What are the common causes of Achilles tendon injuries. How can you recognize the symptoms of an Achilles tendon tear or rupture. What treatment options are available for Achilles tendon injuries.

Understanding the Achilles Tendon: Anatomy and Function

The Achilles tendon is the largest and strongest tendon in the human body. It connects the calf muscles to the heel bone, allowing us to point our toes, stand on tiptoes, and push off when walking or running. Despite its strength, the Achilles tendon is vulnerable to injury due to its limited blood supply and the high tensions placed on it during physical activities.

Key Facts About the Achilles Tendon

• Stretches from the heel bone to the calf muscles
• Can be felt as a springy band at the back of the ankle
• Enables plantarflexion (pointing toes downward) and rising onto tiptoes
• Prone to injuries ranging from mild strains to complete ruptures

Types of Achilles Tendon Injuries

Achilles tendon injuries can vary in severity and location. Understanding the different types can help in proper diagnosis and treatment.

Achilles Tendinitis

Achilles tendinitis is an inflammation of the tendon. It can be categorized into two main types:

1. Noninsertional Achilles tendinitis: Affects the middle portion of the tendon, causing fibers to break down, swell, and thicken.
2. Insertional Achilles tendinitis: Occurs at the lower part of the heel where the tendon attaches to the heel bone. This type can lead to bone spur formation.

Achilles Tendon Rupture

A rupture is a partial or complete tear of the Achilles tendon. This injury is often more severe and may require surgical intervention.

Common Causes of Achilles Tendon Injuries

Achilles tendon injuries often occur during activities that involve sudden acceleration, deceleration, or pivoting movements. These injuries are not limited to athletes and can happen to anyone, even during everyday activities.

Activities Associated with Achilles Tendon Injuries

• Running and sprinting
• Gymnastics
• Dance
• Football
• Soccer
• Basketball
• Tennis
• Volleyball

Is there a specific moment when Achilles tendon injuries are most likely to occur? Injuries often happen during the push-off phase of movement, rather than during landing. For example, a sprinter might injure their Achilles tendon at the start of a race when explosively pushing off the starting blocks.

Recognizing Symptoms of Achilles Tendon Injuries

Identifying the symptoms of an Achilles tendon injury is crucial for prompt treatment and recovery.

Symptoms of Achilles Tendinitis

• Mild to moderate pain above the heel
• Stiffness or tenderness in the affected area
• Pain that may worsen with activity
• Swelling or thickening of the tendon

Signs of Achilles Tendon Rupture

• Sudden, severe pain in the back of the ankle or calf
• A popping or snapping sound at the moment of injury
• Swelling and bruising around the affected area
• Difficulty pointing toes or pushing off when walking
• Inability to stand on tiptoes on the affected side

How can you differentiate between a mild strain and a complete rupture? A complete rupture typically causes immediate, intense pain and a noticeable loss of function, while a mild strain may cause discomfort but allow for continued movement.

Risk Factors for Achilles Tendon Injuries

Several factors can increase the likelihood of experiencing an Achilles tendon injury. Understanding these risks can help in prevention and early intervention.

Common Risk Factors

• Age: Men over 30 are particularly susceptible
• Sudden increases in exercise intensity or duration
• Wearing high heels regularly
• Having flat feet or fallen arches
• Tight leg muscles or tendons
• Presence of bone spurs
• Improper footwear for physical activities
• Exercising on uneven surfaces
• Certain medications (e.g., glucocorticoids, fluoroquinolone antibiotics)
• Chronic conditions such as rheumatoid arthritis, lupus, gout, or diabetes

Can certain occupations increase the risk of Achilles tendon injuries? Occupations that involve repetitive stress on the lower legs, such as ballet dancers or construction workers, may have a higher risk of developing Achilles tendon problems.

Diagnosing Achilles Tendon Injuries

Proper diagnosis is essential for effective treatment of Achilles tendon injuries. Healthcare providers use a combination of physical examination and imaging techniques to assess the extent of the injury.

Diagnostic Procedures

1. Physical examination: The doctor may observe your gait and perform a calf squeeze test to assess tendon function.
2. Range of motion tests: These help determine the extent of mobility limitations.
3. Imaging studies:
   • X-rays: To rule out other ankle or heel problems
   • MRI: Provides detailed images of soft tissues, helping to determine the severity of the tendon injury
   • Ultrasound: Can visualize the tendon’s structure and any tears or inflammation

Why is the calf squeeze test important in diagnosing Achilles tendon ruptures? This test, also known as the Thompson test, helps doctors differentiate between a complete rupture and other ankle injuries. When the calf is squeezed, a intact Achilles tendon will cause the foot to point downward, while a ruptured tendon will not produce this movement.

Treatment Options for Achilles Tendon Injuries

Treatment for Achilles tendon injuries varies depending on the severity of the injury and the individual’s circumstances. Options range from conservative management to surgical intervention.

Non-Surgical Treatment

For minor to moderate Achilles tendon injuries, non-surgical treatments are often effective:

• Rest and activity modification
• Ice therapy to reduce swelling
• Compression bandages to support the tendon
• Elevation of the affected leg
• Non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief
• Physical therapy exercises to improve strength and flexibility
• Orthotics or heel lifts to reduce stress on the tendon

Surgical Treatment

In cases of severe tears or ruptures, surgical intervention may be necessary:

• Traditional open surgery
• Minimally invasive techniques
• Tendon repair or reconstruction

How long does recovery typically take after Achilles tendon surgery? Recovery time can vary, but most patients require 4-6 months of rehabilitation before returning to normal activities. Full recovery and return to high-impact sports may take up to a year.

Rehabilitation and Recovery Process

Proper rehabilitation is crucial for successful recovery from Achilles tendon injuries, whether treated surgically or non-surgically.

Phases of Rehabilitation

1. Immobilization: Protecting the tendon with a cast or boot
2. Range of motion exercises: Gradually increasing ankle mobility
3. Strengthening exercises: Building up calf and leg muscles
4. Functional training: Reintroducing sport-specific or daily activities

What role does physical therapy play in Achilles tendon injury recovery? Physical therapy is essential for guiding patients through proper exercises, monitoring progress, and preventing re-injury. Therapists can also provide treatments like ultrasound or massage to promote healing.

Timeline for Return to Activities

• Walking without a boot: 6-8 weeks post-injury or surgery
• Low-impact activities: 3-4 months
• Running or high-impact sports: 6-12 months, depending on individual progress

Preventing Achilles Tendon Injuries

While not all Achilles tendon injuries can be prevented, there are several strategies to reduce the risk of occurrence or recurrence.

Preventive Measures

• Gradually increase exercise intensity and duration
• Incorporate proper warm-up and cool-down routines
• Maintain flexibility through regular stretching
• Strengthen calf muscles and ankles
• Wear appropriate, well-fitting footwear for activities
• Use proper technique during sports and exercise
• Cross-train with low-impact activities
• Listen to your body and avoid overtraining

Can dietary changes help prevent Achilles tendon injuries? While no specific diet can prevent injuries, maintaining overall health through proper nutrition can support tendon strength and healing. Adequate protein intake and staying hydrated are particularly important for tendon health.

Long-Term Management

For individuals with a history of Achilles tendon problems, ongoing management is key to preventing future injuries:

• Regular check-ups with a healthcare provider
• Consistent adherence to strengthening and stretching routines
• Modification of high-risk activities when necessary
• Use of supportive devices or orthotics as recommended

Achilles tendon injuries can be debilitating, but with proper understanding, prompt treatment, and diligent rehabilitation, most individuals can return to their desired activities. By recognizing the signs of injury early and taking preventive measures, the risk of severe Achilles tendon problems can be significantly reduced. Whether you’re an athlete or someone who enjoys an active lifestyle, caring for your Achilles tendon is an important aspect of maintaining overall foot and ankle health.

Achilles Tendon Injuries (Tear, Rupture) Causes, Symptoms, Treatments

Written by WebMD Editorial Contributors

In this Article

• What Is an Achilles Tendon Injury?
• Achilles Tendon Injury Symptoms
• Achilles Tendon Injury Causes
• Achilles Tendon Injury Risks
• Achilles Tendon Injury Diagnosis
• Achilles Tendon Injury Treatment
• Achilles Tendon Surgery
• Achilles Tendon Injury Recovery
• Achilles Tendon Injury Prevention

An Achilles tendon injury can happen to anyone, whether you’re an athlete or just going about your everyday life.

