Finishing my Doctor of Physical Therapy degree in December, I thought it would be a nice change of pace to give a little insight into some of the injuries going on with the Anaheim Ducks and others around the league. I know how confusing some of the injuries can be, so I thought I would provide some brief background into injuries as they come up and hopefully explain them in a way that makes sense to everyone.
As we all know in our beloved sport of hockey, coaches and management give us insightful terms such as “upper-body” and “lower-body” injuries that can drive fans absolutely mad as to what really is going on with their favorite players. Luckily, with technology the way it is now, we can use our medical minds to cipher through game footage to see if we can pick up what exactly that “lower-body” injury is. After, we can try to guess what structures were affected and what the player may have injured. At best, this is just a guessing game. However, sometimes, as in the case of the Anaheim Ducks’ Nate Thompson, the injury is explicitly stated to make our lives easier. The Anaheim Ducks had this bothersome news to report regarding the injury:
— Anaheim Ducks (@AnaheimDucks) June 14, 2016
If any of you are wondering how the heck he can be out so long while players like Tyler Seguin and Erik Karlsson came back so soon with a similar injury, then keep reading! I will tell you exactly what is going on.
A fun side note about this structure is in order before we get to the real fun. Achilles was an ancient Greek hero of the Trojan war and a stud of a warrior. Achilles’ mother, Thetis, tried to make her son immortal by dipping him in the river Styx. However, when she dipped him in the river, she held him by his heel, or Achilles tendon. Later in his life, the Trojan prince Paris shot a poisoned arrow into the one vulnerable part of his body that was not dipped into the river, his Achilles heel, eventually leading to the death of the great Greek warrior. Today, we have the famous term to describe someone’s weakest point as their “Achilles heel.” A little Hollywood magic with Brad Pitt gives us an insight into Achilles the motivational speaker:
Okay, enough Hollywood fantasy. For those who did not know or did not click the link above, earlier this summer, it was reported that Thompson tore his Achilles tendon while participating in an off-season workout session. Do not worry, I am not going to post any NSFW pictures or anything that might leave your stomach unsettled unless I tell you beforehand like Tyler Seguin decided to do with this picture, but here is a breakdown of what is going on.
The Nitty Gritty
Starting off with basic anatomy, the Achilles tendon (a tendon is a tissue that attaches muscle to bone) is the thickest tendon in the human body and attaches on to the back of your calcaneus (or “heel bone”). For the more visual learners, this picture may help. Basically, the Achilles serves to attach your gastrocnemius and soleus muscles (AKA “calf”) to your heel and allows your foot to plantarflex (point your toes like a ballerina). Another important feature of this cool tendon is for shock absorption when you land in walking or running and helping with pushing off with walking, running, or jumping.
More often than not, athletes who participate in explosive push-off sports such as basketball, tennis, baseball, or tennis are the most susceptible to tearing this tendon. The reason for this is that when we go to push-off quickly (think of exploding up to grab a rebound or going out all out for a sprint), a large amount of force must be generated by our Achilles tendon in order to produce that large amount of force. Usually, due to poor training habits or biomechanics, an athlete who’s tendon cannot handle that amount of force can end up tearing their Achilles.
As a side note, a complete tear is different from what happened to Erik Karlsson. Here is a link to explain a bit of the difference, but I will also just summarize. Karlsson had his tendon sliced with a skate and returned in three-four months. Muscle and tendon strains and ligament sprains are sorted by a Grade 1, 2, or 3 scale. A Grade 1 sprain/strain represents an overstretching of the ligament/muscle/tendon resulting in microscopic tears of the involved tissue. A Grade 2 involves more fibers tearing, but the tissue is still intact or together. A Grade 3 is the worst and involves a complete rupture of the tissue. Complete rupture means the two sides are no longer together and usually needs to be surgically repaired.
The cases of Karlsson and Seguin are completely different because their tendons were still together, meaning they suffered from either a Grade 1 or Grade 2 strain. Thompson suffered a Grade 3 strain and just had surgery, so the recovery from that is much more difficult and a longer process.
So, What Next?!
Athletes who tear this large tendon normally elect for surgery since the likelihood of returning to their sport and not re-tearing their tendon is greater than electing for more conservative treatment. Then comes the part when an awesome physical therapist comes in and performs rehabilitation.
For those who want a nicely laid out rehabilitation plan on this, here is a link to a basic protocol I found online. Generally, this type of recovery can take anywhere from six-nine months depending on a variety of factors. Keep in mind, these are professional athletes who are focusing on nothing but getting better and will generally get better faster than the normal human being. Having said that, I am going to summarize and give the likely scenario of what is playing out with Thompson’s recovery at this point.
Once the surgery is complete, most people are completely non-weight bearing for seven to eight weeks. The clinical reasoning behind this is due to tissue healing time and how much stress the tendon has to go through. Keep in mind what the Achilles does when you walk. If you try to walk normally right away, that tendon is most likely going to rupture again. Now imagine exploding to sprint or jump and how much stress is placed on it. He is going to be in a boot in a plantarflexed (remember, toes pointed) position to allow the tissue to heal, but can still work on hip, core, upper body strengthening as long as that foot is not being stressed. Putting that in perspective, Thompson most likely is still in his boot today.
Next phase after roughly week eight is to transition to full weight bearing with wedges placed inside the boot. This still allows the tendon to be put in a more relaxed position (toes are still pointed slightly) but now he can be without an aide to walk (crutches, cane). From weeks nine to twelve you are slowly transitioning into taking the wedges out of the boot, stretching the tendon within tolerance (meaning no pain), and strengthening the tendon. The great thing about how our bodies were designed is that it will let us as physical therapists know when we are pushing it too hard. If we try to stretch it into dorsiflexion (toes towards your shin) and we push a little too much, a pain signal will trigger for us to back off. You cannot forget about your hip and core exercises and do not forget about working out the unaffected side as well.
Weeks 13-16 should be full weight bearing without any wedge support and no boot. He should be performing double leg and single limb exercises within tolerance. The most important aspect, in my opinion of lower extremity injuries, is retraining and restrengthening our proprioceptive system. Essentially, we have receptors in our body called proprioceptors, which basically tells our body where we are in space and helps with our balance. When we get injured, these receptors are damaged or destroyed and need to be retrained just like a muscle or tendon.
Week 16+ is essentially progressing exercises to Thompson’s needs and making them more hockey-specific.
Honestly, I feel Thompson can return sooner than a March deadline if his rehabilitation goes according to plan. March gives us a nine-month deadline to rehab, which is generally the tail end of the spectrum in terms of returning to sport. He is in his 30’s, which plays a role, but he is a professional athlete and has not had a tear like this before, leading me to believe he may be able to come back well before then.
I presented a lot of information and sincerely hoped this helps explain a little bit better of what Thompson’s injury is about and give a brief introduction into what he can expect during his recovery. Simplifying this amount of information is no easy task, but please feel free to contact me with any further questions or research you might have. All in all, every person handles injuries differently, and Nate Thompson will be no exception. Hopefully, he will be back sooner rather than later doing this for us:
Please comment, like, share, or message me! Feedback is always welcomed and encouraged. God bless!