Alex Inj @ Yahoo! Video

Alex Wong

Alex Wong has been in the headlines since So You Think You Can Dance series 7 began on the 27^th May 2010. His breathtaking routines have been the topic of conversation for many. But where did this dancing phenomenon begin?

Alex Wong was Born in Canada and began Jazz and Tap training at the Age of 7. By the age of 10 he began Ballet training at the Goh Ballet Academy. Winning 2 junior titles in Tap and Show-dance. In 2003 Alex won a Bronze Medal in the Gennée International Ballet Competition. He became the first Canadian to win the Prix de Lausanne in Switzerland in 2004. Later that year Alex joined the American Ballet Theatre Studio Company. By 2005 he had danced with the American Ballet Theatre before joining Miami City Ballet.

SYTYCD

Alex Wong became a household name when he auditioned for So You Think You Can Dance in 2010. So You Think You Can Dance is a reality television series which is now broadcast all over the world, with many countries adapting their own form of the series. Created by Simon Fuller the series began in 2005. All dancers from all walks of life are encouraged to audition. From the professional to street dancers. Auditions are held in Dallas, Nashville, Chicago and Miami with countless hopefuls all striving for the price of $100,000, a new car and a dancing contract. Alex Wong auditioned in 2010 and beat millions to become one of the top 11 who would perform weekly on live television. Over 5 weeks Alex gained millions of fans as he dazzled America with his awesome routines and personality.

Career highlights:

“One of the recent highlights of my career was when we went to New York City Center this past January. After we danced ‘In The Upper Room’ Twyla Tharp surprised us by coming on stage, bowing with us, and then told us that it was the best she had ever seen the piece done. It was the best feeling in the world!”

Alex Wong’s Achilles Surgery

His Career Low-point must have been when he ruptured his Achilles Tendon in training for the show.

Doctors told Alex that the only treatment option viable for him was an operation to repair his Achilles. Alex underwent surgery on the 13^th of July, and has been keeping fans up to date using Twitter and according to his posts he is doing well. After surgery Alex will need 2-3 months rest, followed by rehabilitation to return to full fitness. We wish him a speedy recovery and look forward to his return to So You Think You Can Dance next year.

For more information on what is involved in Achilles Surgery – click this link “Surgical Repair of Achilles Tendon Rupture“

Check out Alex’s Blog at thewinger.com

In the past the patient was put in a plaster cast with the foot pointing down and it was hoped that the tendon healed well enough to provide function. Surgery was considered less suitable because there was an increase risk of infection particularly as the wound in the leg needed to be 20 cm long to get proper access to the tendon. The surgery can now be carried out through very small incisions with a much lower risk of infection.

There is a body of opinion that surgical correction of the ruptured tendon is almost always necessary. This is performed in order to regain the maximum strength of the Achilles, as well as the normal pushing-off strength of the foot. The strength of the muscle depends on the correct tension between the muscle and the tendon. The only way that the correct tension on the tendon can set is by accurately repairing the tendon ends.

The Achilles Tendon generally tears about 5 cm above the heel attachment. The ends separate from each other a bit like cutting the ends of an elastic band.
These ends are pulled together at the surgery and stitched with strong sutures.

If the rupture has been present for many months, there is no urgency to do the surgery, but one really should not wait too long, since the Achilles tendon continues to pull up into the leg and the gap between the tendon ends gets larger, making the surgery more difficult.

Acute vs Chronic Tear

An Achilles tear can be considered acute if it is less than a few weeks since the injury occurred. Ideally it should be operated on quickly. Sometimes however, especially with amateur athletes and the so-called ‘weekend-warriors’ over the age of 30, the problem is sometimes missed and it is only after several weeks that a diagnosis of ruptured Achilles is made. These chronic tears almost always require surgery as the ends have separated and the muscle has shortened which means that conservative management is not likely to produce a satisfactory result.
The type of surgery performed depends on the size of the gap between the tendon ends and the extent of separation that is present.
In an acute injury the separation is minimal, then the tendon ends can be stitched together. If the separation is more significant, then other procedures need to be performed.
As the gap gets bigger, the options then range from using a strip of the lining of the existing Achilles, using another tendon as a tendon transfer, or even using an Achilles tendon graft which comes from the tissue bank.