The Achilles tendon is the largest tendon in your body. It stretches from the bones of your heel to your calf muscles. You can feel it: a springy band of tissue at the back of your ankle and above your heel. It lets you point your toes toward the floor and raise up on your tiptoes.

It’s common for this tendon to get injured. It can be mild or moderate and feel like a burning pain or stiffness in that part of your leg. If the pain is severe, your Achilles tendon may be partly or completely torn.

Achilles tendinitis is another type of injury in which some part of your tendon is inflamed. There are two main types of this condition, which affect different parts of your tendon:

• Noninsertional Achilles tendinitis. Fibers in the middle of your tendon break down, swell, and get thick.
• Insertional Achilles tendinitis. This affects the lower part of your heel, where your tendon inserts, or goes into, your heel bone. It can cause bone spurs.

The most obvious sign is pain above your heel, especially when you stretch your ankle or stand on your toes. It may be mild and get better or worse over time. If the tendon ruptures, the pain is instant and severe. The area may also feel tender, swollen, and stiff.

If your Achilles tendon tears, you may hear a snapping or popping noise when it happens. You could have bruising and swelling, too. You also may have trouble pointing your toes and pushing off your toes when you take a step.

Achilles tendon injuries are common in people who do things where they quickly speed up, slow down, or pivot, such as:

• Running
• Gymnastics
• Dance
• Football
• Soccer
• Baseball
• Softball
• Basketball
• Tennis
• Volleyball

The Achilles tendon is the strongest tendon in the body, but is vulnerable to injury due to its limited blood supply and the high tensions placed on it. (Photo Credit: WebMD)

These injuries tend to happen when you start moving suddenly as you push off and lift your foot rather than when you land. For instance, a sprinter might get one at the start of a race as they surge off the starting block. The abrupt action can be too much for the tendon to handle. Men over 30 are especially prone to Achilles tendon injuries.

You can also injure your Achilles tendon if you stress it over and over again with high-impact activities. These are known as repetitive stress injuries.

You don’t have to be an athlete to get this kind of injury. If you step into a hole or fall from a high place, you could rupture your Achilles.

These things may make you more likely to get an Achilles tendon injury:

• You wear high heels, which can stress the tendon.
• You have “flat feet,” also called fallen arches. This means that when you take a step, the impact causes the arch of your foot to collapse, stretching the muscles and tendons.
• Your leg muscles or tendons are too tight.
• You have bone spurs.
• You add time to your exercise routine or do more intense activity.
• You start a new type of exercise.
• You wear shoes that don’t fit well or aren’t right for the kind of physical activity you do.
• You work out on uneven surfaces.
• You take medicines called glucocorticoids or antibiotics called fluoroquinolones.
• You have a chronic condition that can weaken your Achilles, like rheumatoid arthritis, lupus, gout, or diabetes.

Doctors sometimes mistake an Achilles tendon injury for sprained ankle. To make the right diagnosis, your doctor will start with a physical exam. They may want to see you walk or run so they can look for problems that might have led to your injury.

They also might do something called the calf squeeze test. You’ll kneel on a chair or bench or lie on your stomach on the exam table. Your doctor will gently squeeze the calf muscle on your healthy leg. This will pull on the tendon and make your foot move. Next, they’ll do the same thing on your other leg. If your Achilles tendon is torn, your foot won’t move, because your calf muscle won’t be connected to your foot.

Your doctor may test your range of motion to see if you can move your ankle the way you should. They may also do imaging tests, such as X-ray or MRI. These tests can show what kind of tendon damage you have and help them decide on the best treatment for you.

Minor to moderate Achilles tendon injuries should heal on their own. To speed the process, you can:

• Rest your leg. Avoid putting weight on it as best you can. You may need crutches.
• Ice it. Ice your injury for up to 20 minutes at a time as needed.
• Compress your leg. Use an elastic bandage around the lower leg and ankle to keep down swelling.
• Raise (elevate) your leg. Prop it on a pillow when you’re sitting or lying down.
• Take anti-inflammatory painkillers. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can help with pain and swelling. Follow the instructions on the label to help prevent side effects, such as bleeding and ulcers. Take them with food. Check with your doctor first if you have any allergies, have medical problems, or take any other medication. If you need them for longer than 7 to 10 days, call your doctor.
• Use a heel lift. Your doctor may recommend that you wear an insert in your shoe while you recover. It will help protect your Achilles tendon from further stretching.
• Practice stretching and strengthening exercises. Your doctor or physical therapist can recommend ones for you to try. 
• Take part in low-impact activities. When your doctor says it’s OK, activities like swimming can help promote healing. 
 

If your Achilles is torn, your doctor may recommend surgery. The younger and more active you are, the more likely that surgery will be the best option.

You should have the surgery within 4 weeks of the injury. Your surgeon will make a small incision in the back of your ankle and sew the Achilles back together. Sometimes they’ll need to sew other tendons in to make things even stronger. Between 80% and 90% of these operations are successful.

Your doctor could decide not to do surgery if you’re older and less active, or if you have only a partial tear.

The nonsurgical route will involve lots of physical therapy and doing stretches and exercises on your own. You might also have ultrasound or shockwave therapy. You may have to wear a cast, a walking boot, or heel cups to take pressure off the tendon and keep it from moving.

You’ll have a longer road to full recovery, and you’ll run a bigger risk of reinjuring the tendon.

Recovery may take months, but it depends on how serious your injury is. Different conditions heal at different rates.

You can still be active while your injury heals. Ask your doctor what’s OK to do. But don’t rush things. Don’t try to return to your old level of physical activity until:

• You can move your leg as easily and freely as your uninjured leg.
• Your leg feels as strong as your uninjured leg.
• You don’t have any pain in your leg when you walk, jog, sprint, or jump.

If you push yourself too much before your Achilles tendon injury fully heals, you could get injured again, and the pain could become a long-lasting problem. You may be able to avoid some of these issues if you replace high-impact sports like running with low-impact exercise. Activities such as swimming or cycling put less stress on your tendon.

Here are some things you can try:

• Stretch and strengthen your calves.
• Cut down on uphill running.
• Wear shoes with good support that fit well.
• Stop exercising if you feel pain or tightness in the back of your calf or heel.

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Achilles Tendon Rupture – StatPearls

Continuing Education Activity

Achilles tendon rupture is the most common tendon rupture in the lower extremity. The injury most commonly occurs in adults in their third to fifth decade of life. Acute ruptures often present with sudden onset of pain associated with a “snapping” or audible “pop” heard at the site of injury. Patients may describe a sensation similar to being kicked in the lower leg. Achilles tendon rupture causes significant pain and disability. This activity reviews the etiology, presentation, evaluation, and management of Achilles tendon rupture and examines the role of the interprofessional team in managing it.

Objectives:

• Describe risk factors associated with Achilles tendon rupture.

• Explain how the Thompson test is performed and what a positive test suggests.

• Describe the factors to consider when deciding whether to treat an Achilles tendon rupture with operative versus nonoperative management.

• Describe how an optimally functioning interprofessional team would coordinate care to enhance outcomes for patients with Achilles tendon rupture.

Access free multiple choice questions on this topic.

Introduction

Achilles tendon rupture is the most common tendon rupture in the lower extremity. The injury most commonly occurs in adults in their third to fifth decade of life.[1]  Acute ruptures often present with sudden onset of pain associated with a “snapping” or audible “pop” heard at the injury site. Patients can describe the sensation of being kicked in the lower leg. The injury causes significant pain and disability.

Achilles tendon injuries typically occur in individuals who are only active intermittently (i.e., the “weekend warrior” athletes). The injury is reportedly misdiagnosed as an ankle sprain in 20% to 25% of patients. Moreover, patients in their third to the fifth decade of life are most commonly affected, as 10% report a history of prodromal symptoms, and known risk factors include prior intratendinous degeneration (ie, tendinosis), fluoroquinolone use, steroid injections, and inflammatory arthritides. [2][3][4][5]

Etiology

Causes of Achilles tendon rupture include sudden forced plantar flexion of the foot, direct trauma, and long-standing tendinopathy or intratendinous degenerative conditions. Sports often associated with Achilles tendon rupture include diving, tennis, basketball, and track. Risk factors for a rupture of the Achilles tendon include poor conditioning before exercise, prolonged use of corticosteroids, overexertion, and the use of quinolone antibiotics. The Achilles tendon rupture usually tends to occur about two to four cm above the calcaneal insertion of the tendon. In right-handed individuals, the left Achilles tendon is most likely to rupture and vice versa.[6][7][8]

The exact cause of Achilles tendon injury appears to be multifactorial. The injury is most common in cyclists, runners, volleyball players, and gymnasts. When the ankle is subject to extreme pronation, it places enormous stress on the tendon, leading to injury. In cyclists, the combination of low saddle height and extreme dorsiflexion during pedaling may also be a factor in an overuse injury.

