Appropriate stimuli at the right time

Return-to-play following Achilles tendon rupture

From Bauerfeind Life Magazin on 02.03.2023

In short After an Achilles tendon rupture, national handball player Hendrik Pekeler followed an intense return-to-play process. Medical products provided by cooperation partner Bauerfeind helped him. Dr. med. Frank Pries, team physician of THW Kiel, operated on Hendrik Pekeler and prescribed a walking boot with pads, including a raised heel, and compression stockings until the rehabilitation phase. He recommends the AchilloTrain both in cases of a rupture and achillodynia. For Markus Engelmann, Chief Physical Therapist at THW Sport Physio, the AchilloTrain is an important product, in cases of achillodynia in particular, to reduce irritation in the tendon. He treated Hendrik Pekeler almost every day after the rupture with physiotherapy, manual therapy as well as cryotherapy. Hendrik Pekeler returned to the court after 180 days to play for his team THW Kiel, Bauerfeind’s long-standing cooperation partner.

The high risk of injury associated with professional handball became a harsh reality for Hendrik Pekeler, member of the national team. But the medical department of THW Kiel carefully brought the defensive specialist back to playing action with a personalized rehabilitation plan.

May 2022, Champions League match between THW Kiel and Paris Saint-Germain: during a duel, Hendrik Pekeler tore his right Achilles tendon. “Not your typical handball sports injury,” explains Dr. med. Frank Pries who has been the team physician for the German record holders for 25 years. According to the sports physician, Achilles tendon ruptures often occur without warning, in amateur athletes, too – even without the busy match schedules and high demands of competitive sports. “The rupture is usually triggered by the high acceleration of the player with an extended ankle.” If the player then has to pay attention to the opponent’s movements, whatever happens becomes unpredictable, meaning it cannot be trained for. Hendrik Pekeler underwent surgery at Mare Med Hospital in Kiel-Kronshagen/Germany, where Dr. Pries runs the Department for Arthroscopic Surgery and Sports Traumatology. The ­orthopedic surgeon reconnected the fibers of the Achilles tendon, which was torn in the middle, back together using an end-to-end suture repair. “An established primary intention technique that I’ve been using for many years. It leads to neither shortening nor lengthening of the tendon.”

VenoTrain compression stockings and a CAM walker

After surgery, Hendrik Pekeler was immobilized with a plaster splint for twelve days. The tendon was then subjected to initial load in a CAM walking boot, with Hendrik’s foot initially in a drop-foot position. The CAM walker was removed six weeks later, with the foot having returned to an almost normal position. During this time, the patient wore Bauerfeind’s VenoTrain business compression stockings in the walking boot. In contrast to amateur athletes, the professional handball player underwent closely monitored rehabilitation for six months which was tailored to the needs of competitive athletes. This return-to-play process for professional sports complies with specific guidelines, and its outcome is checked by the German employers’ liability insurance association at the end. “The healing of the tendon’s connective tissue, including restoration of the tendon sheath, alone takes three months,” explains Dr. Pries. “Before that, major loads, training sessions and strength exercises are out of the question.”

Markus Engelmann, physical therapist, explains that Hendrik Pekeler wanted to return to competitive sports as quickly as possible after tearing his Achilles tendon.

The rest of the body must also be kept stable

After taking off the CAM walker, Hendrik Pekeler should have been prescribed a slightly raised heel block for his shoe to protect the tendon. However, the 31-year-old 2016 European Champion underwent frequent physiotherapy with manual treatment and cold applications which resulted in an almost complete reduction of the swelling and tissue inflammation caused by the injury and surgery. A heel wedge was no longer required, and the training sessions could begin gradually. The THW Sports Physiotherapy Department with leading physical therapist Markus Engelmann was responsible for the measures that took place several times per day. “The challenge with Peke was: applying the right regeneration stimuli in the right place at the right time. And we did that successfully. Peke’s tendon didn’t cause any trouble – from the day after surgery to starting his training again. He was almost pain-free during the entire process. That’s not the norm. There are players you can’t even touch three weeks after surgery,” adds the physical therapist. With all the focus on the Achilles tendon, one thing had to be remembered: “During the rehabilitation phase, the competitive athlete’s entire body must be kept stable, in addition to the structure itself,” emphasizes Markus Engelmann. “If possible, without any major loss of muscles or performance.”

“The AchilloTrain support is a useful and suitable solution”

In amateur sports, though based on a different level, loss in performance after an Achilles tendon rupture is a frequently discussed topic as well. The AchilloTrain support is often used for conservative treatment and in cases of achillodynia, which many amateur runners develop because of highly cushioned running shoes (see Bauerfeind life 3/17). The support’s compression knit exerts comfortable compression on the skin and muscles. A viscoelastic pad surrounds and protects the painful tendon and guides it during movement. A removable heel wedge provides the tendon with relief. THW’s physical therapist is convinced of the opportunities presented by the AchilloTrain: “I would use the support for stabilization with recreational athletes in particular who will not receive daily 1:1 support after a rupture. In cases of achillodynia, too, it’s a useful and suitable solution to alleviate tendon irritation without much hassle.”

“For orthopedists, the AchilloTrain is the go-to support for achillodynia.”

Dr. Frank Pries

Individualized treatment and load control in professional sports

For Dr. Pries, using the AchilloTrain is a useful strategy, too: “I mainly use Bauerfeind’s larger braces, such as the SecuTec Genu knee brace. But I know from my conservatively treating colleague Dr. Lübke (Dr. med. Philip Lübke, also Mare Med Hospital Kiel, team physician for the German National Handball Team), that the AchilloTrain works extremely well during treatment. For orthopedists, it’s the go-to support for achillodynia.” And what was treatment like for Hendrik Pekeler? During the initial stage of rehabilitation, he wore the walking boot with medical compression stockings. The pads and the raised heel in the walking boot as well as the compression exerted by the stockings correspond to the active principles of the AchilloTrain. This played a crucial part in his recovery. “And it helped me regain my proprioception,” comments the 2.03-meter pivot player with a pleased smile.  After exactly 181 long days of individualized treatment and load control, he was back on court for the THW Kiel. ­Bauerfeind’s long-term cooperation partner can now play the next matches with the valuable support of Hendrik Pekeler. The Sports Achilles Support, Bauerfeind’s sports product for the Achilles tendon, helps him. “I can absolutely imagine wearing it for additional stabilization during future training sessions and matches even though I try to give my foot as much room as possible,” says Hendrik Pekeler. 

Images: Bauerfeind, Stefan Volk

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