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Don’t come back to sports cold

22 September 2021

We’re seeing an increase in return-to-sport injuries and in particular Achilles tendon ruptures since lockdown restrictions ended. 

Our rupture clinic has been seeing more than six Achilles tendon ruptures per week, compared to an average for Leicester and Leicestershire of only two per week since 2014. During lockdown, this number reduced to less than one per month.  

Achilles tendon ruptures can be managed successfully without surgery. But with a recovery period of up to a year before people can return to playing recreational sport, the injury can have significant personal and financial implications. 

The reason for the increase in cases is that during lockdown, our bodies have been ‘detrained’. Without participation in their regular sporting activities, people have lost their sport-specific fitness, with the involuntary lack of sporting activity having a significant impact on our bodies.  

Two recent studies looking at the effects of such a long period of detraining in elite athletes (Paoli / Musumecci) and footballers (Biscotti et al) highlighted significant decreases in: 

  • Cardiovascular fitness – centrally in the heart / lungs and in the periphery by a decrease in oxygen supply to the muscles / tendons, etc  
  • Muscle strength  
  • Muscle power 
  • Cartilage 
  • X-sectional area of muscle tissue 
  • Collagen synthesis in tendon tissue 
  • Neuromuscular system 
  • Flexibility 

This can happen rapidly over a two-to-eight week period, leading to an increase in injury risk, as seen for example in pre-season football / rugby training.  

Comparisons can be drawn with the forced lockout of players in the US National Football League (NFL) between March - July 2011, during which there was a sharp rise in the incidence of Achilles tendon injuries and ruptures. One third of players with ruptures never returned to the NFL, while the two-thirds who did typically needed 11-12 months of rehabilitation before returning. Not since World War II has the population had such a prolonged period of detraining, for which there is no research to compare.  

During the pandemic, some people have reported a lack of means or motivation to keep fit, with many reporting a rise in body weight. Others who might usually have participated in sports have found alternative ways of keeping fit – for example through cycling, running, walking, or home weights, but this does not mean that they should return to usual sporting activities ‘cold’, as they will still need to retrain their bodies to decrease their risk of injury.  

It’s important to consider how fit you are, how long you have been inactive for or away from your sport and this will give you an indication of how long you need to train to return to sport safely and to minimise the risk of injury.  
Depending on your pre-lockdown fitness, a graded exercise programme of up to 12 weeks should be considered. 

We recommend that the graded exposure training period should include sessions on:

  • Cardiovascular fitness 
  • Strength and conditioning 
  • Neuromuscular  
  • Flexibility 

Later training sessions should progress to speed and explosive training for contact sports such as football, rugby, netball, basketball, tennis and badminton. 

To help reduce the risk of Achilles ruptures, our Physiotherapy team have produced a video with some example exercises to help. 


Communications team: communications@uhl-tr.nhs.uk