Hi, I'm Ali! I’m one of the physios from treatmyachilles.com.
We’re an online virtual physiotherapy service for people with Achilles pains or problems. They can
be tendonitis and tendinopathies, or they could be recovery from tears or complete ruptures.
This is a series of videos in regards to partial tears or partial ruptures of the Achilles tendon.
And today, we're going to be talking about what we might expect about healing and how
long healing takes if we were to have a partial rupture or a partial tear. There are links to
the other videos in this series underneath this, and please have a click on those and
read through, as it would all make sense if you watched the series together.
So, in the last episode, we were talking about the anatomy and what makes up the Achilles tendon and
what happens when we have a partial tear. So, we talked about how we have lots of fibres that make
up our Achilles tendon. And with a partial tear, it's when a few of those fibres, not all of them,
but quite a lot of them, or indeed only a few of them, still classify as a partial Achilles tear
rather than all of them, which would be a complete rupture. So, what happens when we have this tear
is, immediately our body goes into a state of inflammation and this inflammation can come out
over the first few hours, and indeed, over the first two or three days, it might seem quite bad.
This is normally the peak of that inflammation time, unless we were to do something to irritate
it again. And signs of that inflammation is a great sign - it's the first stage of
healing and it's an important phase. What we're doing there is getting symptoms like swelling,
redness, a bit of warmth, or a bulgy look to the back of that tendon. We also mentioned in the
last episode that it might be worth seeking some medical advice at this stage to make sure that
your diagnosis of a partial tear is correct, and we aren't missing anything like a complete tear.
What happens next is, our body is really quite clever. While this inflammation is happening
and as it starts to go away, we then start to send our blood vessels … our blood supply to that area,
and that blood supply is fabulous. It sends with it all of the cells that we need to help knit
those tendons back together again. And how that knits, if you imagine, our Achilles tendon is
made up of lots of bundles of fibres in straight lines. And when we pull a few of those fibres,
everything is a bit torn and not attached together again. So, what happens is, we gradually get to
the point where they're knitting back together. But instead of knitting back together in a nice
straight line, it knits back together in what I call higgledy-piggledy. And I know some people
have commented before: ‘What you mean by higgledy piggledy?’ What I mean by that is, not in a
straight line. They grow in different directions as things knit back together again. Now, this
knitting back together takes a few weeks. It takes a few weeks, from about Week 1, Week 2,
all the way through to about 12 weeks. Now, this means we can start to do a bit more,
and we'll come on to talk about the rehabilitation of a partial rupture or a partial tear in the next
video, and what you might expect. Around about nine, ten weeks we can be relatively confident,
depending on the severity of your tear, that things have knitted back together. After about
this 12 weeks, three months kind of marker ... and again, these are approximate times,
some people are a little bit slower, some people are a little bit quicker than this ... and what
happens around that time is that we start to then reorganise those collagen fibres. So, instead of
them being in that higgledy-piggledy fashion in that non-straight-line fashion, our body then
remodels them back into that. And that can take a period of months to get back to that position.
Now, it's quite interesting when we look at these scans of people that have had
Achilles partial ruptures of partial tears, and sometimes - and again, this isn't everyone
and it's not all that common - there can be signs that there was a tendonitis or tendinopathy in
that tendon before there was a rupture. And so, if you've had a grumbling tendon that's been causing
you problems for a while before, or symptoms of a tendinopathy, and if you're not sure what that is,
again, there's a link to a video for that in the description underneath. If you've had signs
of that, now this rehabilitation may need to include rehabilitation for a tendinopathy. So,
it might take just a little bit longer than the actual healing process does.