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David Beckham-Ruptured Achilles tendon

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Alex Fry

on 17 November 2014

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Transcript of David Beckham-Ruptured Achilles tendon

The injury is an indirect, soft tissue injury


Management of Injury
To manage the injury, it must first be classified, TOTAPS is a procedure used to determine injuries.
Classification of Injury
Return to play
Rehabilitation process
David Beckham-Ruptured Achilles tendon
T
The first step T is for talk, giving the assessor information on how the suspected injury occurred, this is useful in determining whether the injury was direct or indirect.
O
O is for observe looking for signs of injury
T
The next step T stands for touch, the assessor will feel for swelling or deformity
A
If an injury had not been detected up until now Beckham would not have made it through A. Active movement where the player moves through full range of movement
P
P is for passive movement, the assessor moves the joint to identify pain or instability
S
Skills test is the final stage where the player attempts a skill used in the game
Thompson test
If a ruptured Achilles tendon was suspected Beckham may have been put through a Thompson test. The player is put prone onto their stomach, the assessor will squeeze the players calf muscle, it is normal for plantar flexion to occur reacting to the squeezed muscle, if no movement occurs the Achilles tendon has been ruptured.
RICER
Beckham would have been treated using RICER soon after the injury during the inflammatory phase of the injuries inflammatory response. The aim of RICER and any immediate treatment of a soft tissue injury is to reduce swelling, further damage and pain. To help restore flexibility, full functioning, prevent recurrence and get the player back on the field quickly. In Beckham’s case however the use of RICER would have been to allow for surgery more quickly and safely.
R
R is for rest, used to reduce bleeding and prevent further injury
I
The next step I, for ice would be used to reduce pain and swelling with an ice pack put over the injury
C
C, compression is then used to decrease bleeding and swelling, done with a compression band
E
Beckham’s leg would have been elevated, to decrease bleeding and swelling, by raising the injury above heart level
R
The final step of RICER is a referral, to determine the extent of injury and the rehab necessary with a professional, Beckham went to Doctor Sakari Orava, A Finnish sports medicine surgeon.
After Beckham’s surgery on the 15th of March 2010, the day after his injury, Orava stated that “The prognosis is he needs rehabilitation for the next few months, and the plaster cast is the next six to eight weeks. I would say that it will be maybe four months before he’s running, but six months before he’s jumping and kicking.”
The aim of Beckham’s and any rehabilitation program is to restore optimal function of the injured area, return the athlete to competition quickly and safely and to prevent re-injury.
The procedures followed to achieve this are:
• Progressive mobilization
• Graduated exercise
Through stretching, conditioning and total body fitness
• Training
• Use of heat and cold

Progressive mobilisation
Beckham’s rehabilitation process began with progressive mobilization, the goal of which is to free hindered joints to allow improved range of motion, this phase was 12 weeks for Beckham
Ankle Flexion/extension
exercises which Beckham did in this stage was Ankle flexion/extension, done with high repetitions 15-20 three times throughout the day.* This exercise will help to bring back motion in the ankle, improve the flexibility of the joint and strengthen the tendon.
Standing hamstring curl
Beckham would also have done a standing hamstring curl, 20 repetitions done throughout the day*. This would be done to strengthen the hamstring, protecting the repaired tendon by taking pressure of the ankle when performing exercise
Graduated exercise
Stretching
Conditioning
Total body fitness
The aim of stretching in the rehabilitation process is to improve the elasticity of muscles and tendons so that the chance of further injury is decreased, Beckham would have worked on stretching the hamstrings and quadriceps with a greater focus on the gastrocnemius, soleus and Achilles tendon. For Beckham the stretching phase was focused on during weeks 4-8 after his surgery
Calf stretch
The calf stretch held for 15-20 seconds 3-5 times. The stretch would improve the elacsticity of the gastrocnemius, soleus and Achilles tendon.
Dorsiflexion stretch
The dorsiflexion stretch would also be held for 15-20 seconds 3-5 times. The stretch isolates the Achilles tendon in both legs improving elasticity
Conditioning is about keeping your body in shape for your sport, Beckham was given a number of strengthening exercises to keep his leg from muscle atrophy or wasting muscle tissue, Beckham focused on conditioning at weeks 8-12 after surgery.
Ankle plantar flexion
The ankle plantar flexion is done with 30 repetitions. To strengthen the gastrocnemius and protect the injured tendon
Ankle Inversion
Done with 30 repetitions the exercise isolates the Achilles tendon and the supporting muscles, building strength to protect the injured tendon
The aim of total body fitness is to return the athlete to their pre-injury level of fitness, the athlete does this by working the uninjured muscle groups with activities that do not put stress on the injured part.

