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Pickleball and the Achilles: Staying in the Game Without Getting Sidelined · Meaningful Medicine with Novant Health

• 0:03
  Joey (Host): They're seeing a recent rise, so we're discussing Achilles injuries.
• 0:08
  Our guest is Dr.
• 0:09
  William Corey.
• 0:10
  He's an orthopedic surgeon specializing in foot and ankle surgery.
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  For Novant Health, This is Meaningful Medicine, a podcast from Novant Health.
• 0:20
  Thanks for joining us.
• 0:21
  I'm Joey Wahler.
• 0:23
  Hi there, Dr.
• 0:24
  Welcome.
• 0:25
  William Corey, MD: Hi, Joey.
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  Joey (Host): Great to have you board.
• 0:27
  So, first, pickleball, of course, is exploding in popularity these days,
• 0:33
  especially among adults over 50.
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  So what do you think is driving this trend and why as a result are
• 0:39
  you seeing more Achilles injuries?
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  William Corey, MD: Well, pickleball first off is very fun.
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  I've done it several times with my kids.
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  it's grown in popularity, I believe, because.
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  not to take away from any professional pickleball players, but it,
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  very easy for people to pick up, at any age, from young to old.
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  so it's very easy for, people that aren't necessarily active, to pick
• 1:04
  it up and go play with friends.
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  And it's a nice social event, so I believe that's why it's picked up in popularity.
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  Joey (Host): Gotcha.
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  Now, one thing that puzzles me about pickleball related injuries is one of the
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  advantages of pickleball is supposed to be the fact that compared with tennis,
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  it's a smaller court, less running around.
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  So why all the Achilles
• 1:25
  injuries?
• 1:26
  William Corey, MD: Well, I think that's exactly why we're having
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  so many Achilles injuries.
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  One is the, clientele or the people playing pickleball sometimes
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  aren't necessarily those that have remained active their entire lives.
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  They've decided to pick it up later in life.
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  two, it is a lot of stop and go a lot of lunging, instead of tennis
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  where you have a larger court and you're, running for longer distances.
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  I think that's why we're seeing a rise in Achilles injuries with pickleball.
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  Joey (Host): So more sudden movements as opposed to having to run around
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  more and cover more court then.
• 1:59
  Right.
• 2:00
  William Corey, MD: Correct.
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  Joey (Host): Gotcha.
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  So for people new to pickleball, what are some early signs of Achilles
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  strain or overuse that shouldn't be ignored so that hopefully you can
• 2:10
  fend off that more serious injury?
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  William Corey, MD: You might feel a little bit of tightness in your heel cord.
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  sometimes you'll feel pain at the end of playing or tightness when
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  you first wake up, but unfortunately with a lot of Achilles ruptures.
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  There's no prodromal phase before it, you'll just feel
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  apoB in the back of your leg.
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  It'll feel like somebody kicked you in the back of the leg
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  or you got hit with a rock.
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  and there's really no way to know that it's coming.
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  Joey (Host): How about.
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  Of steps we can take as pickleball players.
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  I say we, even though I've never played pickleball, but speaking for
• 2:44
  those who do to protect their Achilles and other foot or ankle structures.
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  How about if we start with stretching?
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  We all hate to stretch, but especially as you get older, you have to do it
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  if you really want to do everything you can to avoid these injuries.
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  Right.
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  William Corey, MD: Sure.
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  Achilles stretches, there's a runner's lunge with a hands on the wall, one
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  foot behind you bending the front knee.
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  getting up on, stairs and letting one heel fall down towards the ground, like
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  Gravity, take it towards the ground.
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  and you'll feel it stretch in your achilles and your calf muscle.
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  And then stretching all your other muscles as well.
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  Quads, hamstrings, Those are very important.
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  Before and after playing.
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  Joey (Host): Anything else?
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  Pickleball players should do as part of their warmup routine.
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  William Corey, MD: Certainly warming up by running around the court, doing
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  stretches, And then, you maybe just hitting the ball back and forth before
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  just getting right into the game.
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  Joey (Host): How about footwear?
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  We know that they have tennis sneakers for years for that sport.
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  How about for pickleball?
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  What should you be wearing?
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  William Corey, MD: A good supportive shoe.
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  making sure that the age of your shoe is not old.
