We have a new series here on Hogs Haven, currently using the working title you see above. I think every great medical publication has to have a name that translates well to an acronym, and in this case, the HHMJM sounds pretty dang official (sorry...I meant #HHMJM). Here we go...
Ken: I want to introduce the latest contributor to Hogs Haven this offseason: Sam Lawrence. Sam, tell the good folks here at HH a little about your background—as both a medical expert and Redskins fan.
Sam: Hey everyone! I’m a medical student at the Georgetown University School of Medicine getting ready to go into the field of Sports Medicine (the docs who team up with orthopedic surgeons to take care of athletes). Super excited to be able to contribute to HH. Sports injuries are something people always have questions about and I’ve encountered a lot of vague and confusing information about injuries in the media. So, I thought I’d come here and lend what I know to HH readers about injuries and their management. I’m a DC native and yes, I bleed burgundy and gold. I remember (most of) 2012 very fondly, I miss Sean Taylor every day, and I’m all aboard with Captain Kirk.
Ken: Let’s get right to our first entry in our HH Journal of Medicalness: Junior Galette and his Achilleseses’. Make us smarter, Sam.
Sam: RGIII’s ACL injury was one of the things that got me interested in sports medicine years ago. I think knowing a little about the body and how it works goes a long way in understanding these injuries. So let’s take a quick look at the anatomy, physiology, and recovery process of Junior Galette’s injuries. As you know, at the start of both the 2015 and 2016 seasons, Galette injured his left and right Achilles tendons, respectively. The Achilles tendon is the largest tendon in the human body and is formed by the joining of two major muscles in our calf, the gastrocnemius and the soleus. It stretches from our middle calf to our heel bone, sometimes measuring up to 6 inches long.
Ken: Well, for some people maybe…
Sam: When these muscles contract, it causes our heel to rise and our toes to point towards the floor, a movement called plantarflexion. Injury to the Achilles tendon usually occurs when athletes move from a period of light workout (offseason) to heavy workout (training camp). We put stress on our Achilles when we accelerate or decelerate quickly when running, and when we jump. These are the common movements in sports that require our foot to plantarflex.
Ken: How does a world-class athlete like Galette suffer this injury twice though?
Sam: Studies have shown that repeated microscopic trauma to the Achilles, such as with strenuous training over time, causes it to lose integrity. When tendons become damaged, they harden, thicken, and become less flexible. Since the Achilles tendon is so long, our blood vessels have a hard time reaching its entire length, slowing the healing process. As you can imagine, a sudden shearing motion (like cutting off the defensive line) with a harder, more brittle tendon can result in rupture. Not surprisingly, the average age of Achilles rupture is 35 years old, when we typically see elite athletes begin to lose a step. In all, 80% of Achilles ruptures occur during sporting activities not limited to football: sprinters, soccer players, and basketball players have been shown to have a lifetime risk of just under 20% of Achilles rupture over a career.
Ken: Blogging and podcasting can also cause problems in this area, no?
Sam: Actually most people who suffer Achilles injuries are not competitive athletes; they are “weekend warriors.” For these individuals, surgery is often not necessary and rehab does the trick. However, professional athletes usually require both surgery and rehab to return to form. Galette underwent surgery for both of his Achilles injuries.
Ken: Was he fully healed after his first surgery? How long does that recovery take?
Sam: Overall, surgical patients recover very well and can return to sporting activities in 3-6 months. Returning to play often takes about 12 months. Galette’s Achilles injuries were nearly a year apart (August 2015 and July 2016), so from a rehabilitation perspective, Galette had time to recover. Studies have shown that surgery plus rehabilitation has certain benefits over rehabilitation alone. These include decreased risk of re-rupture (5% vs. 12%), greater calf muscle strength, greater plantarflexion strength, and decreased risk of chronic nerve injury. However, data is fuzzy regarding whether athletes are able to return to their pre-injury level of activity. Rehabilitation is focused on resistance training, such as weighted heel raises, and ankle mobility exercises. Without being there, it’s hard to say how dedicated Galette has been to his rehabilitation schedules. However, I’ll take the optimistic option and say he has put in the work to get back on the field, especially considering the Redskins’ eagerness to re-sign him after both injuries.
Ken: Will he ever be the same? Can he be?
Sam: Studies on outcomes after surgery suggest patients re-gain their previous level of strength and power, while some data suggests ankle fatigue and push-off ability never quite reach previous levels. So will Galette return at 100% of his previous playing ability? Likely not. Does he have an increased risk of re-rupturing his Achilles? He does, as 10% of Achilles injuries are repeat injuries, most occurring within 3 months of repair. However, the true key to recovery with Achilles ruptures, as with most other sports-related injuries, is proper rehabilitation. And along with his young age (28 years old), Galette’s access to world-class rehabilitation services at the Redskins facilities is the best predictor that he will achieve a full recovery. Galette may not return as the same player he once was, but he has a great opportunity to return as the best he can be.
Ken: It’s a good news day Jim! Sam, I want to thank you for your time and knowledge. In spite of my efforts, I think people may actually learn something!
Sam: Thanks, Ken. Here’s to hoping for a healthy offseason. I’ll leave you with something everyone can try at home:
Test your own Achilles: The best way to diagnose an Achilles injury is with the Thompson test. Try it at home! Lay someone on their belly on a flat surface with their legs hanging off the end. Then squeeze their calf muscle with your hand. This results in the plantarflexion motion of the foot. The absence of this motion suggests an Achilles injury.