A tendon transfer is only used when there is a massive gap present, or the Achilles has been ripped off its’ attachment on the heel bone. When it comes to using a different tendon to substitute for the Achilles there are a few tendons which can theoretically be used, but the tendon transfer which is preferred uses the second strongest muscle in the leg, the muscle to the big toe (the flexor hallucis longus).
The disadvantage of this operation is that the flexor hallucis muscle is not as strong as the Gastrocnemius which powers the leg. Nonetheless, patients are able to push off fairly comfortably with the tendon transfer and can even participate in some sporting activities. This operation can be performed through a very small incision on the back of the ankle although there are risks of damage to a nerve and local blood vessels with this technique.

After Surgery

The individual surgeon has his own preferences for how quickly the patient is allowed to put weight through the leg. In the past the leg could be immobilised post op in a plaster cast for a few weeks but that does not always happen nowadays. Current thinking is that early weight bearing encourages a better healing of the repair with much less muscle wasting and therefore better function. So walking is begun in a removable boot which controls the range of motion at the ankle.

Here is a quote from the surgeon who operated on David Beckham – Dr Orava said: “Today we allow patients to do motion earlier than before. In this case we try to get motion back as soon as possible. The operation takes less than one hour. [After the] first month, there can gradually be more and more motion and muscle contractions, and very gradually [shifting] from light training to harder training in the second month. After that, one is usually able to walk and maybe start running lightly after two months if everything goes fine. All this depends on the type of tear.”
“Top athletes usually heal well but it’s a few months until you are back at the same level as you were before. I don’t think it is a big difference to be [aged] 25 or 35, it will be three, four, five months. Most of these patients come back at the same level, even in a top soccer player.”

Japanes surgeon Yotsumoto and his colleagues have applied a side-locking loop technique of their own design for the core suture, using braided polyblend suture thread, with peripheral cross-stitches added. Their patients started active and passive ankle mobilization from the next day, partial weightbearing walking from 1 week, full-load walking from 4 weeks, and double-legged heel raises from 6 weeks after surgery. The results showed range of motion recovery equal to the intact side averaged 3.2 weeks. Double-legged heel raises and 20 continuous single-legged heel raise exercises were possible at an average of 6.3 weeks and 9.9 weeks, respectively. The patients resumed sports activities or heavy labor at an average of 14.4 weeks. There were no complications.

Rehab post op

Early Rehab is all about maintaining and regaining range of movement at the ankle especially dorsiflexion (the foot up towards the front of the leg)
Rehab is then about recovering strength in the tendon and calf muscles while not putting the repair at risk.
As mentioned earlier walking is started in the boot very quickly and this helps to maintain the normal muscle control.
Patients work with elasticated bands as resistance to increase strength and can use static bicycles to maintain aerobic fitness.
Balance exercises are used to recover normal neurological patterns and improve proprioception.
Swimming helps aerobic fitness and allows weight bearing to take place with some of the bodyweight supported by the buoyancy of the water.
Eccentric exercises (lowering down from up on toes) are essential because this is how the calf and Achilles tendon function normally.
After the boot is removed walking is progressed to fast walking and then gentle running.
The speed and intensity of the running is gradually increased.
Sports specific drills and training are introduced as soon as possible – this make it easier to return to sport quickly.

Other Achilles Related Posts

Poor David Beckham’s dreams of a fourth consecutive World Cup appearance disappeared in a ‘SNAP’
Beckham’s Achilles Tendon Rupture happened in a game just by stepping backwards. There was no-one else involved.
I am going to look at footage of David Beckham’s Achilles Tendon Rupture and analyse it for you.
At the end of this post you will have an understanding of how the Achilles and Calf muscle work and why Becks tore his tendon.