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  You know, if you're playing pickleball frequently, I would say have a pair
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  of shoes that you have set aside strictly for pickleball, and should
• 4:00
  probably be changing those shoes out at least every six months.
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  for runners, we tell them they should be changing 'em out every four to 600
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  miles or at least every six months.
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  and non-slip shoes.
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  So just like in tennis when you're playing on a clay court,
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  you don't want to go out in your running shoes and slide all around.
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  So you wanna make sure that there's, a good amount of grip on the shoes.
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  so they're supporting you when you're running back and forth.
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  Joey (Host): So simply put, doctor, is it safe to say that
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  a lot of these Achilles injury.
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  And pickleball occur for much the same reason among older folks that
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  other sports related injuries do, which is oftentimes it's people
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  trying to do too much too soon, right?
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  William Corey, MD: Correct.
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  but prior to pickleball, probably the number one injury we would see it in
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  is what we would call weekend warriors.
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  Or girls and guys in their, thirties and forties.
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  say a guy wanted to go play pick up basketball with his son, and he hasn't
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  necessarily played for maybe 10 years.
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  He goes out and tries to play and ruptures his achilles.
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  But again, we see it in, professional athletes as well.
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  Kobe Bryant ruptured hit playing basketball recently.
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  Daniel Jones, the quarterback for the Indianapolis Colts ruptured
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  his, so you see it in really all age groups and all levels of athletes.
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  Joey (Host): So if someone does experience an Achilles injury.
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  At what point should they consider seeing a specialist like yourself?
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  Where is the line do you think?
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  William Corey, MD: Well, I would say if somebody believes that
• 5:30
  they ruptured their Achilles, they probably should be seen the same-day.
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  an urgent care center or the emergency room, certainly if
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  it's during business hours.
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  you could call straight to an orthopedic office like ours and
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  get put on the schedule same-day or next day, preferably the same-day.
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  oftentimes we will order an MRI and discuss, options for conservative
• 5:53
  or operative management, depending on the injury and, And the patient.
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  Joey (Host): And before we talk about those options in just a moment
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  or two, what's the basic range of Achilles injuries themselves
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  from say least to most serious?
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  What can you wind up suffering?
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  William Corey, MD: probably least, Would be a strain of the calf muscle or the
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  Achilles, you feel a little twinge or maybe a little bit of pain, but you don't
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  have a complete rupture of the Achilles.
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  we oftentimes see chronic injury, more often in the older population, which
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  is Achilles tendonitis, both insertional tendonitis, which is inflammation of the
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  tendon itself, where it inserts into the heel bone And also sometimes higher up.
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  And the Achilles proper.
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  And then, achilles ruptures, like we talked about, would
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  be the, the most severe,
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  Joey (Host): And when we say rupture, is that the same as tear?
• 6:45
  William Corey, MD: a complete tear.
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  so you can have a partial tear where the two tendon ends don't completely separate.
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  where a rupture is typically, 80, 90% to a complete rupture.
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  Joey (Host): And a completely ruptured or torn.
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  Achilles is really one of the top dreaded injuries in all of sports, isn't it?
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  William Corey, MD: yes, it definitely can be.
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  especially for specific athletes that require.
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  Bursts of speed, acceleration, like a running back or a wide
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  receiver or a cornerback.
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  and basketball players.
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  You'll see, like when Kobe Bryant ruptured his, he went from doing,
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  You know, 360 dunks to become, you know, more of a jump shooter.
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  You don't get that explosive, power through your Achilles.
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  and often these can lead to really the detriment of,
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  athletes like a running back.
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  You very rarely see a running back, get back to their peak potential after
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  ruptures of their Achilles, where somebody like Aaron Rogers that ruptured his.
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  He's not a very mobile quarterback.
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  So getting back on the field and and throwing in the POCAT is not as
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  difficult as say, if Lamar Jackson ruptured his Achilles, he is known
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  as a dual threat quarterback, it would be very difficult for him to
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  get back, to that top line speed.
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  And it'll be interesting for Daniel Jones 'cause he is a
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  dual threat quarterback as well.
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  if he changes his, play after he comes back from his rupture.
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  Joey (Host): Yeah, very good analogy there.
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  So how about treatment options?
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  What are the typical choices there?
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  William Corey, MD: So to go back the history of, Achilles ruptures,
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  for a while, everybody treated all Achilles ruptures with these big
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  incisions in the back of the heel.
