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The Achilles Tendon Repair

Author: Graham Bishop
Date: 25 February, 2014

Disclaimer: The information contained in this article/paper is intended for

educational purposes only and is not a substitute for advice, diagnosis or treatment by a
licensed physician. It is not meant to cover all possible precautions, drug interactions,
circumstances or adverse effects. You should seek prompt medical care for any health
issues and consult your doctor before using alternative medicine or making a change to
your regimen.
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Abstract

Medical practitioners world-wide are not in agreement on the best way to treat a full
rupture of the Achilles tendon. Traditional methods require up to 8 weeks in plaster with the
tendon fully immobilized after a surgical repair. Recovery after a severely atrophied leg is slow
and difficult and often a full recovery is not achieved. The surgery has its dangers with the risk
of wound infection and the accidental damage to the sural nerve (Jacobs, Lin., et. al., 2012).
New research is now showing that a full recovery is now possible with both surgical and non-
surgical Achilles tendon recovery methods provided the Achilles tendon is given early
movement and weight – bearing exercise which increases the strength of the collagen that creates
the new part of the Achilles tendon (Twaddle & Poon, February 2014). There are also several
other factors related to diet and healing methods that may also positively contribute to a full
recovery.

Introduction

The following is a description of a protocol used that gave an effective and full recovery
from a full rupture of an Achilles tendon. The goals with this rehabilitation program are to firstly
reduce swelling and pain and then work towards a gradual recovery of both ankle motion and
power (Strom, Casillas, 2009, p. 1). The protocol has been implemented by the author who
suffered a full rupture of the Achilles tendon and made a full recovery. The rationale for the
choices made for the procedures has been supported by previous research by qualified personnel
– scientists and medical practitioners. The author has simply researched a wide range of studies
and reports and formulated and tested a recovery program based on validated research.

The recovery protocols proposed have been carried out for a non-surgical recovery but it is
believed that protocols practiced during the recovery should also apply to a surgical recovery.

Initial action

Immediately after the full rupture of the left Achilles tendon (March, 2013) the injured area
was given an ice pack for about 45 minutes to reduce immediate swelling to the injured area.
The hospital medical personnel, without a scan, supported the belief of a full rupture of the left
Achilles tendon. The left foot was then placed in the position of equinus (plantar flexion:
keeping the foot pointed – similar to how a ballet dancer stands on her toes) using a plaster cast.
This is standard procedure after sustaining an Achilles tendon injury. Between the initial
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consultation at the emergency out-patients of the hospital and the next visit to have the injury
scanned, the injured leg was given knee movement exercises to promote blood flow to a typically
poor blood-flow area (Ahmed, Lagopoulos, et. al. 1998) but when any swelling occurred the leg
was elevated above the level of the torso.

The injury was scanned 48 hours after the rupture occurred using ultra-sound to confirm
the initial diagnosis of a full rupture of the Achilles tendon with the two sides of the ruptured
tendon in close proximity to each other. A plaster cast was placed from the foot to below the
knee with the foot again placed in plantar flexion. The cast remained in place for exactly 2
weeks.

Recovery Protocols

During the 2 weeks with the cast in place, the leg was given regular exercise instead of the
usual practice of keeping the leg elevated. Each morning an exercise routine including 100 knee
raises and 100 straight leg raises from lying on the back, 100 scissors – type leg raises whilst
lying on the side, and another 100 knee and 100 leg raises whilst lying on the front. For body
balance both legs received the same exercises. Also, “Vigorous exercise of the uninvolved
contralateral ankle muscles produces a neurological stimulus in the injured muscles (called the
“cross-over effect”), and helps to prevent atrophy” (Christensen, 2014).

Also at home instead of using the crutches to get around, walking on the hands and knees
was mainly practiced. The rationale was to keep a higher level of blood flow to the injured area
to help accelerate the healing process. These exercises were performed daily for the first 10
weeks including a preference to movement on all fours instead of using the crutches when at
home.

Also within the same two week time-frame a nutrition routine was established. This
included regular daily intake of approximately a dessertspoon full of the so-called super food
‘Chia seeds’ ((BBC News, March, 2012) & ( Ali, Ho et.al.)), two teaspoons of honey whose
quality could be verified (Kumar, Bhowmik, et. al., 2010) and cinnamon (Gruenwald, Freder,
et.al., October 2010), a regular intake of bee pollen – an amount of about one dessertspoon, a
low sugar diet, a minimum intake of processed food with an accent on natural foods, a low wheat
diet – to avoid gluten concerns (Sapone, Bai, et.al., 2012) and no alcohol, which retards the
healing process including decreasing the collagen production (Guo, DiPietro, L, March, 2010).
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This diet was predominantly adhered to for approximately 26 weeks. Collagen production is a
necessary ingredient for tendon repair.

