. (2015). Rehabilitation Guidelines for Achilles tendon Repair. Retrieved July 25, 2017, from http://www.uwhealth.org/files/uwhealth/docs/sportsmed/SM-41576_AchillesTendonProtocol.pdf
Silbernagel, K., Helender, K., & Willy, R. (2016, February). Achilles Tendon Rupture: Is full Recovery Possible?Lecture presented at Combined Section Meeting, Anaheim.
Mullaney, M., McHugh, M., Tyler, T., Nicholas, S., & Lee, S. (july 2006). Weakness in end-range plantar flexion after Achilles tendon repair. American Journal of Sports Medicine,34(7), 1120-1125. Retrieved July 25, 2017.
Lantto, L., Heikkenin, J., & Flinkilla, T. (september 2016). A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles Tendon Ruptures. American Journal of Sports Medicine,44(9), 2406-2414. Retrieved July 25, 2017.
Ode, G. (2016, February 29). Causes and Risk Factors for Achilles Tendon Damage. Retrieved July 23, 2017, from https://www.sports-health.com/sports-injuries/ankle-and-foot-injuries/causes-and-risk-factors-achilles-tendon-damage
Connor Fedge, SPT
Return to sporting activity is the final phase of the rehabilitation process for many athletes. It is an essential step to be sure that the patient can safely return to a
practice or game situations without putting him or herself at an increased risk for
injury. However, many authors agree that before beginning sport specific
movements certain criteria must be met.
It has been reported in the literature that a patient rehabilitating an upper
extremity injury should demonstrate the following prior to beginning return to
sport training; full functional range of motion, no pain or tenderness, strength 75-
80% to the non injured extremity and satisfactory shoulder stability. The Gleno-
Humeral joint is designed more for mobility than stability; therefore neuromuscular
control is required to create a stable joint. Neuromuscular control is difficult to
assess with a single measurement, therefore the each of the factors that impact
shoulder stability needs to be thoroughly assessed.
Numerous studies have pointed out that there is a lack of a correlation from
certain measurements (strength, ROM, subjective reports, etc.) and the ability to
perform functional activity, emphasizing the importance of functional testing.
Functional testing is common in the lower extremity when attempting to return to
sporting activity, however there is a lack of evidence and tests that involve the
The following presentation explains and summarizes nine upper extremity
functional tests and discusses the strengths and weaknesses of each. More research
is needed to determine the ideal populations or outcomes in many of these tests, yet
despite the lack of statistical support they may still contribute to the assessment of
the upper extremity shoulder stability.
For more information:
1. Wilk, Kevin E., et al. "Current concepts in the recognition and treatment of superior labral(SLAP) lesions." Journal of Orthopaedic & Sports Physical Therapy 35.5 (2005): 273-291.
2. Wilk K, Romaniello W, Soscia S, Arrigo C, Andrews J. The relationship between
subjective knee scores, isokinetic testing, and functional testing in the ACL-reconstructed
knee. J Orthop Sports Phys Ther. 1994;20:60–73.
3. Wilk, Kevin E., Christopher A. Arrigo, and James R. Andrews. "Current concepts: the stabilizing structures of the glenohumeral joint." Journal of Orthopaedic & Sports Physical Therapy 25.6 (1997): 364-379.
4. Wilk, Kevin E., and Christopher Arrigo. "Current concepts in the rehabilitation of the athletic shoulder." Journal of Orthopaedic & Sports Physical Therapy 18.1 (1993): 365-378
5. Yang JL, Lin JJ. Reliability of function-related tests in patients with shoulder pathologies. J Orthop Sports Phys Ther. 2006;36:572-576. https://doi.org/10.2519/jospt.2006.2133
6. Shah, Kshamata M., Timothy Baker, Abigail Dingle, Thomas Hansmeier, Matthew
Jimenez, Sarah Lopez, Dylan Marks, Daniel Safford, Amanda Sternberg, Jeffrey Turner,
and Philip W. Mcclure. "Early Development and Reliability of the Timed Functional Arm and Shoulder Test." Journal of Orthopaedic & Sports Physical Therapy 47.6 (2017): 420-31. Web.
7. Kumta P, MacDermid JC, Mehta SP, Stratford PW. The FIT-HaNSA demonstrates
reliability and convergent validity of functional performance in patients with shoulder
disorders. J Orthop Sports Phys Ther. 2012; 42: 455– 464.
