Should I quit play­ing foot­ball af­ter in­jury?

Irish Independent - Health & Living - - ADVICE - WITH DR NINA BYRNES drn­ina@in­de­pen­

THE Achilles ten­don is the largest ten­don in the body. It con­nects the calf mus­cles to the heel bone and is used for any move­ment that in­volves us­ing your tip­toes such walk­ing, run­ning, stair climb­ing, and jump­ing. The Achilles ten­don is very strong and can with­stand great stresses from run­ning and jump­ing, but it is also prone to in­jury and strain.

The Achilles ten­don most com­monly rup­tures if there is a sud­den force­ful down­ward move­ment of the foot against re­sis­tance.

Th­ese kinds of in­juries are most likely when push­ing off to jump with great force. Trauma can also hap­pen fall­ing from a height or stum­bling into a hole.

Achilles in­juries are par­tic­u­larly com­mon in sports such as bas­ket­ball, ten­nis and foot­ball. Rup­ture can also hap­pen spon­ta­neously in oth­er­wise healthy ac­tive in­di­vid­u­als. In­jury is most com­mon in those aged 30 to 50, and men are more com­monly af­fected than women.

There are cer­tain risks. Med­i­ca­tion such as steroids and flu­o­ro­quinolone an­tibi­otics in­crease the risk of ten­don in­flam­ma­tion or rup­ture. Poor train­ing and con­di­tion­ing can put un­due stress on the ten­dons. Those who have pre­vi­ously in­jured their Achilles re­main at risk of fu­ture in­juries on the same or op­po­site side.

Ten­don rup­ture causes a sud­den, sharp pain in the back of the heel. Those af­fected de­scribe a “snap”. The foot then may drop and drag, mak­ing walk­ing dif­fi­cult. Ten­don rup­ture may be com­plete or par­tial depend­ing on the strain.

Treat­ment for Achilles ten­don rup­ture can be con­ser­va­tive or sur­gi­cal. You don’t men­tion what kind of treat­ment you had. Con­ser­va­tive treat­ment in­volves im­mo­bil­is­ing the an­kle for 10 weeks in a cast or boot.

The ad­van­tage of this treat­ment

II’m a rea­son­ably ac­tive 40-year-old dad, but in the past four years — while play­ing five-a-side at the week­ends — I have torn my Achilles ten­don not once, but twice. On both oc­ca­sions it was ex­cru­ci­at­ingly painful and I spent many weeks on crutches

in re­cov­ery. I sup­pose that af­ter the first tear, the ten­don must have weak­ened and I’m not sure if it is now re­ally weak. My wife says I should give up the five-a-side

and stick to low-im­pact ex­er­cise like cy­cling, but I re­ally love the week­end kickaround with the lads and don’t want to give it up. Do you have any ad­vice? is that surgery and its re­cov­ery is avoided, how­ever re­peated rup­ture is more com­mon, oc­cur­ring in up to 40pc of cases.

Sur­gi­cal treat­ment of a rup­tured ten­don may be a more de­fin­i­tive treat­ment. There are risks in­volved, as

I suf­fer ter­ri­bly with mi­graines and I’ve no­ticed they’ve be­come

worse since I started the menopause. What’s go­ing on?

t is es­ti­mated that 10pc to 15pc of the Ir­ish pop­u­la­tion suf­fer from mi­graine. Pain is de­scribed as puls­ing or throb­bing and usu­ally starts on one side of the head, around the eye area, but can spread to both. About one third of those who suf­fer with mi­graines no­tice a change in taste or smell, or visual changes, prior to the headache. This al­tered sen­sa­tion is called an aura.

There is of­ten as­so­ci­ated nau­sea and oc­ca­sional vom­it­ing with the headache. Mi­graines can go on for hours or, in rare in­stances, days. We do not re­ally know what causes mi­graines, but they can with any surgery, but re­peated rup­ture risk is re­duced to 5pc. Re­turn­ing to full ac­tiv­i­ties is also more likely.

There are things you can do to help pre­vent Achilles ten­don in­jury. En­sure ad­e­quate stretch­ing and strength­en­ing of your calf mus­cles. Don’t bounce

run in fam­i­lies and ge­net­ics do seem to play a role.

Hor­mone fluc­tu­a­tions are a com­mon mi­graine trig­ger in women. Many no­tice mi­graines are worse pre-men­stru­ally. Per­i­menopause is the pe­riod of a woman’s life when the end of men­stru­a­tion is draw­ing close. It can start up to 10 years be­fore men­stru­a­tion stops com­pletely. Dur­ing this time, hor­mone swings can be more or less dra­matic, pe­ri­ods may change or be­come more er­ratic. Hot flushes and uri­nary symp­toms oc­cur in some.

Due to the change in hor­mone lev­els, women may be­come more or less sus­cep­ti­ble to mi­graine. dur­ing stretches. Don’t run on hard sur­faces, and al­ways wear well-fit­ting and cush­ioned shoes for sport.

If you are train­ing, in­crease in­ten­sity by no more than 10pc per week. Abrupt in­creases can put the ten­don at risk of da­m­age. Vary the types of ex­er­cise be­tween low- and high-in­ten­sity work­outs. Swim­ming, cy­cling and el­lip­tic train­ing all put less stress on the Achilles ten­don.

If you have not had surgery to the ten­don, I would ad­vise dis­cussing spe­cial­ist re­fer­ral with your GP.

An or­thopaedic sur­geon who spe­cialises in foot and an­kle surgery will be able to help to guide you to­wards the treat­ment best suited to the in­jury you have. This is prob­a­bly your best chance of get­ting back to the foot­ball you love.

If you have had surgery, it may be that your wife’s ad­vice to con­sider lower-im­pact ac­tiv­i­ties is a good idea.

Those af­fected by ten­don rup­ture de­scribe a ‘snap’

Menopausal symp­toms last on av­er­age from six months to five years, but in a small per­cent­age of women they may carry on much longer than that. If mi­graines are truly hor­mone-re­lated, they tend to ease in the post-menopausal pe­riod.

It is im­por­tant to be aware that other headaches be­come more com­mon as you age. Those who are over 50 and have a new headache need to take heed. If it is worse when eat­ing, wakes you at night or is worst first thing in the morn­ing, lasts more than a few days and is not re­lieved by rest, flu­ids and painkillers, I ad­vise an early GP ap­point­ment.

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