October 24, 2014

TA

TA? British readers might be thinking ‘Territorial Army’. The American majority, maybe the ‘Telluride Association’? Maybe not. Rest of the world, who knows? Physiotherapists, now I’m on firmer ground. They think the tibialis anterior muscle or, not so far away anatomically, the Achilles tendon. These days I’m very aware of this specific tendon. I’ve arrived in a mixed metaphor, the foothills of the learning curve about the TA. “Midsubstance Achilles tendinopathy is more common than the insertional variant.” Yes, yawn, I know that. “Rupture is most common in men in the fourth and fifth decades of life.” Phew, thank goodness I’m over that particular hump. “Eccentric exercises are the best treatment for Achilles tendinopathy.” Eccentric? Well, something that has you perching halfway up the stairs on the ball of one foot, with the heal dipped, and grimacing. That’s eccentric. Or staring at a wall from a range of three inches, as if to minutely verify the job the painter has done, foot bent upwards at an awkward angle, veins standing out on the forehead, again grimacing. That’s eccentric. (To be clear, to a physiotherapist, an eccentric exercise is one where the relevant muscle/tendon combo is s-t-r-e-t-c-h-e-d.)

“Disorders of the Achilles tendon are common in active people, competitive and recreational athletes alike.” Aha, ‘athlete’, I like that. I’m an athlete! I first felt discomfort in my TA some time back in May, the morning after a game of squash. It soon settled down to becoming a minor inconvenience, mitigated by various of the grimace-inducing exercises. I say mitigated. Stretching, or merely kneading the tendon, produced an immediate, miraculous relief from the pain, but it provided no cure.

A first class review in the British Medical Journal by Chad Apslund and Thomas Best (http://dx.doi.org/10.1136/bmj.f1262) tells me that “cadaveric studies suggest that there is an area 2-6 cm above the calcaneal insertion with a relatively poor blood supply, and… this predisposes the region to chronic inflammation and rupture.” Rupture! Most of us know a player whose TA has ruptured. We may even have witnessed the event. There is a sharp CRACK, audible to all. The victim goes down as if shot. Their first comment is, ‘why did you hit me?’. So far the event has taken all of ten seconds. Still to go then, ten seconds short of probably ten months. A ruptured TA is the season over. Usually it means an operation and having your foot encased in a cumbersome orthopaedic boot. Apslund and Best don’t hold back, fortunately in language that’s almost impossible to decipher: “Initially, reactive tendinopathy is caused by overload. This results in a non-inflammatory response that thickens the tendon, reduces stress, and increases stiffness in response to overload. If overload continues, this leads to tendon dysrepair and highly disorganized tissue and, finally, degenerative tendinopathy, with even greater cellular disorder.” I suspect that something like this has happened to me, to a mild degree only. As a leftie, my right leg is the one I mainly push off, especially as I have a permanently sore left knee. Presumably my right TA has been doing too much work. Thank you Drs Apslund and Best.

So, what to do? I made the decision to continue the exercises regularly and carry on as normal, playing three or four times a week and throwing in some shuttle running. After all, hurt is relative and other parts of my carcass hurt more than the TA. A couple of good players at my club have got on fine with this approach to a sore Achilles.

Come the start of September, aagghhh, what’s the Plan B! I had been building up nicely to the first English Masters tournament of the year, the East of England, in the pretty East Anglian town of Bury St Edmunds. I usually do well there. However, during a weekend break, after a day’s gentle sightseeing, I woke up with my TA cripplingly sore. I could hardly walk. No East of England Masters then but a period of complete rest, rest from squash, rest from shuttle runs, and rest from hopping about in exasperation at a mysterious slowing down of my home wi-fi connection. Megabits per second? Not a hope. Bits per millennium would be closer.

And here’s the interesting angle. Since adopting a zero exercise regime, a pompous way of saying doing nothing physical, I’ve been getting SO much else done! All those little jobs, some of which had been buried in lists since the noughties: they’re all complete. Collectively they must have taken less than a morning. My garage? Fizz, it’s cleaned out, organized, tidy. Clothes that I’ll never wear again? They’re sorted; they’re at the charity shop, not hanging unwanted in a wardrobe. Books that merely confirmed my status as an intellectual lightweight no hoper (but not Dan Brown, I promise)? Ditto, gone. They’re propping up a shelf in the selfsame shop. My sons are currently addressing me as ‘Sir’, because I’m redoing my will. I’m rattling through the second part of my Jon Lantern trilogy (see Kindle, ‘Jon Lantern’s NIGHTMARE’, a scary Hallowe’en story for young readers).

The point I’ve come to understand is that squash routinely consumes so much of my internal energies, so many megabytes of my RAM, that not enough is left for living an efficient life. Squash occupies time, certainly, but you can make time for anything, if you have the will. This episode with my TA has shown that the will, mine anyway, is finite. When I’m playing squash regularly, my will is neutralized in the fretting over last night’s loss from 2-0 up, or how to get more shoulder into my backhand, or what to do about Billy Blocker’s minimal movement in next week’s league game. Like the proverbial cuckoo chick, squash expels the competition from the nest. Poof, another fledgling bit of will gone, another commitment deferred.

I’m glad to say that the news on the TA front is good. Normal service will soon be resumed. I’ve consigned the Apslund and Best review to a pile of stuff that I must re-read… some day soon.

 

Aubrey Waddy is an English writer and squash player, now past 65 and what-happens-next! Aubrey is a consultant in the medical device industry, and apart from this and writing, spends his time titrating squash against the diminishing capacity of his bad knee. He returned to the game twenty five years after retiring from a moderately successful amateur career, and surprised himself by achieving selection for the English o-60s Masters team in 2011, and subsequent o-65 teams in 2013 and 2014.

Aubrey’s writing credits include the first ever novel to be set in the world of competitive squash, “Sex and Drugs and Squash’n’Roll”, about a young player trying to make it on the pro tour, and in 2012 he published his second novel, “Just Desserts”, a humorous story of the rivalry between two doctors, over their patients… and the gorgeous wife of the good guy. The books are available on Amazon, Kindle etc. A scary children’s Hallowe’en ghost story followed in 2013, "Jon Lantern’s Nightmare", available on Kindle.

Aubrey has three sons, and lives with his new partner Alison, by fortunate chance - or judicious selection - a physiotherapist, outside of London.

www.aubreywaddy.co.uk


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