Nightmare on Achilles Street

Two weeks ago, I fell victim to one of the most debilitating yet most common injuries a squash player can endure. I ruptured the Achilles tendon in my left leg.

It happened on court during a match whilst lunging for a forehand drop. I spent the whole rest of that day asking around for surgery recommendations. All roads led to the Hospital for Special Surgery on New York's Upper East Side. They were great and operated on me same day as seeing me. Even though I was totally incapable of walking after the injury, it did not hurt as much as I thought it would and the whole experience at the hospital was quite pleasant actually. Relative to the thought of this going unattended and me limping around for the rest of my life, the experience was wonderful. Thank goodness for modern medicine, I kept thinking.

The few weeks subsequent to surgery have truly sucked though. It is the stuff nightmares are made of. In fact, I am not even going to write about it.

If you care to know, the Achilles tendon is a large rope-like band of fibrous tissue in the back of the ankle that connects the calf muscles to the heel bone. It is the largest tendon in the human body. Your Achilles tendon allows you to point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you move your foot. Clearly it is relied upon heavily whilst playing squash.

In most cases, a rupture of the Achilles tendon occurs at a spot on the tendon that receives less blood flow and is thus weakened. When the doctor opens you up he can tell whether this is the case based upon where and how the tendon breaks. The best case for a healthy tendon is a break that results in a frayed end. This is harder to operate on but is a sign of a healthy tendon (before the injury) and will likely heal well. The doctor said mine broke high up and looked liked a horse’s tail. So that is a good thing, I hope.

Ruptures often are caused by a sudden increase in the amount of stress on your Achilles tendon. A rupture normally happens when you make a forceful push-off with your foot while your knee is straightened. The full force of one of the most powerful muscles in your body (your thigh) is transmitted through your tendon. A great example of this is your starting position for a forward lunge off the T on a squash court.

My opponent was buried in the back left and boasted the ball to the front. I had no need to move as quickly as I did (I mean, tried to) but wanted to, as a quick deft drop may have earned me game ball. So I did a usual (i.e. subconscious) split step where you right foot goes forward and your left goes back to push off. The problem was - my left leg got too low and too straight and the angle of my foot relative to my leg was too acute, so my thigh and calf pushed down with too much force for the tendon to bear at that angle and it just snapped.

But I have done that movement many times before. So, as for the underlying reasons, I guess age is a factor that may have contributed. It was not owing to a lack of warming up. I did stretch before the game, and we had been playing for forty five minutes at that point. I suspect there may be another more sinister reason though. There is one obvious thing that I did differently than before.

I find this a rather morbid thought: I was playing squash at 7am in the morning. And I never used to play squash in the morning; it always seemed harder. As a young man, I remember playing in tournaments and always faring better in the afternoon or evening games. And there are many people who swear that squash is way too hard on your body to play it early in the morning. I knew this, so what was I thinking? It is safe to assume I will now add the following to my list of do's and don’ts to protect my body: "Don't play hard games of squash early in the morning.”

This does not mean morning exercise is out completely, however. Jonah Barrington, a world squash champion in his late thirties, believed that a training session in the morning was worth two training sessions later in the day. If by that he meant your body has to work harder in the morning (in the same activities) then I would tend to agree with him. I think I'll stick to more moderate activity when I wake up from now on, like swimming or just walking to the kitchen, or something.

Anyway, during surgery the Achilles tendon is stitched together and a vestigial muscle (I like to think bionic) is harvested and wrapped around the Achilles tendon, increasing the strength of the repaired tendon. Is that why the lower calf always looks thicker on those that have had the surgery? I am not a doctor so what do I know.

In the final analysis, I take comfort in the fact that many friends and squash players have suffered through the same nightmare and have made a full recovery. Plus, I am part bionic now so totally expect to come back stronger than before.

At the very least, I'll have a nice gory scar to remind me that the nightmare was, in fact, real.