After two weeks with the cast in place, the plaster cast was removed and a ‘moon boot’ was
fitted as a replacement. In addition to the leg raises exercises already described two new
exercises were added. Both exercises required the removal of the moon boot during the exercises
and were attempted during week three. – The first exercise was to carefully and slowly move the
foot up and down about 10 times while lying on the back, allowing the foot to move as far as it
naturally would move without applying any stresses to it. The second exercise began with the
foot flat on the floor and while sitting on the side of the bed, and then a gentle lifting of the foot
by using mainly the toes was carried out. This exercise began with about 10 repetitions. As the
weeks progressed the numbers of repetitions were gradually increased. These two exercises were
performed daily until week 20.

Latest research shows that early mobilization of the Achilles tendon will facilitate in a
stronger tendon (Nilsson-Helander, Grävare Silbernagel, et.al, 2010). “Key Point: Ninety-seven
patients (79 men, 18 women; mean age, 41 years) with acute Achilles tendon rupture were
treated and followed for 1 year. The primary end point was re-rupturing. There was no
statistically significant difference between surgical and nonsurgical treatment. Early mobilization
is beneficial for patients with acute Achilles tendon rupture whether they are treated surgically or
non-surgically.” (Also see: Twaddle & Poon, February 2014 for ‘Early Motion for Achilles
Tendon Rupture’)

Concurrently, after the plaster cast was removed, twice a day, a natural anti –inflammatory
topical administration of comfrey and arnica was applied – a large enough amount to cover the
whole front and back of the foot and from the Achilles attachment at the back of the foot to the
base of the calf muscle. “The therapeutic properties of comfrey are based on its anti-
inflammatory and analgesic effects. Comfrey also stimulates granulation and tissue regeneration,
and supports callus formation” (Staiger, October 2012). “Arnica (Arnica montana) has been
used for medicinal purposes since the 1500s and is still popular today. Applied to the skin as a
cream, ointment, liniment, salve, or tincture, arnica has been used to soothe muscle aches, reduce
inflammation, and heal wounds” (University of Maryland, 2014).

Also two drops each of the essential oils wintergreen and helicrysum were applied each
time the comfrey/arnica lotion was applied. Clinical studies have shown that the synergistic
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interaction of helicrysum extracts has antibiotic properties that are good against wound infection
(Aiyegoro, O., Afolayan, A., et. al., 2009). Traditionally it is also believed to aide in the collagen
production – which is essential for tendon repair. It is possible that helicrysum’s proven anti–
inflammatory properties allow better blood flow to the injured tendon which allows for a better
production of collagen (Atunes Viegas, Palmeira de Oliviera, et. al. November, 2013). Public
results of clinical studies into Wintergreen are hard to locate. Traditionally it is believed to be an
antiseptic and disinfectant but it is also believed to be an analgesic. It is extremely toxic if taken
orally. Once the oils and lotion were applied, the area was also massaged. Massage promotes
blood flow and aids the healing process. With a predominant absence of swelling in the injured
area there wasn’t any requirement to keep the foot elevated (elevation of the foot causes a lower
blood flow to the affected area).

About mid way through week 4, after the Achilles rupture, standing on both feet was begun, and
initially a few steps were made. From the beginning of week 4 to the beginning of week 6 some
very short distance walking around the house was done. Usually, some walking on one particular
day, and then the next two days spent without walking to allow for recovery. By the end of week
5 the flexibility and strength in the injured area was showing marked improvement and the
ability to walk over an increased distance was demonstrated. Also the range of motion in the
ankle was increasing.

From weeks 6 to 10 the amount of walking began to increase. Also there was a continuation of
the exercises previously begun. Work now had also begun on building the flexibility back into
the injured area. To achieve more flexibility, sitting on a chair and leaning forward onto the toes
until the point of maximum flexibility was reached. It was important to work on flexibility at this
early stage as the first type of collagen that repairs tendons is more flexible. The second type of
collagen begins to replace the more flexible type around week 6 after the injury. So to achieve a
return to full flexibility the stretching needs to begin earlier rather than later.

