In the muscle-tendon unit, the area where the muscle joins the tendon is often the weakest link in the chain. Consequently, this is often the location where acute ruptures (or complete tearing) of the tendon occur. The tendon, however, can also completely tear away from its bony attachment. The most common tendon ruptures in sport are of the biceps tendon and Achilles tendon. Rupture of the Achilles tendon is most commonly found in soccer.

Mechanism of Injury

Tendon ruptures often occur when:

• quick, explosive actions are involved (like when you are cutting to get away from an opponent or running to a soccer ball)
• after prolonged tendonitis where there were micro tears of the tendon

Signs and Symptoms

• Loss of muscle function (if your Achilles tendon ruptures you will not be able to push off to run using your calf muscle).
• Localized pain.
• Swelling may or may not be present.
• Deformity such as an indentation may or may not be present (with a ruptured Achilles tendon there is often a divet above the back of the heel. The affected muscle will be bunched up in a contracted state.
• The soccer player will usually report hearing a "snap" or "pop" sound at the time of injury. The athlete may complain that they were hit in the area.
• Site specific tests can be completed to determine the severity of tear, such as the calf muscle squeeze (Thompson test) for Achilles tendon rupture.

On-Site Management

P.R.I.C.E. PROTECT the area from further injury (i.e. bracing). REST the area to promote healing. ICE the area 10-20 minutes every 1.5 to 2 hours the first 2-3 days until the pain has reduced. COMPRESSION is NOT recommended. ELEVATE the area to increase circulation towards the heart, this can be done while icing.

Medical Referral. In most cases surgical reattachment of the muscle is necessary.

Rehabilitation. After physician approval, see a physiotherapist for modalities, range of motion, and strengthening exercises.

Return to Activity. Only after complete healing with a physician's OK. If surgery is required, an exercise rehabilitation program can return the athlete to play soccer only after a minimum of four months.

Prevention

• Adequate warm-up, ongoing soccer specific strength and conditioning.
• Proper management of tendonitis can reduce the risk of complete tendon rupture.

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