8. MacDermid, Joy C et al. “Validation of a New Test That Assesses Functional Performance of the Upper Extremity and Neck (FIT-HaNSA) in Patients with Shoulder Pathology.” BMC Musculoskeletal Disorders 8 (2007): 42. PMC. Web. 14 June 2017.
9. Negrete, Rodney J., et al. "Reliability, minimal detectable change, and normative values for tests of upper extremity function and power." The Journal of Strength & Conditioning Research 24.12 (2010): 3318-3325
10. Baumgartner, Ted A., et al. "Objectivity, reliability, and validity for a revised push-up test protocol." Measurement in Physical Education and Exercise Science 6.4 (2002): 225-242.
11. Goldbeck TG, Davies GJ. (2000). Test-retest reliability of the Closed Kinetic Chain Upper Extremity Stability Test: a clinical field test. J Sport Rehabil. 9:35-45.
12. Hegedus EJ, Vidt, ME & Tarara, DT. (2014). The best combination of physical
performance and self-report measures to capture function in three patient groups. Physical Therapy Reviews. 19(3), 196-203.
13. Roush, J. R., Kitamura, J., & Waits, M. C. (2007). Reference Values for the Closed
Kinetic Chain Upper Extremity Stability Test (CKCUEST) for Collegiate Baseball
Players. North American Journal of Sports Physical Therapy : NAJSPT. 2(3), 159–163.
14. Schulte-Edelman, J, Davies, GJ, Kernozek, TW, & Gerberding, ED. (2005). The Effects of Plyometric Training of the Posterior Shoulder and Elbow. Journal of Strength and Conditioning Research. 19(1), 129-134.
15. Tucci, HT, Martins, J, Carvalho Sposito, G, Camarini, PM, Siriani de Oliveria, A. (2014).
Closed Kinetic Chain Upper Extremity Stability test (CKCUES test): a reliability study in
persons with and without shoulder impingement syndrome. BMC Musculoskeletal
Disorders. 15(1), 1-9.
16. Butler, Robert J., Myers, Heather S., Black, Douglass et al. (2014). Bilateral Differences
in Upper Quarter Function of High School Aged Baseball and Softball Players. The
International Journal of Sports Physical Therapy, 9(4). 518-524.
17. Garrigues, G., Gorman, P., Plisky, P., Kiesel, K., Myers, H., Black, D. Queen, R., Butler,
R. (2012). Differences on the Upper Quarter Y Balance Test Between High School and
College Baseball Players. American College of Sports Medicine.
18. Gorman, P. P., Butler, R. J., Plisky, P. J., & Kiesel, K. B. (2012). Upper quarter y balance test:reliability and performance comparison between genders in active adults. Journal of Strength and Conditioning Research, 26(11), 3043-3048
19. Hazar, Z., Ulug, N., Yuksel, I. (2014). Upper Quarter Y Balance Test score of patients
with shoulder impingement syndrome. Orthopaedic Journal of Sports Medicine, 2(3).
20. Teyhen, Deydre S., Riebel, Mark A., McArthur, Derrick R. et al. (2014). Normative Data
and the Influence of Age and Gender on Power, Balance, Flexibility, and Functional
Movement in Healthy Service Members. Military Medicine, 179(4), 413-420.
21. Westrick, R. B., PT, DPT, DSc, OCS, SCS, Miller, J. M., PT, DPT, DSc, OCS, SCS,
Carow, S. D., PT, DPT, DSc, OCS, & Gerber, J. P., PT, PhD, SCS, ATC. (2012).
Exploration of the Y-balance test for assessment of upper quarter closed kinetic chain
performance. The International Journal of Sports Physical Therapy, 7(2), 140-147.
22. Falsone SA, Gross MT, Guskiewicz KM, et al. Onearm hop test: reliability and effects of
arm dominance. J Orthop Sports Phys Ther. 2002;32(3):98- 103
Here's one of Tim's recent talks to whet your appetite. Given in Bern, Switzerland, it's worth watching just to see Tim try his little jersey (or should I saw sweater) stunt. I have to hand it to him, he actually pulls it off.
We are very excited to introduce the PRO Blog for our patients, colleagues, and students. Our goal is to introduce the latest research, supply updates on the world of sport's medicine, propose though provoking questions, and generally disrupt the status quo. We would love feedback on topics of interest, questions, corrections, counterpoints, or other mildly entertaining anecdotes. Stay tuned!