Is a ruptured Achilles tendon the end of her sporting life?

Dear Gary,
I have a friend who is 35 yrs old, with young children, who has just ruptured her Achilles and is now in her third week of plaster. She was advised by a Specialist this week that her life will have to change now she has had this injury… his words “if you were a good tennis player before this injury then you will be a bad one for the rest of your life now”. I am enquiring on her behalf if her life will be as bad as this “expert” claimed as he has totally depressed my friend and she still has weeks left in plaster. He also informed her that she would be at great risk to snap in again if she is not very careful in the future. Can you offer any words of encouragement, advice?
Regards.
R.
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Gary comments:
There is hope - a ton of it.
As somebody who has seriously injured both achilles, including one partial rupture requiring 12 weeks in plaster, I can understand partially the distress your friend is going through right now. The good news is recovery can be complete and there are more successes than failures. I am a good example of that and so is my sister, Lorraine, who underwent at least one achilles operation and still managed to win a bronze Olympic medal. There is hope. That's for sure.

An achilles tendon rupture is a nasty, catastrophic injury and the best resources and expertise need to be mustered to ensure the fullest recovery. If it was a complete rupture, as you appear to imply, then the general consensus is that the tendon be surgically sewn back together and then immobilised for several weeks. If that has not been done for your friend, it is probably too late. This method of repair generally gives a faster and fuller recovery than placing the leg in plaster and hoping that ends meet and join back up again.

It is when the plaster comes off that the hard work really begins. Especially if the tendon was not sewn then extreme care must be taken when gradually mobilising the ankle because reinjury can happen without warning. Many years ago when I was working in the physio department of Dunedin Hospital, a young physio was giving a patient with a post achilles rupture some heel raise exercises. There was an audible snapping as the tendon snapped again. It was hard to tell who was the most upset - the patient or the physio. The lesson here is not to push things - to take one's time for a good 12 weeks or so after the plaster comes off while the tendon completes its recovery. Seek the services of a physiotherapist who has been working for several years, rather than an inexperienced Young Gun.

Recovery is probably well on the way about 12 weeks after getting out of plaster, but it is that final 10% that might take a good one-two years to be completed. The initial stages should be guided by an experienced physiotherapist who can guide your friend.

In the meantime, she is in plaster, and there are several extremely positive things she can do to aid her recovery:

Get into a gym and work out vigorously:

• It is only the bottom part of one leg that is immobilised - the rest of the body is in perfect order, so here is an opportunity to get super fit, including working on all those lose and soft bits. Being super fit will improve circulation to the injured area and ensure that she does not put on excess weight which could be a burden on her leg when the plaster comes off.

Improve nutrition and healing:

• Take some glucosamine and chondroitin which aids tendon as well as joint healing
• Take up to 4,000mg of MSM per day. Perfect for tendons and fantastic for skin, hair and nails and a natural anti-inflammatory
• Take up to 2,000mg of vitamin C per day for the same reasons as the MSM
• The same advice applies for vitamin E which is traditionally used for softening scar and for promoting healing.

All of these are available through http://www.myotec.co.nz/

The good news is that a properly treated and rehabilitated achiiles tendon is very strong. Some argue that it can be stronger. I tend to agree. My experience is that if an achilles is going to rupture again 1-2 years following the first time, it is usually the other one! (Not sure if that is good or bad news??).

Rehabilitation, nutrition and management of multiple sclerosis and pernicious anaemia

Hi Gary, I was wondering if you could please help me. I have been looking on the internet and in some books but I cannot find why fats and fat soluble vitamins D, E, K and A are so important for someone living with MS. Please could you tell me why. My client also has pernicious anaemia. She is not a big meat eater so are there other ways to increase her protein intake to ensure she is getting adequate protein daily to build up her muscles...which in turn will help with her strength with MS? Your help as always is greatly appreciated. Vicki (Vicki is a First Year Nurse in New Zealand)
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Gary Moller comments:

Vicki,
First of all, being a nurse, I still like to think the people you care for are patients rather than clients. A client is more of a business transaction than a healing process of care. Don't you think? We should resist the move by hospital bureaucrats to dehumanise hospitals which are becoming little more than over sized industrial processing complexes. In case you wondered: The only reason I use "client" now and then in my writing is I do not like to refer to "patient" unless I am hands-on with a person. Removing the word "patient" from the professional vocabulary of nursing is part of the conspiracy. Nurses you must resist!

What you are asking about is a topic of intense interest for me, so thanks for writing in and asking. Please have a good read of the PDF here which has been prepared by Hyperhealth Pro. I can provide any of the nutrition supplements that it refers to. It gets quite convoluted and depends very much on individual circumstances as to what is best done nutritionally.

With regards to multiple sclerosis, the purpose of nutrition and exercise is not to cure; but to assist the ongoing management of the condition, including quality of life and maybe even reducing the incidence and severity of inflammatory flare-ups.

The fat soluble vitamins are essential for health with the list of benefits growing by the day. Vitamins A, D, E and presumably K are essential for a healthy nervous system and deficiency is definitely not helpful for a person who is suffering multiple sclerosis. There is a relationship between the incidence of multiple sclerosis and vitamin D levels. For heaps of information about this, you can do no better than to spend several hours perusing the information available through the Vitamin D Council. A low fat diet is distinctly unhealthy and the map above that shows the distribution of MS could also be an overlay for dietary intakes of the fat soluble vitamins, including vitamin D from sunlight.