Systemic Factors

Systemic diseases that may be associated with Achilles tendon injuries include the following:

• Chronic renal failure

• Collagen deficiency

• Diabetes mellitus

• Gout

• Infections

• Lupus

• Parathyroid disorders

• Rheumatoid arthritis

• Thyroid disorders 

Foot problems that increase the risk of Achilles tendon injuries include the following:

• Cavus foot

• Insufficient gastroc-soleus flexibility and strength

• limited ability to perform ankle dorsiflexion

• Tibia vara

• Varus alignment with functional hyperpronation

Achilles tendon rupture is often more common in people with blood group O. Further, anyone with a family history of tendon rupture is also at a high risk of developing Achilles tendon rupture at some point in their life.

Epidemiology

The incidence of Achilles tendon ruptures vary in the literature, with recent studies reporting a rate of 18 patients per 100,000 patient population annually. Regarding athletic individuals, the incidence rate of Achilles tendon injuries ranges from 6% to 18%, and football players are the least likely to develop this problem compared to gymnasts and tennis players. About a million athletes are believed to have Achilles tendon injuries each year.

The true incidence of Achilles tendinosis is unknown, although reported incidence rates are 7% to 18% in runners, 9% in dancers, 5% in gymnasts, 2% in tennis players, and less than 1% in American football players. Achilles disorders affect approximately 1 million athletes per year.[9]

The incidence of Achilles tendon injuries is increasing in the USA because of more participation of people in sporting activities. The exact incidence of Achilles tendon injuries is unknown outside the USA, but studies from Denmark and Scotland reveal 6 to 37 cases per 100,000 persons.

Achilles tendon injuries appear more commonly in males, probably related to greater participation in sports activities. Most injuries are seen between the third and fifth decade of life. Many of these individuals are only active intermittently and rarely warm up.

Pathophysiology

Achilles tendonitis is often not associated with primary prostaglandin-mediated inflammation. It appears there is a neurogenic inflammation with the presence of calcitonin gene-related peptide and substance P present. Histopathological studies reveal thickening and fibrin adhesions of the tendon with the occasional disarray of the fibers.

Neurovascularization is frequently seen in the degenerating tendon, which is also associated with pain. Tendon rupture is usually the terminal event during the degeneration process. After rupture, type 111 collagen appears to be the major collagen manufactured, suggesting an incomplete repair process. Animal studies show that tendon rupture is most likely if there is more than 8% stretching of their original length.

The proximal segment of the tendon receives its blood from the muscle bellies connected to the tendon. Blood supply to the distal segment of the tendon is via the tendon-bone interface.

History and Physical

Patients often present with acute, sharp pain in the Achilles tendon region. On physical exam, patients with Achilles tendon rupture cannot stand on their toes or have very weak plantar flexion of the ankle. Palpation may reveal a tendon discontinuity or signs of bruising around the posterior ankle.

The examiner performs the Thompson test to assess for Achilles tendon continuity in the setting of suspected rupture. The examiner places the patient in the prone position with the ipsilateral knee flexed to about 90 degrees. The foot/ankle is in the resting position. Upon squeezing the calf, the examiner notes the presence and degree of plantarflexion at the foot/ankle. This should be compared to the contralateral side. A positive (abnormal) test is strongly associated with Achilles rupture.

Evaluation

In the setting of trauma to the lower leg, radiographs are obtained to rule out the presence of a fracture. The diagnosis can be confirmed with ultrasound imaging or MRI based on clinical suspicion following the physical examination. [10]

Treatment / Management

Operative Versus Nonoperative Management

The initial management of Achilles tendon rupture is rest, elevation, pain control, and functional bracing. There is still debate surrounding the potential benefits versus risks of surgical intervention. Studies have demonstrated good functional results and patient satisfaction with both operative and nonoperative modalities. 

Healing rates with serial casting/functional bracing are no different compared to the surgical anastomosis of the tendon, but return to work may be slightly prolonged in patients treated medically. All patients require physical and orthotic therapy to help strengthen the muscles and improve the range of motion of the ankle.[11][4][12]

Rehabilitation is critical to regaining maximal ankle function. While the debate remains regarding the optimal treatment modality, the consensus includes the following:

• Patients with significant medical comorbidities or relatively sedentary lifestyles are often recommended for nonoperative management.

• The patient/surgeon discussion should include a detailed discussion concerning the current literature reporting satisfactory outcomes with both treatment plans and the following topics:

  • Possibility of quicker return to work with operative intervention

  • Equivalent plantar flexion strength at long-term followup

  • Possibility of an increased risk of re-rupture and re-injury with nonoperative management (compared to operative management)

  • Lower complication rates for nonoperative treatment compared to operative management

Several techniques for Achilles tendon repair exist, but all involve the reapproximation of torn ends. Sometimes the repair is reinforced by the plantaris tendon or the gastroc-soleus aponeurosis.

Overall, the healing rates between casting and surgical repair are similar. The debate about an early return to activity after surgery is now being questioned. If a cast is used, it should remain for at least 6 to 12 weeks. Benefits of a nonsurgical approach include no hospital admission costs, no wound complications, and no risk of anesthesia. The most significant disadvantage is the risk of re-rupture, which is as high as 40%.

Differential Diagnosis

• Achilles bursitis 

• Ankle fracture

• Ankle impingement syndrome

• Ankle osteoarthritis

• Ankle sprain

• Calf injuries

• Calcaneofibular ligament injury

• Calcaneus fractures

• Deep venous thrombosis (DVT)

• Exertional compartment syndrome

• Fascial tears

• Gastrocnemius or soleus muscle strain or rupture

• Haglund deformity

• Plantaris tendon tear

• Psoriatic arthritis

• Reiter syndrome

• Retrocalcaneal bursitis

• Ruptured Baker cyst

• Syndesmosis

• Talofibular ligament injury

Prognosis

For most patients with Achilles tendon rupture, the prognosis is excellent. But in some non-athletes, there may be some residual deficits like a reduced range of motion. Most athletes can resume their previous sporting activity without any limitations. However, non-surgical treatment has a re-rupture rate of nearly 40% compared to only 0.5% for those treated surgically.

Complications

Re-rupture

Wound Healing Complications

• Overall, a 5-10% risk following surgery

• Risk factors for postoperative wound complications include the following:

  • Smoking (most common and most significant risk factor)

  • Female sex

  • Steroid use

  • Open technique (vs percutaneous procedures)

Sural Nerve Injury

Postoperative and Rehabilitation Care

No matter which method is used to treat the tendon rupture, participating in an exercise program is vital. One may swim, cycle, jog, or walk to increase muscle strength and range of motion.

Rehabilitation 

Rehabilitation will vary based on surgical versus non-surgical approach and referring physician’s protocol, highlighting the importance of the therapist working closely with referring physician to optimize care. This is particularly important for brace use and weight-bearing status as these areas are those in which therapy management tends to vary the most with this condition. Depending on operative vs. non-operative, immobilization may range from approximately 3 to 4 weeks in operative and 3 to 9 weeks conservative with orthotic use following both approaches depending on referring orthopedic protocol. Varying degrees of plantarflexion to neutral positioning are utilized during this time, with specifics on the optimal positioning still widely debated.[14][15][16] Emphasizing the need to avoid hyper dorsiflexion during this time has been noted as an important component in avoiding elongation of the Achilles tendon and long-term functional deficits.[14]

If conservative methods are used, therapy begins during the immobilization phase of cast wear for weight-bearing mobilization training and exercise to promote the maintenance of strength in the remainder of the affected limb. More recent studies have shown the benefits of initiating functional casts coupled with early weight bearing in conservative treatment, including a faster return to activity and improved ankle dorsiflexion (traditionally operative treatment corresponded with earlier weight-bearing and exercise initiation), but this continues to vary and will be determined by the referring physician.[14][15][16] 

For surgical patients, rehabilitation exercises typically begin 2 to 4 weeks postop.[17] Post-immobilization therapy consists of exercise progression, including ankle range of motion exercises, resistive and progressive strengthening exercises, isometric exercises, cardiovascular exercises, and balance exercises as appropriate.[18] 

Exercise focus is typically low impact for the first six months, with high-impact exercises incorporated after six months, emphasizing a return to sport as appropriate. Data has shown a need for a heavy focus on calf strengthening within the first year of injury as a reduction in strength gain potential has been demonstrated beyond the one-year post-injury date. [14]

Deterrence and Patient Education

While active patients and recreational athletes often return to baseline activity levels and work following both nonoperative and operative management of these injuries. High-level professional athletes most often report inferior results and return to play regardless of the chosen management plan.