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  And we would suture the tendons, end to end with a bunch of
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  suture, and close it up and.
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  Occasionally it is an area that doesn't have great blood supply.
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  The skin doesn't have great blood supply.
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  So occasionally we would see, wound dehiscence, which means that the
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  wound opens up sometimes infections.
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  So.
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  Way back people decided to try to treat Achilles ruptures conservatively,
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  and they would do that with casting.
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  And then they found that with casting, once they took the patient out of
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  the cast and did their therapy, that they would be more likely to
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  re-rupture their Achilles tendons.
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  So then people went back to treating Achilles ruptures open through
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  smaller incisions, and now through the advent of minimally invasive surgery.
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  started treating patient's with what's called the pars technique or the
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  percutaneous achilles repair system.
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  So we can treat the Achilles through a tiny little incision, and
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  percutaneous suture technique, which has been, fabulous for, recovery.
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  very minimal, risks involved with it.
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  faster recovery.
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  so that's been great.
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  But also recently there's been studies.
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  Where they've started treating patient's again conservatively.
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  they did it with, IM mobilization for two weeks, And then early range
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  of motion and early weightbearing, through a boot and with, frequent
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  physical therapy or range of motion.
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  they've actually found that these patient's, the re-rupture rate
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  is equal to operative management and they actually do fairly well.
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  So there's.
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  Times when we can treat patient's conservatively without surgery.
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  That being said, I have yet to hear of any professional athlete treating
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  their Achilles rupture conservatively.
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  But for the lay person That is not very active, That is an option.
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  Joey (Host): And then you mentioned recovery time.
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  What is the typical surgery recovery time?
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  William Corey, MD: Typically, after surgery, the patient's
• 10:19
  splinted for two weeks.
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  They have their sutures removed at two weeks in the office.
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  And then they go into a, range of motion boot and slowly bring their ankle back
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  into neutral dorsiflexion, allowing them to, bear weight at six weeks in the boot.
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  starting early range of motion And the early physical therapy.
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  And then they're allowed to start bearing weight in the boot at six weeks.
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  And the boot typically comes off at by 10 to 12 weeks starting,
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  light jogging at 12 weeks.
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  some more aggressive cutting exercises.
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  By six months.
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  And occasionally you'll see athletes back, in the seven to nine month range.
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  But typically it's a, a one-year to 18 months before you're really back, fully
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  Joey (Host): Yeah, that's what we often hear with these big pro athletes.
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  Like some of those you mentioned, right?
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  Guy tears it or gal and boom.
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  That's a year, so you have an idea there in summary.
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  Finally, doctor, simply put, you've covered a lot of great details for
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  us here, but overall, how can older or recreational athletes continue
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  enjoying pickleball, and other active hobbies, while minimizing their risk
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  for injury on a long-term basis?
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  William Corey, MD: Like we talked about slowly, getting into the sport, not just
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  going out and, playing a match right at the beginning, getting lessons, proper
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  shoe wear, stretching, And also just knowing that, there is that risk involved.
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  But I always tell.
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  People that being inactive is much more risky than taking a risk and going
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  out and being active because there's so many comorbidities that go along with
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  sedentary lifestyle, obesity, heart disease, diabetes, that, I think the risk
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  of going out there and being active is.
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  Better than, than the alternative.
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  And also, I always tell patient's cross training is very important.
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  If you do the same thing over and over again, there's a very high-risk
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  of, just repetitive use injuries.
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  So, walking, weight training, especially for the, older patient,
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  uh, is very important for, bone.
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  And working in, a sedentary bike or a regular bike or rowing, yoga, instead of
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  just doing the same thing over and over.
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  Joey (Host): Yeah, just basically try and prep your body so that it's not a
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  complete shock to the system, whether it's pickleball or anything else.
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  Well, folks, we trust you're now more familiar with Achilles injuries.
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  Dr.
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  Corey, appreciate it.
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  Keep up all your great work and thanks so much again.
• 12:49
  William Corey, MD: Thank you, Joe.
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  Joey (Host): And for more information, please do visit novant health.org.
• 12:55
  If you found this podcast helpful, please do share it on your social media.
• 12:59
  I'm Joey Wahler.
• 13:00
  Thanks so much again for being part of Meaningful Medicine.
• 13:03
  A podcast from Novant Health.