Guest Blog by Dr. Andres Masis.
Recently, internationally renowned soccer star Adriano Ribeiro, best known for his tenure with world soccer powerhouse Inter Milan, was released from his current club following a second surgery on his Achilles tendon. Club officials accuse Adriano of failing to attend his Physical Therapy appointments and failing to adhere to the post-operative guidelines for his recovery.
The role of the Surgeon is to repair the mechanical or structural instability that is created by anatomical disruption. The process of rehabilitation following this surgery focuses on restoring functional stability. In construction terms, the surgeon creates or repairs the frame of the house and the Physical Therapist dry walls it.
Why is post-operative adherence to rehabilitation protocols so important? Few people realize that it takes three days of inactivity for muscle atrophy to set in. More importantly, it takes 6-8 weeks of consistent exercise to recover that which was lost in 3 days. In addition, the body creates scar tissue during the healing process. The role of scar tissue in healing is to protect the injured muscle while it can repair itself. A pound of scar tissue has more tensile strength than a pound of steel, and it will typically set in within approximately 72 days from the date of surgery. Unfortunately, because of its strength, it restricts movement considerably, making Physical Therapy important for restoring full range of motion and function.
The role of post-operative rehabilitation is to restore function. It is important to note that in Adriano’s case the Achilles tendon didn’t fail because it was defective. The failure in the tendon was more likely the result of repetitive stress with improper foot and ankle mechanics, and dynamic stability. The surgery fixed the resulting injury, but in many cases does not address the cause of the injury. The tendon failed because of the way that he reacts and interacts with his environment and if these dysfunctions are not addressed, the surgical repair of the tendon only allows for the athlete or patient to have a fresh start to beating up this tendon. In order to avoid a repeat injury or further surgical intervention, it is important to help patients understand the role they play in their own recovery and the importance in adhering to their post-op guidelines.
About the author
Dr. Andres “Andy” Masis is a doctor of physical therapy and athletic trainer at Orthopedic Rehab Specialists. He is Functional movement screen certified, and a former member of medical staff for the Costa Rican world cup soccer team at Victoria 2007.