A 2017 study from the American Journal of Sports Medicine reported professional athletes’ follow-up performance (NBA, NFL, MLB, and NHL) at 1- and 2-year follow-ups after surgery performed between 1989 and 2013: 

• >30% failure to return to play

• Athletes returning noted (at 1-year follow-up) the following:

  • Fewer games played, overall

  • Less playing time, overall

  • Suboptimal performance level, overall

• Athletes able to return to play by 2-year follow-up show no statistically significant difference in performance level[19]

Thus, athletes demonstrating the ability to return to play by 1-year should expect to achieve continuous improvement to baseline performance by the ensuing season.

Pearls and Other Issues

To prevent Achilles tendon rupture, adequate warming and stretching before physical activity is recommended.

Enhancing Healthcare Team Outcomes

Even though there are several treatments for Achilles tendon rupture, there is no consensus on which to undertake. There is a wide variation in the management of Achilles tendon injury between orthopedic surgeons and sports physicians. Further, there is no uniformity in postoperative rehabilitation. Experts recommend that an interprofessional approach may help achieve better outcomes.[10][20] [Level 5]

The team should include a trauma surgeon, an orthopedic surgeon, a rehabilitation specialist, and a sports physician. The pharmacist must ensure the patient is not on any medications that can affect healing. The nurse should educate the patient on the importance of stretching before any exercise and participating in a regular exercise program after repair.

Outcomes

Conservative treatment is usually preferred for non-athletes, but the risk of re-rupture is high. While surgery offers a lower risk of re-rupture, it is also associated with post-surgical complications that may delay recovery. Overall, the outcomes for Achilles tendon rupture are good to excellent after treatment.[21][22][23] [Level 5]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

achilles tendon rupture. Image courtesy S Bhimji MD

Figure

Achilles tendon rupture. Image courtesy S Bhimji MD

Figure

Achilles Tendon Rupture
T2 MRI demonstrating a full-thickness Achilles rupture with gapping at the classing “watershed” area. Contributed by Mark A. Dreyer, DPM, FACFAS

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Dams OC, van den Akker-Scheek I, Diercks RL, Wendt KW, Zwerver J, Reininga IHF. Surveying the management of Achilles tendon ruptures in the Netherlands: lack of consensus and need for treatment guidelines. Knee Surg Sports Traumatol Arthrosc. 2019 Sep;27(9):2754-2764. [PMC free article: PMC6706364] [PubMed: 29971520]

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Kanchanatawan W, Densiri-Aksorn W, Maneesrisajja T, Suppauksorn S, Arirachakaran A, Rungchamrussopa P, Boonma P. Hybrid Achilles Tendon Repair. Arthrosc Tech. 2018 Jun;7(6):e639-e644. [PMC free article: PMC6019910] [PubMed: 30013904]

12.

Westin O, Svensson M, Nilsson Helander K, Samuelsson K, Grävare Silbernagel K, Olsson N, Karlsson J, Hansson Olofsson E. Cost-effectiveness analysis of surgical versus non-surgical management of acute Achilles tendon ruptures. Knee Surg Sports Traumatol Arthrosc. 2018 Oct;26(10):3074-3082. [PMC free article: PMC6154020] [PubMed: 29696317]

13.

Lantto I, Heikkinen J, Flinkkila T, Ohtonen P, Siira P, Laine V, Leppilahti J. A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles Tendon Ruptures. Am J Sports Med. 2016 Sep;44(9):2406-14. [PubMed: 27307495]

14.

Park SH, Lee HS, Young KW, Seo SG. Treatment of Acute Achilles Tendon Rupture. Clin Orthop Surg. 2020 Mar;12(1):1-8. [PMC free article: PMC7031433] [PubMed: 32117532]

15.

Saxena A, Giai Via A, Grävare Silbernagel K, Walther M, Anderson R, Gerdesmeyer L, Maffulli N. Current Consensus for Rehabilitation Protocols of the Surgically Repaired Acute Mid-Substance Achilles Rupture: A Systematic Review and Recommendations From the “GAIT” Study Group. J Foot Ankle Surg. 2022 Jul-Aug;61(4):855-861. [PubMed: 35120805]

16.

Yang X, Meng H, Quan Q, Peng J, Lu S, Wang A. Management of acute Achilles tendon ruptures: A review. Bone Joint Res. 2018 Oct;7(10):561-569. [PMC free article: PMC6215245] [PubMed: 30464836]

17.

Amendola F, Barbasse L, Carbonaro R, Alessandri-Bonetti M, Cottone G, Riccio M, De Francesco F, Vaienti L, Serror K. The Acute Achilles Tendon Rupture: An Evidence-Based Approach from the Diagnosis to the Treatment. Medicina (Kaunas). 2022 Sep 01;58(9) [PMC free article: PMC9500605] [PubMed: 36143872]

18.

Zellers JA, Christensen M, Kjær IL, Rathleff MS, Silbernagel KG. Defining Components of Early Functional Rehabilitation for Acute Achilles Tendon Rupture: A Systematic Review. Orthop J Sports Med. 2019 Nov;7(11):2325967119884071. [PMC free article: PMC6878623] [PubMed: 31803789]

19.

Trofa DP, Miller JC, Jang ES, Woode DR, Greisberg JK, Vosseller JT. Professional Athletes’ Return to Play and Performance After Operative Repair of an Achilles Tendon Rupture. Am J Sports Med. 2017 Oct;45(12):2864-2871. [PubMed: 28644678]

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Hertel G, Götz J, Grifka J, Willers J. [Achilles tendon rupture : Current diagnostic and therapeutic standards]. Orthopade. 2016 Aug;45(8):709-20. [PubMed: 27405457]

21.

Song YJ, Chen G, Jia SH, Xu WB, Hua YH. Good outcomes at mid-term following the reconstruction of chronic Achilles tendon rupture with semitendinosus allograft. Knee Surg Sports Traumatol Arthrosc. 2020 May;28(5):1619-1624. [PubMed: 30128686]

22.

Westin O, Nilsson Helander K, Grävare Silbernagel K, Samuelsson K, Brorsson A, Karlsson J. Patients with an Achilles tendon re-rupture have long-term functional deficits and worse patient-reported outcome than primary ruptures. Knee Surg Sports Traumatol Arthrosc. 2018 Oct;26(10):3063-3072. [PMC free article: PMC6154022] [PubMed: 29691618]

23.

Becher C, Donner S, Brucker J, Daniilidis K, Thermann H. Outcome after operative treatment for chronic versus acute Achilles tendon rupture – A comparative analysis. Foot Ankle Surg. 2018 Apr;24(2):110-114. [PubMed: 29409231]

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Holm C, Kjaer M, Eliasson P. Achilles tendon rupture–treatment and complications: a systematic review. Scand J Med Sci Sports. 2015 Feb;25(1):e1-10. [PubMed: 24650079]

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Xergia SA, Tsarbou C, Liveris NI, Hadjithoma Μ, Tzanetakou IP. Risk factors for Achilles tendon rupture: an updated systematic review. Phys Sportsmed. 2022 Jun 10;:1-11. [PubMed: 35670156]

26.

Humbyrd CJ, Bae S, Kucirka LM, Segev DL. Incidence, Risk Factors, and Treatment of Achilles Tendon Rupture in Patients With End-Stage Renal Disease. Foot Ankle Int. 2018 Jul;39(7):821-828. [PMC free article: PMC6023765] [PubMed: 29582683]

27.

Meulenkamp B, Stacey D, Fergusson D, Hutton B, Mlis RS, Graham ID. Protocol for treatment of Achilles tendon ruptures; a systematic review with network meta-analysis. Syst Rev. 2018 Dec 23;7(1):247. [PMC free article: PMC6304227] [PubMed: 30580763]

28.