Beckham was doing total body fitness from the beginning of his graduated exercise to his return to training week 4 after his surgery to week 24

For Beckham a stationary cycle in his brace was used to maintain his fitness levels. The stationary cycle allowed Beckham to maintain his high level of fitness putting his ankle under no stress.
Training
Training in the rehabilitation process is used to return the athlete to full competition, by preventing re-injury targeting the athletes movement skills, specific game skills and confidence.
Beckham was closely monitored through normal training sessions until he could complete them without pain and showed a similar level of skill before his injury
Use of heat and cold
Ice was used for Beckham during the acute injury phase, this is 24-48 hours after the injury, for no longer than 30 minutes at a time. Ice was used to reduce swelling and inflammation
Heat is used after the acute injury phase, regularly throughout the day for no longer than 20 minutes. Heat increases blood flow, which promotes healing and relieves pain
For an athlete to return to play they must show indicators of readiness to play these include being pain free and having high mobility in the injured area, monitoring progress and assessing the psychological readiness of the athlete determine this. The athlete will be put through specific warm up procedures and go through correct return to play policies and procedures
Indicators of readiness to return to play
The two important indicators of readiness are being pain free and the mobility of the injured are
To assess if Beckham's injury was pain free and that he had mobility of the injured area he was put through a series of drills, which were closely monitored and then compared to his pre-injury results
Ladder side run
Beckham was monitored doing a ladder side run, his times where compared. This drill was used as it puts the ankle under stress.
Illinois agility test
Beckham may have also been monitored doing an Illinois agility test, the sharp changes in direction would have put stress on his ankle and his confidence could be easily seen in the test
Psychological readiness
The athletes psychological readiness is a significant factor in the athletes safe return to play.

Assessed by discussion with the athlete and observation
specific warm up procedures
For Beckham specific warm up procedures would be very important for his safe return to play, he would have spent longer on his warmup and he would have added isolated Achilles stretches such as the dorsiflexion stretch into his warm.
Return to play policies and procedures
Beckham did not go through any specific or detailed return to play policies or procedures from the LA Galaxy or FIFA, his return to play was determined by the coach and medical staff of the LA Galaxy
Beckham played his first game back on the 11th of September 2010, since the 14th of March, just under 6 months of treatment.

Becham retired from professional football in 2013 and had no problems with his ankle.

This was a result of the speed that the surgery was undertaken and the successful early treatment of the injury
Bibliography
References
Achillesrehab.blogspot.com.au, (2014). Achilles Rehab: Beckham Reveals Gruesome Surgery & Rehab. [online] Available at: http://achillesrehab.blogspot.com.au/2010/05/beckham-reveals-gruesome-achilles.html [Accessed 13 Nov. 2014].
Bedi, A. (n.d.). Achilles Tendon Injury. [online] Sportsmd.com. Available at: http://www.sportsmd.com/SportsMD_Articles/id/263/n/achilles_tendon_injury.aspx [Accessed 16 Nov. 2014].
Constable, I. (2010). Analysis of Beckham's Achilles Rupture. [video] Available at: [Accessed 13 Nov. 2014].
Foot & Ankle Alliance, (2009). Achilles Tendon Rupture , Repair, foot condition, foot pain, Injury. [video] Available at: [Accessed 13 Nov. 2014].
Massachusetts General Hospital-Orthopaedics, (2014). Achilles Tendon Rupture. [online] Available at: http://www.massgeneral.org/ortho/services/sports/rehab/Achilles%20repair%20rehabilitation%20protocol.pdf [Accessed 15 Nov. 2014].
O'Hara, M. (2013). Preventing Achilles Tendon Injury. [video] Available at: [Accessed 15 Nov. 2014].
Sickmiller, M. (2010). David Beckham Injury - Achilles Tendon. [video] Available at: [Accessed 10 Nov. 2014].
Sma.org.au, (2014). Achilles Tendon Injuries | Sports Medicine Australia. [online] Available at: http://sma.org.au/resources-advice/injury-fact-sheets/achilles-tendon-injuries/ [Accessed 15 Nov. 2014].
University of Toledo Medical Center, (2010). Achilles Tendon rupture ,tear, tendonitis - Everything You Need To Know - Dr. Nabil Ebraheim. [video] Available at: [Accessed 14 Nov. 2014].
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