Watch the video below a few times and then read on for a full explanation.

Gastrocnemius – a ‘two-joint’ muscle

The Gastrocnemius muscle has it’s lower attachment to the Achilles tendon through which it is attached to the heel bone or Calcaneum. This means that it crosses the ankle joint.

The upper attachments of the Gastrocnemius muscle are attached to the lower thigh bone (femur) on either side of the back of the knee.
This means that it also crosses the knee joint.

Actions of the Gastrocnemius muscle :-

• Helps to bend the knee acting with the Hamstring muscles
• Also helps to stop the knee from straightening under load
• Points the foot downwards at the ankle / raise you up on your toes when standing
• Also controls the heel as it lowers under bodyweight

The reason that ‘two-joint’ muscles and their tendons are prone to injury is precisely because they are acting on two joints at once.
This extra load can result in them almost working against themselves in an uncontrolled fashion – just like us men they can’t do two things at once!!

Take another look at the video of Beckham’s Achilles Tendon Rupture below. All David does is step backwards with no-one around him!

When I say “all he does …” He takes quite a big step backwards and his ankle joint is particularly bent which stretches his Calf and Achilles, however there is nothing particularly violent or sudden about his movement – is there?
However look at this picture below:

In this freeze-frame, if you look closely you can see that his heel is off the ground, his knee is slightly bent. I have put some red lines parallel to his foot, shin and thigh to demonstrate these angles.

Now if you think about what his Gastrocnemius muscle is doing here – you can see that it is keeping his heel off the ground and also helping to keep his knee slightly bent. (Just take my word for it that the muscle is helping to keep the knee bent for a few sentences and then I’ll explain it further.)

He would want to keep his knee bent in this situation because he is about to push off his back leg and he can’t push off effectively with a stiff knee. He wants to use his Quadriceps and Gluteal muscles to push off and to do this his hip and knee joints need to be slightly flexed (bent) and this is achieved by using his Hamstrings and Gastrocnemius muscles together.

Now look at the picture below. This is 80 milliseconds later (trust me I took it off the video editor!)

Poor Becks’ Achilles has just snapped!!

As a result he can’t hold his heel off the ground and also he can’t keep his knee flexed!
This means that instead of pushing off and moving forward, his knee shoots backwards to slightly beyond straight – what is called hyperextension.

It is the loss of function in his Gastrocnemius (because it’s lower attachment has become torn) that causes his knee to hyperextend.
Again I have included the red lines to help you see what is happening at the knee and ankle joints.

Why did David Beckham’s Achilles Tendon Rupture?

He possibly either had some pre-existing problem with his Achilles ( I recall he had a problem with the right Achilles in the World Cup against Portugal in July 2006 and it’s not uncommon to get both sides affected) or he has been particularly unlucky – but you can now see how much force can be generated by the calf muscles if they work against themselves for a fraction of a second at exactly the wrong moment!

Patients with a torn Achilles generally do not report significant pain – they hear a “SNAP” and they feel as though they have been struck from behind! If you watch David’s reaction carefully you see that his first thought is to look behind himself to see who has just kicked him! Watch his reaction in the video!!

He then sees that no-one is there and tries to continue with the game. He actually steps backwards again onto the left foot but this time his foot is turned outwards. This means that he actually doesn’t need to use his calf muscle or Achilles. It is only when he steps forwards and realises that there is no forward propulsion coming from his calf, and then when he goes to put his left foot down and realises that he can’t point his foot that he knows there is a major problem and his World Cup dream is over…

Watch the whole thing again with your new-found insight – watch for him looking round to see who “kicked” him and then especially look out for the knee snapping backwards when the Achilles tears.

Click here to view the embedded video.

The surgery apparently went really well and we all hope the he gets back to full fitness in a few months – but unfortunately not in time for the World Cup

Other Achilles Related Posts