Edama M, Takabayashi T, Yokota H, Hirabayashi R, Sekine C, Maruyama S, Otani H. Classification by degree of twisted structure of the fetal Achilles tendon. Surg Radiol Anat. 2021 Oct;43(10):1691-1695. [PubMed: 34263342]

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Hijazi KM, Singfield KL, Veres SP. Ultrastructural response of tendon to excessive level or duration of tensile load supports that collagen fibrils are mechanically continuous. J Mech Behav Biomed Mater. 2019 Sep;97:30-40. [PubMed: 31085458]

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Cao S, Teng Z, Wang C, Zhou Q, Wang X, Ma X. Influence of Achilles tendon rupture site on surgical repair outcomes. J Orthop Surg (Hong Kong). 2021 Jan-Apr;29(1):23094990211007616. [PubMed: 33845659]

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Lorimer AV, Hume PA. Achilles tendon injury risk factors associated with running. Sports Med. 2014 Oct;44(10):1459-72. [PubMed: 24898814]

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Nichols AEC, Oh I, Loiselle AE. Effects of Type II Diabetes Mellitus on Tendon Homeostasis and Healing. J Orthop Res. 2020 Jan;38(1):13-22. [PMC free article: PMC6893090] [PubMed: 31166037]

33.

Winnicki K, Ochała-Kłos A, Rutowicz B, Pękala PA, Tomaszewski KA. Functional anatomy, histology and biomechanics of the human Achilles tendon – A comprehensive review. Ann Anat. 2020 May;229:151461. [PubMed: 31978571]

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Ho JO, Sawadkar P, Mudera V. A review on the use of cell therapy in the treatment of tendon disease and injuries. J Tissue Eng. 2014;5:2041731414549678. [PMC free article: PMC4221986] [PubMed: 25383170]

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Freedman BR, Gordon JA, Soslowsky LJ. The Achilles tendon: fundamental properties and mechanisms governing healing. Muscles Ligaments Tendons J. 2014 Apr;4(2):245-55. [PMC free article: PMC4187594] [PubMed: 25332943]

36.

Reiman M, Burgi C, Strube E, Prue K, Ray K, Elliott A, Goode A. The utility of clinical measures for the diagnosis of achilles tendon injuries: a systematic review with meta-analysis. J Athl Train. 2014 Nov-Dec;49(6):820-9. [PMC free article: PMC4264655] [PubMed: 25243736]

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Garras DN, Raikin SM, Bhat SB, Taweel N, Karanjia H. MRI is unnecessary for diagnosing acute Achilles tendon ruptures: clinical diagnostic criteria. Clin Orthop Relat Res. 2012 Aug;470(8):2268-73. [PMC free article: PMC3392388] [PubMed: 22538958]

38.

Ochen Y, Beks RB, van Heijl M, Hietbrink F, Leenen LPH, van der Velde D, Heng M, van der Meijden O, Groenwold RHH, Houwert RM. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ. 2019 Jan 07;364:k5120. [PMC free article: PMC6322065] [PubMed: 30617123]

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Carmont MR, Rossi R, Scheffler S, Mei-Dan O, Beaufils P. Percutaneous & Mini Invasive Achilles tendon repair. Sports Med Arthrosc Rehabil Ther Technol. 2011 Nov 14;3:28. [PMC free article: PMC3227582] [PubMed: 22082172]

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Oksanen MM, Haapasalo HH, Elo PP, Laine HJ. Hypertrophy of the flexor hallucis longus muscle after tendon transfer in patients with chronic Achilles tendon rupture. Foot Ankle Surg. 2014 Dec;20(4):253-7. [PubMed: 25457661]

41.

Myhrvold SB, Brouwer EF, Andresen TKM, Rydevik K, Amundsen M, Grün W, Butt F, Valberg M, Ulstein S, Hoelsbrekken SE. Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture. N Engl J Med. 2022 Apr 14;386(15):1409-1420. [PubMed: 35417636]

42.

Deng S, Sun Z, Zhang C, Chen G, Li J. Surgical Treatment Versus Conservative Management for Acute Achilles Tendon Rupture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Foot Ankle Surg. 2017 Nov-Dec;56(6):1236-1243. [PubMed: 29079238]

43.

Mansfield K, Dopke K, Koroneos Z, Bonaddio V, Adeyemo A, Aynardi M. Achilles Tendon Ruptures and Repair in Athletes-a Review of Sports-Related Achilles Injuries and Return to Play. Curr Rev Musculoskelet Med. 2022 Oct;15(5):353-361. [PMC free article: PMC9463425] [PubMed: 35804260]

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Indino C, D’Ambrosi R, Usuelli FG. Biologics in the Treatment of Achilles Tendon Pathologies. Foot Ankle Clin. 2019 Sep;24(3):471-493. [PubMed: 31370998]

45.

Bachir RM, Zaia IM, Santos GS, Fonseca LFD, Boni G, Guercia RF, Ferreira GF, Lana JFSD. Bone Marrow Aspirate Concentrate Improves Outcomes in Adults With Osteochondral Dissecans of the Talus and Achilles Rupture. Arthroscopy. 2023 Mar;39(3):881-886. [PubMed: 36543662]

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Disclosure: Alan Shamrock declares no relevant financial relationships with ineligible companies.

Disclosure: Matthew Varacallo declares no relevant financial relationships with ineligible companies.

In April, Dalaloyan tore his Achilles. Today he qualified for the all-around final and did not hold back his tears. Video

July 24, 2021 10:15

The story of overcoming oneself before our very eyes.

The story of overcoming oneself before our eyes.

• On Saturday at the Olympic Games in Tokyo, the gymnasts qualified. Full results – below
• The drawing of the first set of awards in artistic gymnastics will be held on July 26 – the final of the team all-around. The Russian men’s team came to the Games as current world champions in this type of program.
• Arthur Dalaloyan tore his Achilles three months before the start of the Olympics, but managed to restore all the shells. After performing in floor exercises with unusual blots, the three-time world champion gave vent to emotions

Dalaloyan’s performance in floor exercise

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Dalaloyan’s performance in vault

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Artur Dalaloyan: “I didn’t expect to show such laxity in freestyle”

– I didn’t control my emotions a little, I didn’t justify my hope. Therefore, there was a small emotional breakdown. Yesterday I expressed a desire to make all the shells, I felt the strength in myself. I was confident in the floor exercises and the jump. I myself did not expect that I would show such laxity in the free. When I was traveling to Tokyo, I didn’t know that I would be freestyle jumping, but I jumped them. Because of this, emotions are mixed. I need to come to the Olympic village and reassess this situation. Need to be digested. The competition mode is normal, for me the most valuable thing after all this is that I managed to pull myself together and make a horse. I didn’t know how to go to him, I had to go out first, did a warm-up with tears in my eyes. I made a horse, and again I was overwhelmed with emotions,” Dalaloyan said after the speech to our correspondent Sergey Lisin.

Dmitry Zanin: “Arthur is upset that he looked like this on the platform. Although I still had to go to hospitals”

– It really infuriates me when a little boy is reassured by the words “don’t cry, you’re a man.” Artur Dalaloyan broke down in tears today after floor exercises. But he’s just a real man, – wrote the correspondent of “Match TV” in Instagram*. – Achilles tore in April. If someone does not know, when you tear it, the foot dangles just like a piece of meat. The doctors said – well, in the autumn you will be able to walk normally. No, he says, I have three months before the Olympics. If you remember, at the Euro, the Italian Spinazolla tore his Achilles and then sawed cute photos from the hospital, everything is cool with me, everyone is so happy, let’s not rush. And compare with Arthur – he still had anesthesia from the operation, and he was already training in the ward, then he worked on his leg 24/7, pumped it up again, stretched it, restored it, a pool, all sorts of rubber bands, massages, procedures. And in the end I came to Tokyo. He returned exactly three months later – everyone is already in shock from this. But he cannot do vault and floor exercises – too much load on the still healing ankle. There is a chance to return to the doctors. Dalaloyan himself said – I will make only 4 shells.

