Achilles Tendon Injuries

Achilles tendon and calf muscle tears are problems that have recently become near and dear to my heart. This, much like tennis elbow is the source of many athletic midlife crises. The Achilles tendon is actually a combination of three separate tendons. The Gastrocnemius is the big, bulbous muscle that gives the calf muscle shape. The Soleus is a flat muscle that sort of resembles a fillet of sole, and the Plantaris is a very small muscle that does not seem to provide any substantial function.  The tendons of these three muscles come together to form the thick heel cord that is the source of many problems. 

Unfortunately, as we age the healing process is not quite enough to support the constant pounding that the Achilles tendon receives.  When an injury occurs, it is typically described as a feeling of being kicked in the back of the leg.  Typically these tendons are injured during an explosive events such as jumping, landing or starting a "sprint".  The typical age for this type of injury is between 40 and 50 years old and occurs predominantly in male patients. Up until recently, the recommendation was almost universally for surgical repair.  The rationale behind this was to decrease the rate of rerupture.  Now, with more advanced rehabilitation techniques, we are able to spare many people the pain of surgery.  In the highly athletic population however, there is still the belief that surgical repair improves the strength and function in the long run.  The recovery from any type of Achilles tendon rupture is quite long.  It frequently takes 6-12 months to completely recover from such an injury and requires intensive rehab.

-J Fallon

The Biology of ACL Reconstruction and Regeneration

One of the best examples of the wonders of modern medicine is Anterior Cruciate Ligament reconstruction.  Because the body is unable to heal the ACL on its own, it requires reconstruction in order to restore normal function to the knee.  The process of ACL regeneration relies heavily on the biology of your knee.

When I reconstruct your ACL, I take a tendon, either from an organ donor or from a different part of your body, then place it where I want a ligament to grow.  Your body uses this tendon as a scaffolding to regenerate a new anterior cruciate ligament.  This process occurs and 3 phases.  The initial phase is characterized by necrosis or cell death.  During the first 4 weeks after surgery, your body tears down all of the living cells in the graft, leaving only nonliving tissue as a blueprint for the final ligament.  The second portion of the regeneration process is called the proliferation phase.  This usually occurs in the second and third month after surgery.  This is characterized by influx in your own body’s cells into the remaining scaffolding.  The scaffolding also undergoes changes that cause significant weakness in the graft.  6-8 weeks after surgery is typically thought of as the weakest point and the time where of the structure of the graft needs the most protection.  The final phase, the ligamentization phase begins about 3 months after surgery.  During this time, the graft is slowly and steadily getting stronger and becoming more like the original ACL.  There is no clear end point however there is plenty of evidence suggesting that the graft will continue to mature over the following year.

Will My Frozen Shoulder Ever Get Better?

Frozen shoulder, or Adhesive Capsulitis is a frustrating and painful condition that typically effect people in the 40's and 50's.  It almost sneaks up on you, feeling like a tweaked shoulder from doing something dumb like trying to catch the soda can as it rolls off the counter.  It can be a very painful process to go through, interrupting your sleep, your work and effecting pretty much every aspect of your life.  Along with the pain comes an inability to move your shoulder.

The frustrating part of this is that it doesn't matter how high a pain threshold you have or how hard you work to stretch, you can't make this go away any faster.  Beyond that, there is not much I, as your surgeon and physician can do about it either. It has a mind of it's own.   Aggressive physical therapy, forceful manipulation, surgery all fail to make this go away any sooner.  My role in getting you better is primarily supportive.  I can offer you cortisone injections to help make the pain bearable.  I can show you some stretches to help make you shoulder slightly more useful, but ultimatelly, frozen shoulder thaws on its own schedule.  Even worse... it can take up to 2 years to go away.  Ulitimately, it does resolve and you should expect full use of your arm in time.

For more information, you can read this handout from the Journal of Orthopaedic and Sports Physical Therapy or call our office for and appointment.

What to Expect after a Rotator Cuff Repair

If you are having, or considering having shoulder surgery, you should be aware of the recovery from the surgery. 

Shoulder surgery hurts!  There is no way around that one.  Typically patients have difficulty getting back to their daily routine for about 2 weeks after surgery.  It is difficult to find a comfortable position to sleep and it is hard to adapt to one good arm and one arm stuck in a sling.