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Rachel Choi is a PhD student at the Murray Maxwell Biomechanics Lab and the Raymond Purves Research Lab at the IBJR. Her research interest in tendon biology coincides with a personal interest in music and sporting performance, and associated injuries. She graduated in 2012 from the University of Sydney (B. Engineering (Biomedical), B. Commerce (Economics)), while squeezing in academic credit for wind orchestra and symphony orchestra during her year of study abroad at the University of California Irvine.


The surf was perfect this morning, as was my post-surf breakfast at the local cafe. Equipped with one functioning leg and one walker boot, I had surmounted the last of the cafe stairs when a familiar conversation begins: “What have you been doing to yourself”, in reference to my boot. I’ve had a total rupture of my right Achilles tendon. “How did it happen?” Playing touch footy. “Ah, some really rough fields eh?” Well, actually no, I was just taking off in a straight line with the ball in hand. “Achilles tendon, gee that must’ve really hurt”. Nope. It took me a good half minute to deduce that I might have a total Achilles tendon rupture. The pain only really set in after the operation.

Just as I appreciate the kindness shown to me as a crutch user, I really do enjoy these “crutch/cast conversations”. However, I find it awkward anticipating the complete mismatch in how much we know about tendons.

Irony alert: Yes, I am a PhD student in tendon biology with an Achilles tendon rupture.

I find myself in a unique position where I’m a tendon rupture patient (right leg), a chronic tendinopathy patient (left leg), and also a tendon basic science researcher in training (brain, bilateral). So Bob, my dear waiter, how much did you want to know about my tendon exactly?

If two years of PhD research has taught me anything, it’s that tendon injuries and pain occur with many variations. What we know is only a small part of what’s happening inside and around our tendons. And so it’s natural that my waiter’s guesses about my conditions didn’t match up with my very own, unique patient experience. MyInjury™? iRupture™?

But let’s start with what we know.

1. Tendon ruptures are common.

I meet at least 2 people every week who tell me they know someone who’s ruptured an Achilles tendon. Usually, they are someone’s father, sometimes mother. A young person’s athletic drive in a not-so-young body. My surgeon estimates he operates on about 20 Achilles tendons per year. In the state of NSW, 400 Achilles tendons are surgically operated each year. In the sporting world, you don’t have to look far to find chronically painful tendons: Achilles, hamstrings, tennis elbows and biceps.

2. You don’t get a warning shot
While you can’t believe everything you hear, physios have told me that the Achilles tendons that rupture are usually pain-free prior to rupture. I can confirm this was true in my case.

3. Most tendons have a natural spiral arrangement of the main structural element - collagen fibers (fascicles). Problem tendons tend to present with pain associated with being compressed by other structures around the tendon.


3b. Surgeons are often asked to repair tendons which cross over two joints (hamstring, achilles, biceps). I thought I’d include this one since I picked this up as I lay on the operating table, with the surgeon teaching his junior medical officer.

About what we don’t know:

You would imagine that tendon injuries have a lot to do with load. Unfortunately, almost all the research done to date focuses on solely how tension related loads affect tendons. But if you’re an engineer like me, you’re going to be wondering what about impingements and pressing on the tendon - compression? What about twisting the tendon - torsion? That is, being a tendon is a 3D experience and that involves much more than just one type of load. And 30kg of force on an Achilles tendon is completely different to a hamstring tendon, but we don’t know why.

That’s where my PhD comes in: To you and me, my PhD means 4 years of my life are spent making a sufficiently important scientific discovery understanding tendons and how they are affected by different loads, and why they are affected by those loads.

And why do I do this? So we can build new bullet trains to recovery. But first we need to understand the science.

Making the most of the scenic road to recovery. Data analysis in the sun.

Spot the chicken leg. The effect of 8 weeks of immobilization on lower limb muscles and melanin levels.

While researchers have made important discoveries focusing on these tensile loads, we still lack the information and strategies that could’ve prevented my tendon rupture. And the road to a full recovery is still under construction. Meanwhile, we know nothing about what these other loads do to tendon, despite associations that implicate their role in injuries. Now, if I were a certain talkback radio host with a surfeit of vitriol, I would condemn the narrowness of this research focus as outrageous, a disgrace and probably wasteful. But since I’m not, I’m just going to back to my PhD to try to figure out how to fix this tendon problem.

We’re not there yet.

p.s. Robbie the lifeguard and soccer player/referee has calcifications forming inside his achilles tendon. His mother gets them too in her rotator cuff. I love hearing about tendons, so if you (or someone you know) has a tendon injury, pain or anything interesting, please contact me at Rachel.choi@sydney.edu.au. Maybe I’ll start a survey. Or just a patient support group. It’s actually really hard living with an Achilles tendon rupture.

p.p.s. Since this is a research blog, it wouldn’t be right to finish without some more statistics.



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