Artur Dalaloyan / Photo: © Laurence Griffiths / Staff / Getty Images Sport / Gettyimages.ru

And now the qualification begins, if you want to fight for the prestigious all-around, then you have to do 6. Everyone is watching – Arthur first makes a very good jump, and then goes to floor exercises. Come on?! He has not done them for three months, he can aggravate the injury. But it starts all the same, diagonal after diagonal – it turns out a little dirty. Dalaloyan is an exemplary gymnast in terms of purity of performance, he can be photographed for textbooks, and then, after a three-month pause, he makes his program with errors and gets upset because of this. That he looked like this on the platform. Although, in fact, Arthur still had to go to hospitals, but instead, in Tokyo, he expected an ideal performance from himself. Just feel the level of ambition and demands on yourself. Nevertheless, Dalaloyan qualified for the all-around final, and imagine if he wins a medal there. But before that there will be another team, where Arthur will also fight like the last time. And there, too, there may be tears, but what a man he is. Well, yes, Arthur has three children.

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Artistic gymnastics

Team all-around

1. Japan — 262.251 points

2. China — 262.061

3. Russia — 261.945

Individual all-around

1. Daiki Hashimoto (Japan) — 88.531

2. Nikita Nagorny (Russia) — 87.897

3. Xiao Zhoten (China) — 87.732…

6. Artur Dalaloyan — 85.957…

18. Alexander Kartsev (both from Russia) — 8 2.299

Horse

1 Xih Kai (Chinese Taipei) – 15,266

2-3. Rhys McClenahan (Ireland) – 15.266

2-3. Kohei Kameyama (Japan) — 15.266…

8. David Belyavsky (Russia) — 14.733

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Rings

1. Eleftherios Petrunias (Greece) — 15.333 900 03

2. Liu Yang (China) — 15.300

3. Ait Sail (France) — 15.066…

7. Denis Ablyazin (Russia) — 14.800

Vault

1. Jehwan Shin (Korea) — 14.866

2 2. Arthur Yes Vtyan (Armenia) — 14,866

3. Nikita Nagorny — 14.783…

5. Denis Ablyazin (both from Russia) — 14.733

Bars

1. Zou Jing Yuan (China) — 16.166

2. Lucas Dauser (Germany) — 15. 733

3. Yu Hao (China) — 15.666

Crossbar

1. Hashimoto Dikes (Japan) — 15.033

2. Milad Karimi (Kazakhstan) — 14.766

3. Tin C rbic (Croatia) — 14.633…

5. Nikita Nagorny (Russia) — 14,466

More words from gymnasts from Tokyo:

• The Russian national gymnastics team is second in the team all-around qualification at the Olympic Games in Tokyo
• Nikita Nagorny: “I’m upset that I didn’t manage to make bars, I made a gross mistake”
• Alexander Kartsev – about falling from the crossbar to the Olympic Games: “I don’t know what happened. Everything was going well, but I decided to do it perfectly “
• David Belyavsky: “The guys coped with their tasks in the qualification”

* A social network recognized as extremist in Russia

No connection

Poetry of V. A. Zhukovsky. Grade 7

V. A. Zhukovsky (1783 – 1852 )

public and literary discussions of recent years have finally led to the rejection of the obligatory linking of the history of literature in the previous decades to the three periods of the “liberation movement”. Today, without ideological tendentiousness and subjectivism, we can fully present to students Russian classical literature rooted in domestic and biblical traditions and at the same time associated with European and ancient literature.

Two hundred years of experience in European literature Russian literature rapidly reworked in just sixty years and acquired its own unique “face”. We are already talking about the writers’ awareness of the direction in which they worked: classicism, sentimentalism, romanticism, realism. The concepts of literary trends are introduced in the 8th grade. Through the analysis of texts, images of heroes, the search for the author’s intention, children determine the main properties of these literary movements. And before that, the selection and layout of reading materials are such that they make it possible to holistically present the features of the work of a particular writer and poet and subsequently terminologically characterize and indicate the features that testify to his characteristic literary direction. This is also facilitated by the inclusion of texts in the reader not only for their detailed analysis, but also for independent reading by children, for intuitive, contemplative, emotional and sensory perception.

Since each new poetic epoch works “on images long since bequeathed, necessarily revolving within their boundaries, allowing itself only new combinations of old ones and only filling them with that new understanding of life” , the study of the artistic creativity of a private writer corresponds to the goal formulated by A. N Veselovsky in “Historical Poetics”: to determine “the role and boundaries of tradition” (historical experience in literature) and “the boundaries of personal initiative” in the process of the author’s creativity. Before giving a description of the individual originality of the artist, it is necessary to correlate his views with the ideas and ideas characteristic of his predecessors, his immediate environment; find in the author’s psychology the types of mental moods and forms of expression of feelings accepted at a given time; to discover in the personal aesthetic inclinations of the poet a reflection of broad literary movements; with the help of comparison, to discover recurring plots, images, stylistic formulas – elements that, being inherited, show the personal contribution of the artist of the word. This allows you to holistically perceive the work of an individual author and project this view on his works, which helps to avoid the gap between the original content of the work, the author’s intention, on the one hand, and the deliberate ignoring of the author’s position, free interpretations and exaggerations, on the other hand. “Following the thoughts of a great man is the most entertaining science” (A. S. Pushkin). We bring to your attention the development of a lesson dedicated to the work of V. A. Zhukovsky.

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U. Remember what you know about the life and work of VA Zhukovsky?

D. and U. – Education, talent, nobility of V. A. Zhukovsky attracted attention at the royal court, and Zhukovsky was appointed to the post of mentor to the heir to the throne – the future Emperor Alexander II the Liberator. The merit of V. A. Zhukovsky was that the emperor, until the end of his days, retained sympathy for goodness and justice.

– He is the author of the first official anthem of Russia “Prayer of the Russians”.

– Asked the question: “…should a poet confine himself to hymns to God alone and consider any other poetic creation as a sin against deity and humanity?” He affirmed the freedom of the poet in choosing the subject of creativity: “high or small, beautiful or ugly, meaningful or light, funny or gloomy – all of it, having passed through your soul, acquires its character, without changing its own at the same time.”

– Founder of the ballad genre in Russian literature. A ballad is a poetic story about historical events. The poet introduced the Russian reader to unknown old stories, to medieval legends of European peoples, but V. A. Zhukovsky processed each Western work in his own way and even gave the original source even more significance.

– Turned to writing fairy tales.

– Used “strange” epithets.

From “The Song of the Bard over the Coffin of the Victorious Slavs”

U. – “Zhukovsky’s creative path began on the eve of the 19th century, and the feeling of belonging to an era of great historical significance was the first manifestation of the future poet’s artistic feeling. At the turn of the XVIII and XIX centuries. Russian literature is entering a time of intense ideological and artistic searches: traditional genres, modifying and transforming them, are penetrated by new themes and ideas. Poetic thought… tries to comprehend the mysterious laws governing the destinies of peoples and states, determining the place of man in the universe, seeks to predict the future and comprehend the path passed by mankind. In the atmosphere of these quests Zhukovsky’s creative individuality is formed” (R. V. Iezuitova).

– The theme of “The Song of the Bard” was suggested to the poet by the “military circumstances of that time” , the battle of Austerlitz.

– What is the name of NM Karamzin’s poem dedicated to the same event?

D. Song of the Warriors.

U. To “Songs of the Bard” V. A. Zhukovsky gave a note: “Here the author was thinking about one young man, Novosiltsev, who in the last war was wounded in battle and died of wounds, separated from his fatherland, separated from his relatives who still mourn his loss. The author would like to name all our heroes who have so recently brought their blood and life as a gift to the fatherland, but their names are known, and gratitude will keep eternal memories of them.

– What was the purpose of NM Karamzin by writing his ode?

E. Call on fellow citizens, inspire courage in their hearts, explain the meaning of war.

U. What genre would you classify “The Bard’s Song” as?

D. Ode: dedicated to famous historical events, praising Russian heroes.

U. – The struggle for an ode in the 20s. nineteenth century had a turning point in the development of lyrics, when the genres of epistle and elegy were exhausted. There was a kind of fusion of oratorical poetry and elements of elegy. The ode has been significantly updated.

– Into whose mouth does the poet put the song?

D. In the mouth of a Celtic bard.

U. – V. A. Zhukovsky uses the Celtic genre of military lamentation, which allows him to convey the mournful mood of the Slavs at the “coffin” of Russian soldiers who fell in the battle of Austerlitz.

– What is the first passage of the “Song” about?

E. Description of the battle: “smoky whirlwind”, “sound of swords” , neighing of horses, crackling of trumpets, trembling of the earth, death of heroes.

