Elsevier

Physical Therapy in Sport

Volume 29, January 2018, Pages 70-78
Physical Therapy in Sport

Case Studies
Return to competition after an Achilles tendon rupture using both on and off the field load monitoring as guidance: A case report of a top-level soccer player

https://doi.org/10.1016/j.ptsp.2017.04.008Get rights and content

Abstract

Objectives

To describe the Return to competition after Achilles Tendon rupture (ATR) in an elite soccer player.

Design

Case report.

Setting

Return to sport (RTS) of a professional soccer player who suffered an ATR during a match. The RTS phase started 15 weeks after surgery and specific on-field activities were gradually introduced. Criteria used to monitor the transition through the different phases were strength and endurance of the calf muscle and ability to sustain specific on-field training loads (TL) monitored with Global Positioning System and heart-rate system. TLs were weekly compared to pre-injury values to evaluate recovery and to prescribe future sessions.

Participant

A 39-year-old (height 178 cm, weight 75 kg) elite soccer defender player, playing in Italian Serie-A league.

Results

Days of absence were lower compared to a cohort presented in UEFA study (119 versus 161 ± 65 days, respectively). External-TL and Internal-TL were organized to gradually increase during RTS and resulted in higher values prior to return to competition compared to pre-injury values. Concentric plantar flexion peak torque increased till 9th months after surgery.

Conclusions

Monitoring of the field activities allowed comparison with pre-injury values and provided a useful and functional criteria to pass return to team activity and competition.

Introduction

An Achilles tendon rupture (ATR) may dramatically influence the sporting career of an elite athlete and only 60% are reported to return to the same professional level (Amin et al., 2013, Parekh et al., 2009). ATR has been classified as a severe injury in soccer players due to the extended absence from activity/sport (median lay-off time of 169 days) (Gajhede-Knudsen, Ekstrand, Magnusson, & Maffulli, 2013).

Return to sport (RTS) is the last part of the rehabilitation process and can be very stressful both mentally and physically for an elite athlete (Ardern et al., 2016). Generally, players want to return to competition as soon as possible and this can lead to an accelerated rehabilitation with increased risk of re-injury. In order to prevent re-injury, it is recommended that an athlete should have recovered both general and specific capabilities of the sport prior to return to practice with the team. However, it is mostly stated in rehabilitation protocols that the athlete should slowly progress to full participation without any specific suggestions concerning how to progress or how to measure the changes in training load (TL). The assessment of TL is widespread in sport science and its monitoring may give guidance in progression during RTS (Hoover, VanWye, & Judge, 2016). Modern technologies as Global Positioning System (GPS) and heart rate monitors provide useful support to monitor load and its changes through the RTS period.

For the above reasons the RTS period is probably one of the most delicate rehabilitation phases where both overloading and underloading have a negative impact on the speed of recovery. Hence, having specific criteria for progression is of benefit for the athlete.

There is a lack of evidence on what to base the RTS decision after ATR in soccer players (Ardern et al., 2016, Drust et al., 2014). Deficits in strength, explosive capability (i.e. jumps), and endurance in patients with an ATR may remain for a long periods (i.e. 1–2 years) after the injury (Nilsson-Helander et al., 2010, Olsson et al., 2011). Furthermore, in elite sport other sports specific criteria may be of greater relevance in the RTS phase. It has been suggested that during the RTS phase the progression can be controlled by monitoring the TLs during activities in the field (Blanch & Gabbett, 2016).

The rehabilitation process after ATR in healthy patients or recreational sports athletes is well examined in recent literature (Brumann et al., 2014, Holm et al., 2015, Huang et al., 2015, Mark-Christensen et al., 2016), however no studies have described the RTS after ATR in elite players. The aim of the present case report is therefore to describe in detail the RTS phase after an ATR in an elite level soccer player.

Section snippets

Participant

The player was a 39-year-old (at the time of injury) defender (height 178 cm, body mass 75 kg) playing in an elite Italian soccer team (Serie-A, 615 matches and 19 seasons played in the same club, total number of Official matches played 1104). During the six weeks before ATR, the player was suffering from symptoms in the Achilles tendon region, however the symptoms were not consistent and allowed him to train and play matches without limitations. The player gave a written informed consent to

Results

The player returned to participate in an official competition (i.e. 15 min) 27 weeks after the injury with a lay-off time of 119 days. The first entire match (i.e. 90 min) was played 30 weeks after the injury. He played in 12 of the remaining 26 matches to the end of the season without suffering of any lower limb injury or pain in the Achilles tendon region.

Discussion

The present case-report showed a successful return to competitions of an elite soccer player after ATR. Despite studies having compared different rehabilitation regimes, the best program that provides a rapid return to competition with the minimal risk of re-injury and maximal performance ability is still debated (Brumann et al., 2014). In the present case-report, functional rehabilitation was preferred to immobilization and no complications were found during the rehabilitation period.

RTS is a

Conclusions

The present case-report showed the feasibility of using both clinical criteria combined with sport performance criteria to design a return to sport/performance plan for an elite soccer player. Strength and endurance ability are important criteria, however the ability to cope with the specific demands coming from the field may be considered most important. The monitoring of TLs can be useful in the decision making process.

Conflict of interest

None declared.

Funding

None declared.

Acknowledgements

The authors want to acknowledge the Club FC Internazionale, the Doctor Giorgio Panico and all the physiotherapists involved in the rehabilitation process Marco Dellacasa, Andrea Galli, Alberto Galbiati, Luigi Sessolo and Max Dellacasa.

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