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PostPosted: 23 Apr 2013, 04:49 
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After reading about the ruptued achilles tendon and subsequent surgery for Kobe Bryant, the star basketball player of the Los Angeles Lakers, I started to think again about ruptured achilles tendon injuries resulting from playing table tennis. In particular, I was wondering whether a ruptured achilles tendon is most likely to occur in defensive players, such as myself. (I have completely ruptured both of my achilles tendons.) (As with my post on the 1975 World Championships, this post ended up being much longer than I had expected. I hope that some people are interested to read this through to the end.)

With regard to my unpleasant experiences with this injury, back in 1987, I completely ruptured my left achilles tendon. I was competing in a tournament, actually the last time I played in a tournament. I was far from the table, chopped a ball too high, and then moved backwards in anticipation of a smash. Instead, my opponent gave me a drop shot. I abruptly changed direction, and it immediately felt as if the back of my ankle was smashed with a baseball bat. Two days later, I had surgery for a completely ruptured achilles tendon (torn in half). My surgeon told me that I would never walk again without the surgery. The recovery was very long and hard, with many weeks of intense pain, 3 months in a cast with crutches, and and long slow recovery afterwards. That injury ended my table tennis for 25 years.

Twenty five years later, in the fall of 2011, I decided to try to play table tennis again. I had assumed that I would be no better than a compete beginnger as I had been away from the sport for so long. However, I was wrong, and my skills were quickly returning. Playing table tennis, chopping back loops, was like a dream come true. I never thought that I would be able to do this again. However, after about 3 or 4 practices, I completely ruptured my right achilles tendon. My movement was essentially identical to the for my first achilles tendon rupture 25 years earlier, i.e., chopping high, moving backwards, followed by an attempt to retrieve a drop shot. I couldn't believe that I had done this again. At the moment of the rupture, I heard that old, familiar, terrible ripping sound from my ankle, and I knew what had done. It was a horrible feeling, and I thought that my wonderful return to table tennis had permanently ended.

Surgery was scheduled again. However, the day before the surgery, I came across the following article on the web. See http://www.ncbi.nlm.nih.gov/pubmed/21037028 . I work as an atmospheric scientist, and so I could not follow the medical terminology, but following the statistics was fine. Basically, this study showed that there is no difference in the outcome between surgery and the non-surgical option, as long as one follows through with physical therapy for the latter option. The authors examined both the rate of re-rupture and the range of various movements following a specified time period after the surgery. Furthermore, with surgery, about 1 in 15 patients developed very dangerous side effects. So, I called up my doctor, and cancelled the surgery. Fortunately, my recovery has been excellent. My achilles tendons probably haven't been this strong since I was in my twenties. And, I am playing table tennis again too, which is absolutely fantastic and a great joy..

Since I have ruptured both of my achilles tendons in the same way, playing defense, I have wondered whether this is mostly a defenders injury. To picture how my movement can tear an achilles tendon in half, consider the best way to rip an elastic band. One would first compress the elastic band, and then rapidly stretch the elastic band as fast as one could. This kind of motion is analogous to first moving backward and then moving forward. I couldn't find any information on the web linking defensive table tennis to ruptured achilles tendons. However, I did find the following badminton article http://www.ncbi.nlm.nih.gov/pubmed/2605439. One particular sentence caught my attention. "This is supported by the fact that the rupture in 87 per cent of the cases happened in a sudden forward movement." Such movement appears to be consistent with the movement in my two ruptures, i.e., lunging forward to retrieve a drop shot.

Does anyone have the impression that a ruptured achilles tendon is primarily a defensive players injury? (Keep in mind that only a few percent of table tennis players play defense.) I don't expect that there has been a careful study of this question, but I would be very interested in hearing any anecdotal links between playing defense and ruptured achilles tendons.

Steven

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Last edited by birding&table.tennis on 23 Apr 2013, 09:36, edited 1 time in total.

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PostPosted: 23 Apr 2013, 05:06 
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Hello Steven.

Yes, I think most regular forumites will most definitely read your posts from start to finish as they are clearly very well thought out.

Whether or not such injuries are oriented toward defensive players I have no idea. I do however concur with your appreciation of the physiotherapists approach to recovery, I had some horrible athletic injuries in my younger years and it has always been the physio who sorted me out..... In fact, as a child my parents were told I would not be able to walk properly or play sport at all..... Guess who sorted that out.....? Yup, physios. A 30 year athletic 'career' and a decent TT revival has followed.....