W. From whom do we find such descriptions of battles?

D. A.S. Pushkin in Poltava, M.Yu. Lermontov in Borodino.

U. – The bard’s song is one of the early attempts to reflect the battle theme, which replaced the “soaring” and “piitic delight” of the ode. The poem by V. A. Zhukovsky gave rise to a special genre of patriotic lyrics – a military anthem, which became very popular in the poetry of the early nineteenth century.

– Find the intonation of the hymn in the ode.

D. – Exclamations: “Oh, the terrible sight of those trampled down by the battle!”, “Oh, the courage of the Slavs! O knights limit!

– Praises: “Praise to the sacrificed / For relatives, brothers and spouses; / Praise to the fatherland to the sacred guardians!”

– Appeals: “Betting, shine, exalted one” . ..

U. How is fate, fate understood in the ode?

D. The fate of the hero – “thunder flow of paths” , fight and fall in battle for the fatherland, for “relatives, brothers and spouses” .

U. How is heroism understood in the ode?

E. This is what promises bliss in the next world:

And in the coffin opposite fear,

And in the coffin is illuminated by a radiant daylight;

Blessed is he who perished in the prime of life… »

D. Remember what is the greatest virtue of a Christian?

E. Giving up one’s life “for one’s friends” is self-sacrifice.

U. How is glory and infamy understood in the ode?

J. – Praise is given to the soldiers who died on the battlefield, eternal glory awaits them, immortality: “Betting, shine, exalted one”, “faded with a thunderbolt”, “the whole world is your mausoleum”.

– Unknown – “inhabitant of dust – a worm in soul; let life count in the valley darkness for years”, “waiting, languishing, for the death of sluggish days”, “invisible flow” .

U. What elegiac intonations sound in the “Song”?

D. – Sadness about the death of Russian soldiers.

– A warrior, wounded, but survived, “decrepit under a wreath, clinging to a crutch with a wounded brow” , sadly looks at “beloved coffins” of fallen soldiers and “ weary is waiting for the end.”

U. What honors are given to heroes?

D.

« Blessed is he who completes the glorious path with glory;

When wreaths and honor take to dust with them

And, turning gray in laurels, fades away on laurels! »

U. What gives special solemnity to the syllable of the ode?

D. – Abundance of Church Slavonicisms: “behold”, “this”, “shuytsa”, “right hand”, “blessed”, “brow” …

– Sublime vocabulary: “dol”, “horugv” , “path”, “lay down” …

– Complex syntactic constructions.

U. From now on, the civic-patriotic theme, the theme of the motherland and its remarkable past, becomes an integral part of the work of VA Zhukovsky. A. S. Pushkin noticed the most important feature of the civil-patriotic lyrics of V. A. Zhukovsky – the absence of a loyal spirit in it and the expression of “truth” to the kings.

“To the Russian Giant”

U. – The writing of this poem was caused by another revolution in France in 1848 and the proclamation of the Second Republic led by Napoleon’s nephew. V. A. Zhukovsky asserts the original opposition between the revolution and Christianity.

– Which poem resonates with the image of the Russian giant?

D. With M. Yu. Lermontov’s poem “Two Giants”.

This poem is for independent analysis by children. It is necessary to identify the techniques of verbal painting, metaphorical images of a cliff – a symbol of Christianity in the face of monarchical Russia, and an ocean – a symbol of revolution in the face of rebellious France:

– The rock is “our solid”, the head is “under the stars”, the eagle is the prince of space, laughs at the rebellious abyss; clutches lightning bolts in claws; in the height of the air observes indifferently the boiling of the waves; “lord of the abyss”, “firstborn of creation”; granite breaking splashes.

– Ocean, whirlwind riot, howl of wild bad weather, abyss, storm, howl and roar, distraught anger, foam, many-headed waves, “cursing squeals”, “the wind that made them angry.”

Recitation of a poem.

An illustration of the poem is possible.

“Achilles”

U. – “Achilles” is a ballad. Along with ballads on medieval and Russian themes, V. A. Zhukovsky created translations and originals in the antique style. In the choice of the plot and in his treatment of the ballad “Achilles”, the influence of the ballads of F. Schiller, written by him on the plots of the “Iliad”, affected.

– How does the author himself explain the plot of the ballad in the note?

D. “Achilles was given a choice: either live a long time without glory, or die in youth with glory — he chose the latter and flew to the walls of Ilion. He knew that his end would soon follow the death of Hector, and he killed Hector, avenging Patroclus. This thought of imminent death followed him everywhere, and into a noisy battle and into a secluded tent; everywhere he remembered her; Finally, he heard the prophetic voice of his horses, announcing his death.

U. What is the theme of the ballad?

E. Fate, fate predetermine a person’s life path. But a person can choose one fate over another.

U. What is almost the entire content of the ballad?

E. Song-monologue of Achilles.

U. Describe the scene against which this monologue unfolds.

E. Mist has fallen on Mount Idu. A bright month rose over the Aegean plain, the stars lit up. Ilion plunged into the darkness of the night. Under the walls of the city, the camp of the Achaeans, the soldiers are sleeping. Bonfires are burning, around which guards are on duty. In the silence, their cries are heard. Priam appeared in the field, going to beg Achilles to give him the body of Hector. Achilles sits on the bank near the barrow.

U. – In the “Trojan Tale” we read that Priam played the lyre, Achilles himself sings with V. A. Zhukovsky.

– What fate does Achilles promise Hector?

E. Prayers of loved ones “Peace will be given in the land of shadows”.

W. What genre does this ballad echo?

D. With an elegy – a poetic genre with the character of thoughtful sadness, motifs of the frailty of earthly existence, loneliness, unfortunate fate.

U. We see that elegiac motifs permeate all the work of V. A. Zhukovsky. Find these moments in the ballad Achilles.

D.

– “We spoke one fate: Zeus also comprehended me.”

– “My hour is near; a fatal arrow is prepared.

– “And the gates of Hades will hide;

And a formidable voice broadcasts:

Everything happened for Pelid;

The torch of his days has gone out.”

– “Thus cruel fate judged me.”

– “… he paved the way to Tenar in revenge for his friend. ”

– “…death fettered his hands, he forgot the path to glory.”

W. Achilles first sang about the fate of Priam, now he foresees the future of his loved ones.

D.

– “Do not wait, Meletius, for a son; he will not come to his father’s house … “

-” In the father’s house, emptiness will soon, soon be established.

– “Oh Peleus, you are an orphan.”

– “Ships will come from Troy – but not me on one.”

– “… the call of the father will not reach the shore of the water of oblivion.”

W. Do you remember from the Iliad what Achilles said to Priam who came?

D. Lamented about the will of the gods and the fate of people, the inconstancy of joy and happiness. He urged Priam to console himself and be patient. He said: he himself understands that his son should be returned to Priam, he received a message about this from Zeus.

U. Was Achilles relieved by the murder of Hector, the desecration of his body, the magnificent funeral of Patroclus, funeral games in honor of a friend?

D. No. Only after a meeting with Priam, the soul of Achilles seems to be enlightened, washed with tears.

U. – The triumph of love, the highest mercy enters the hearts of mortal enemies.

– What range of feelings that flooded over Achilles is reflected further in the ballad?

E. Regret about “the land of the fatherland” , a wish for the native land to bloom and be cleaned with beauty, resound with a cry of joy.

U. Can we imagine that Homeric Achilles experienced similar feelings?

E. No, he complained more, did not utter enthusiastic speeches.

U. – VA Zhukovsky brings elements of sensitivity to the ballad. Achilles’ monologue with great artistic power recreates not so much the attitude of the ancient hero as the author’s inner feelings, elegiac sadness.

V. G. Belinsky emphasized that “Zhukovsky brought too much of his own into Greek contemplation” : inner experiences, striving for harmony and ideal. And “if Homer’s goal is to show the entire Trojan War, then for the Russian poet the main thing is the spiritual, moral content of the life of the ancient Greeks.”

Recitation of two stanzas “Swift horses… a voice that spoke”.

U. In what poem by A. S. Pushkin is this motif visible?

E. In the poem “Why are you laughing, my zealous horse?..”

U. Did Achilles know that he was destined to die from an arrow shot by Apollo?

D. No. The poet tells about his death in the words of Achilles.

U. Do you remember how the shadow of Patroclus appeared to Achilles?

D. Achilles was shocked by the appearance of Patroclus, his soul howled away to Hades.

U. Read how this phenomenon was graciously described by VA Zhukovsky?

D.