By the end of week 10 the crutches and the moon boot were totally abandoned.

From week 11 and onwards the diet was mainly adhered to. At week 6 the helicysum italicum
and wintergreen essential oils were replaced by a product called ‘Ice Blue Rub’ by the company
DoTerra. Its ingredients include both wintergreen and helicysum italicum. The product was used
in tandem with the comfrey and arnica lotion and the afflicted area was then massaged daily.
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From week 11 exercise programs included plenty of walking, flexibility exercises and by week
16 developing strength by beginning calf-raises. Some regular walking on the beach was done to
helped build stability and strength in the Achilles tendon region. An introduction to the exercise
known as squats was performed to also build strength and flexibility. By week 26 a complete full
range of motion was achieved.

Eleven months after the Achilles tendon full rupture, the Achilles tendon feels normal. The
difference is in the size of the tendon. After 9 months of recovery the Achilles tendon was
approximately twice the thickness of the other tendon over its complete length. After 2 months
of running the thickness has now reduced to approximately 1.5 times the other tendon’s
thickness.

Conclusion

The latest research into recovery from acute Achilles tendon injury points towards early
mobilization and weight – bearing of the tendon. In addition to a regime of specialized exercises,
a carefully controlled diet, with the addition of quality honey, cinnamon and Chia seeds, and the
use of natural anti –inflammatory and regenerative products, a full recovery from the full
Achilles ruptured is now more likely to be achieved.

Addendum: Five years on after fully rupturing my Achilles tendon, its function appears to be
completely normal in all ways. I have regularly run and jumped and stressed it in the same way
as the other Achilles tendon. It is never sore first thing in the morning, or after active exercise.
For me, personally, the recovery has been a complete success.
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Reference List

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pedunculatum leaf extracts with antibiotics against wound infection associated bacteria.

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Christensen, K. (2014). Rehab of the Achilles Tendon, American Chiropractic Association Rehab

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Everitt, L. (2012). BBC News magazine, The Chia Craze, Retrieved from

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Additional Websites

Achilles Tendon surgery and recovery

http://consumer.healthday.com/bone-and-joint-information-4/bone-joint-and-tendon-news-
72/surgery-may-not-be-needed-for-ruptured-achilles-tendon-671600.html

http://www.eorthopod.com/content/new-study-challenges-surgery-for-achilles-tendon-ruptures

http://emedicine.medscape.com/article/85024-treatment

http://www.missoulaboneandjoint.com/PatientEducation?ctl=View&mid=86891&ContentPubID
=70

http://lowerextremityreview.com/cover_story/battles-of-achilles-the-operative-vs-nonoperative-
treatment-debate

Chia Seeds

http://www.huffingtonpost.ca/2013/06/03/chia-seed-benefits-_n_3379831.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518271/

Comfrey

http://www.sciencedirect.com/science/article/pii/S0944711304000327

http://onlinelibrary.wiley.com/doi/10.1002/ptr.4612/full

http://link.springer.com/article/10.1007%2Fs10354-012-0162-4#page-1

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259911/

DoTerra Deep Blue Rub

http://www.doterratools.com/documents/Deep_Blue_Rub_Product_Information_Page.pdf

Helicrysum

https://healthyfocus.org/the-top-benefits-of-helichrysum-essential-oil/
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http://theida.com/aromatic-plants/helichrysum-helichrysum-italicum

https://www.ncbi.nlm.nih.gov/pubmed/20933508

https://www.ncbi.nlm.nih.gov/pubmed/17315926

https://www.ncbi.nlm.nih.gov/pubmed/23495152

https://www.ncbi.nlm.nih.gov/pubmed/23140115

https://aromaticstudies.com/helichrysum-helichrysum-italicum/

Honey & Cinnamon

http://www.snopes.com/medical/homecure/honey.asp

https://www.healthline.com/nutrition/honey-and-cinnamon

https://www.ncbi.nlm.nih.gov/pubmed/19433898

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003790/

Wintergreen

http://www.organicfacts.net/health-benefits/essential-oils/wintergreen-essential-oil.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995208/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687118/

About the Author: Graham Bishop has a Bachelor of Engineering, Diploma of Education, and
mainly works as a professional musician. He has developed a keen interest in natural healing,
and Esoteric Knowledge through many years of self-education and investigations.

Email: grahbishop@gmail.com