The fat soluble vitamins are essential for maintaining a robust immune system and for maintaining appropriate inflammatory responses (MS has autoimmune and inflammatory factors at play).

Earlier this year, I had the pleasure of meeting the Head of the Washington-based Weston Price Foundation, Sally Fallon and her husband, Geoff Morrell. Incidentally, Geoff is a retired Southland farmer, turned natural healer. The Weston Price Foundation is championing the health benefits of traditional foods that happen to be rich in the fat soluble vitamins – something that our modern foods are perilously lacking. Please have a good read of the information on their site and their books and newsletters come highly recommended.

Your patient would benefit from a Hair Tissue Mineral Analysis. The results of these are now rolling in and I can tell readers that the results have been fascinating and extremely helpful. Your client will be no different. A HTMA will determine, among many other things her protein requirements and even the types of proteins she needs. It will tell her if she has had exposure to heavy metals which may be a factor in her ill health. If she has not had one yet, she should request a blood test of her vitamin D levels. These should be 120nmol or higher. If she follows the published research of the New Zealand experience, we can assume that her vitamin D levels will be desperately low. I have found levels lower than 10 nmol. Every step should be taken to boost these levels to optimum. A natural fish oil based vitamin D supplement is also a rich source of Omega 3 which is beneficial for the nervous system and has a natural anti-inflammatory effect. She should sunbathe and even consider attending a tanning clinic. The blood test should be repeated about three months later to gauge the effectiveness of the measures and to ensure she is not over-dosing.

The pernicious anaemia is an interesting one that may be indicative of a generally poor state of nutrition which is par for the course for people struggling with chronic health conditions. The anaemia could be assisted by supplementation with a quality B vitamin and iron supplement. I would give her additional B vitamins as well. If she has been on antibiotics and other medication, it is possible that her gut microbial flora is unhealthy and this may interfere with her uptake of minerals and vitamins, including the B ones. I have access to several quality supplements that will help settle the digestion and repopulate the digestive tract with healthy bacteria. Many drugs, including anti-depressants, prednisone and so on may seriously interfere with the production of chlorine and healthy bile; hence the development of chronic digestion-related malnutrition. Again, there are special supplements I can help with that are designed to offset these unwanted medication side effects.

The muscle weakness which may be more pronounced on one side of the body than the other is not principally due to “muscle weakness”. It is because of damage to the parts of the central nervous system that operate the muscles. Of course, there is wasting of the muscles as a consequence of this damage to the brain, including lengthy bed rest related muscle wasting. So, the principal means for strengthening is at the neurological, rather muscle portions of the loop. This means having your client doing activities that reinforce basic movement patterns and coordination: Beginning with rolling over, crawling, walking, marching and so on. You begin with gross movements that are repeated over and over again with the emphasis on quality and then quantity. As gross movements are restored and hard-wired into the brain, then you move to more complex and finer body movements. Regularly review and practice the basic gross movements. You can make a lot of this brain-stimulating fun with dancing being one of the best therapies. Depending on her mobility, she could do anything from Tai Chi to line dancing to Rock’n Roll. These stimulating social activities are every bit as effective as mundane and boring rehab exercises.
The strength of the muscles will return as the nervous system is progressively rewired. This process is repeated following any further flare-ups of her multiple sclerosis.

Give her a whey protein-rich Super Smoothie as a nutrient-packed breakfast. Here is the recipe. I would throw in lots and lots of dark berries which are powerful anti-oxidants that minimise free radical damage that may be associated with multiple sclerosis flare-ups. These dark berries are known to be good for the nervous system, offsetting ailments like dementia and Alzheimer’s. Throw in a raw free range egg for good measure and some brewer’s yeast and maybe even a teaspoon of spirulina. Take a Super Smoothie once or twice per day with the most important being for breakfast.

While none of these measures will cure the problem; you may rest assured that none of them will do any harm either. Your client will benefit enormously by a general improvement in health, by knowing she is doing things that are positive and pro-active. She will have a sense of personal control. And, depending on how advanced the condition is and depending on any co-morbidities, she will have opportunities to have fun and socialise if imagination and fun are applied to the rehab!

The Iraq war from a rehabilitationist's view

We hear that this war is nudging towards costing one trillion US dollars and has already cost over 2,500 young American lives. But this is not even half of the story. At least 50,000 innocent Iraqi citizens have also lost their lives. Some might excuse the lack of concern about this carnage of innocents because these people wear funny clothes. But I'm not buying that.

Let’s talk injury prevention
Back in the good old days when I was a safety consultant with ACC, we had a simple rule of thumb for calculating injuries and deaths by accidents. For each accidental death, it was calculated there would be 10 serious disabling injuries and about 30 less severe ones.

So let’s apply this formula to Iraq:

2,500 dead US soldiers means

• 25,000 young Americans have been physically maimed for life
• 75,000 physically injured; but likely to fully recover

50,000 dead Iraq civilians means

• 5000,000 maimed for life
• 1,500,000 physically injured but likely to recover

These are just the physical injuries. More difficult to calculate is the lasting psychological trauma of war. I will not even attempt to go there.

People with serious physical injuries cost several million dollars each over their lifetimes. Add this to the cost of the war. While we see emotional news footage of the maimed lying in hospitals, what we fail to see is the lifelong impact these terrible injuries have on these people, their families and their communities.

Why not take a quiet moment now and spare a thought for the hundreds of thousands of people who have so far lost a leg, half a brain, an arm, an eye, their face, their family …..