“Like a marshmallow breath,

He blew over me;

I heard a calling,

Sweet voice of my soul;

In a gentle gaze, sorrow of separation

And traces of past tears. ..

I stretched out my hands to my brother… 5 He disappeared into the empty haze.

W. What closes the composition of the ballad?

E. The same picture of Ilion, the plain, sleeping warriors, guards, dying fires.

U. The story of Achilles is reflected in the poetry of modern times, but still reveals eternal human passions and the eternal duel of man with fate.

From translations of the Iliad

U. – Homer was a companion of V. A. Zhukovsky throughout his creative life. For almost 45 years, V. A. Zhukovsky mentally turned to his legacy, drawing inspiration for his work. V. A. Zhukovsky is the author of the translation of Homer’s Odyssey. From the Iliad, he managed to translate two chapters. The translation of these songs was carried out 20 years after the translation of N. I. Gnedich was released. Every significant Russian poet longed to touch the work of the ancient Greek aed.

– The first publication of two songs was accompanied by the following note: “This translation is made for some special reason. The translator, who did not know Greek, tried only to guess Homer, having before his eyes the German translations of the Iliad … This experience of his should not be compared and cannot withstand comparison with the translation of N. I. Gnedich, who gives us Homer himself, listening to its natural language. Here, so to speak, one echo of the echo.

– V. A. Zhukovsky wrote: “The newest poetry, convulsive, hysterical, cloudy, tormenting the soul, disgusted me; I want to rest in the midst of bright visions of the primitive world…” He defined Homer as an “eternal poet”. In Homer and his poems he saw the expression of historical and national mythology. The poet noted Homer’s skill as a great painter in conveying the history and customs of his time, in recreating details, in depicting heroes, in creating “a strong and fiery style”: “Fire and simplicity are the main difference of Homer” . The Russian poet especially emphasized in Homer the “elevation of the spirit” and the philanthropy of his epic: “Hatred is unfamiliar to Homer’s heart”; “The epic poem is the most moral of all kinds of poetry. ..” The spirit of the Homeric epic corresponded to the mental disposition of V. A. Zhukovsky.

– What other passage, besides the first two chapters, was translated by VA Zhukovsky?

E. Meeting of Hector and Andromache.

U. In whose translation, besides NI Gnedich, did we read this passage?

D. Translated by N. M. Karamzin.

U. Let’s compare the translation by N. I. Gnedich, which exactly corresponds to the text of Homer, and the “echo of an echo” by V. A. Zhukovsky.

Working with a single file.

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D. – V. A. Zhukovsky skipped some verses.

– Translation made with hexameter.

– Sublime syllable.

– Close to the translation of N. I. Gnedich.

W. Look for some subtle differences.

D. – “A wonderful husband.” — “Relentless.”

– “I will be a widow, unfortunate one!” – “Soon to the desolate widow.”

– “… at the valleys of the oak forest. ” – “… from the densely wooded pastures.”

– “Hector, you are everything to me now – both father and kind mother.” – “Hector, you are everything to me now: both father and tender mother.”

– “Have pity on me and stay with us on the tower.” – “Be compassionate to me, stay here on the tower.”

– “The famous Hector, sparkling with a helmet, answered her.” – “Hector, decorated with a maned helmet, meekly answers.”

– “There will be a day when holy Troy will perish.” – “Someday this day will come – sacred Troy will fall.”

– “Rivers – and the brilliant Hector rushed to embrace his son.” “Thus answered Hektor, and he stretched out his hands to his son.”

– “This beloved son of mine, like me, is famous among the citizens.” – “Once my son, like me, was the first among the people in charity.”

– “Good! do not break your heart with immoderate sorrow. “Poor girl, you shouldn’t be upset about me so much. ”

– “Having finished his speeches, he picked up the armored Hector from the ground.” “Having finished, the brilliant Hector raises his maned helmet.”

U. V. A. Zhukovsky, by the definition of A. S. Pushkin, was a real “translation genius” . The poet’s passion for transcriptions and translations was sometimes condemned for reasons of patriotism. But in his translations, V. A. Zhukovsky sought to enrich Russian poetry by mastering the literary and artistic experience of the entire world culture.

The Epistle “To Goethe” – for independent reading by children.

Elegy “The Sea”

U. – From the solemn ode, from the messages, V. A. Zhukovsky comes to the elegies proper, which come to the fore in his work. V. G. Belinsky wrote: “From the solemn odes, the audience has already blocked their ears, and she has become deaf to them. Everyone was waiting for something new. Then Zhukovsky appeared.

– What did the sea symbolize in the poem “To the Russian Giant”?

E. Revolutionary unrest.

W. Elegy is a lyrical work, and the image of the sea is associated with the lyrical hero. What, therefore, does the sea symbolize in the elegy of V. A. Zhukovsky?

E. The soul of a lyrical hero.

U. – V. G. Belinsky said that it was V. A. Zhukovsky who “was the first in Rus’ to express in elegiac language man’s complaints about life.”

– What poetic technique is used by the author, endowing the sea with the ability to think and feel?

E. Personification.

U. Consider the states of the sea and draw analogies with the human soul.

E. 1. The state of a slight roughness of the sea — confusion of love, anxious thoughts: “The silent sea, the azure sea… / You are alive; you breathe; confused love, / You are filled with an anxious thought.”

2. A state of rest — a state of peace: “You pour it (the sky) with luminous azure . ..”

3. Storm — human passions, experiences: “You fight, you howl, you raise the waves, / You tear and torment the hostile darkness… ”

4. The calm after the storm – the ensuing calm: “You raise frightened waves for a long time.”

U. What determines the state of the sea?

D. From the sky.

U. Draw parallels between the state of the sky and the sea.

E. 2. The state of rest:

« You are pouring its radiant azure,

You burn with evening and morning light,

You caress its golden clouds

And joyfully shine with its stars .”

3. Storm:

« When the dark clouds gather ,

You tear and torment the hostile mist… »

4. Calm:

“And the darkness disappears, and the clouds go away,

But, full of your past anxiety,

You raise frightened waves for a long time, the sweet brilliance of heaven returned. ..”

U. How does the sea breathe in relation to the sky?

D. Confused Love.

W. The connection of the sea with the sky is a symbolic connection of the human soul with a high spiritual ideal, striving for it, the struggle to achieve perfection. How is this expressed in an elegy?

D.

« Ile pulls you out of earthly bondage

Far bright sky towards you?

You, admiring the sky, tremble behind him “.

U. The sea is in captivity, like everything on earth. Everything on earth is changeable, impermanent, life is full of losses, disappointments and sadness. What words testify to this?

D. “The appearance of your immobility is deceiving.”

U. – Only in heaven everything is eternal and beautiful. That is why the sea stretches “out of earthly bondage” to the “distant, bright” sky.

– Why is the sea called silent?

E. It cannot reveal its secret.

U. How does the lyrical hero comprehend this secret? What is behind these images?

E. Comprehends, looking at the sea and the sky. Reflecting on the states of the soul and the spiritual ideal.

U. – Before us is not ordinary nature, but “breathing the mysterious life of the soul and heart, full of the highest meaning and significance” (V. G. Belinsky). This elegy reflected the deification of nature characteristic of the early work of V. A. Zhukovsky, the attitude to nature as a deity, the discovery in it of good and just principles, the origins of love ^[1] , which stemmed from antiquity. Later, V. A. Zhukovsky will return to an uncomplicated Christian worldview.

– What are the characteristics of elegy versification?

D. – Amphibrach with four feet.

– White verse.

U. – Thanks to these verse properties, the elegy has an extraordinary musicality and melody. With V. A. Zhukovsky in Russian poetry, the solemn, oratorical verse characteristic of the ode came to be replaced by a melodious verse.

– In melodious verse, phrases are subject to musical composition, rhythm and melody.

– Find examples of repetitions similar to those in a song.

D. – « Silent sea, blue sea “.

– “What moves your immense bosom? / How does your tense chest breathe? »

– “You are pure in the presence of his pure: / You are pouring his luminous azure…” you tear and you torment the hostile darkness…”

– “You hide confusion in the abyss of the dead, / You, admiring the sky, tremble for it.”

U. Melodious verse is characterized by an increase in lyrical tension.

D. “When dark clouds gather…”

U. Poems are united symmetrically.

E. The whole poem can be divided into 7 completed quatrains.