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PostPosted: 23 Apr 2013, 16:20 
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Hi Steven, this is a most interesting topic you have raised here for me. We have something in common. I ruptured my left achiilles tendon in 2008. Completely snapped it as you did. How did it happen? Chopping a ball from almost to the floor where I'd gone down so low I was totally on my haunches. It was in doubles and so I was pushing back up on my heels through my knees to get ready for my next shot. Something gave and I fell backwards. I thought I'd twisted my ankle, it was godawful pain! Being the fanatic I am though I kept playing. Not just the doubles, but the 2 other singles I had scheduled for the rest of the night. I played with my left foot barely touching the ground and without being able to take a single step in any direction. Needless to say I lost the other 2 matches, as well as the doubles we were in the middle of.

The next day I was off on holidays, and thinking I had just badly twisted my ankle I went off thinking I'll see a doctor somewhere if I really need to, or get some bandaging for it...or something. I hobbled around on the week's holiday and I did get some strapping for it. Over the course of the week it improved somewhat and so I figured my injury was getting better. When I got back I started a new TT season and I was bearing weight on the leg well enough, so I just kept playing. It was about 7 weeks since the injury and I'd been walking on it a lot and playing and while it had improved, I decided it should have improved more. So I finally went to see a doc and he ordered an Ultrasound on it. I went to the ultrasound clinic and the operator started scanning my leg and then asked me how I got into the clinic. I said I drove. She said, yes but did you then come on crutches or a wheelchair? I looked at her funny as she knew I'd walked into the scanning room. She said I had a 13cm gap between the two ends of my achilles and it was virtually impossible that I was walking. After this she went on got a doctor to verify what she was looking at and he was confounded that I could walk.

After that I had surgery ordered and I went and got it all stitched up and after 8 weeks in plaster and 6 months off TT with rehab I was fine again. When the surgeon spoke to me after the surgery though, he said one end of the achilles had started to attach itself to flesh inside my leg and was trying to knit there as its way of natural recovery. It never would have been as strong as the stitched up achilles, but I guess its what it had done to try to support the weight I'd been putting on it in the time it was broken.

I'm not sure if what I had inadvertently done was some crude form of the non-operative method referred to in your link, as they don't seem to detail what is involved in that method. But if it is, I reckon the rehab would be very hard as I know the exercises I had to do after the surgery to rehab mine would have been nigh impossible without the surgery (like heel raises on the left foot alone).

Thanks for raising the subject. Its always interesting to exchange experiences like this.

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PostPosted: 24 Apr 2013, 09:36 
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Is there an indication if you are to rupture your achilles tendon or just realize it when it happened? Does rupture slowly develops or you will just experience it suddenly?

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PostPosted: 24 Apr 2013, 13:35 
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I think its usually only sudden Red. However, I do know you can experience pain or stress in your achilles. Whether this is a precursor to it rupturing I don't know. I guess its possible, but I think you still have to stretch on it really hard to rupture it. I can sure tell you, reaching for that shot in desperation to win a SINGLE point that may risk snapping it is certainly NOT worth the point!

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PostPosted: 24 Apr 2013, 15:57 
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Interesting topic and I must admit that I had a totally opposite experience than you guys. I've had this type of injury on my football match, just maybe not as severe (I didn't need a surgery). My recovery was very long.. I think I've started to practice football only after 7-8 months and I had to wear protective gear. Almost after every match my ankle hurt, and It was very easy to renew the pain even when not expected.

After I came back to table tennis these problems were gone pretty soon. Now my ankles hurt only on very rare occasions. So at least for me table tennis and it's movement helped to strengthen ankles once again.

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PostPosted: 24 Apr 2013, 18:06 
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RebornTTEvnglist wrote:
I think its usually only sudden Red. However, I do know you can experience pain or stress in your achilles. Whether this is a precursor to it rupturing I don't know. I guess its possible, but I think you still have to stretch on it really hard to rupture it. I can sure tell you, reaching for that shot in desperation to win a SINGLE point that may risk snapping it is certainly NOT worth the point!


Thanks Reb for the share. I believe, a real TT player will always reach for that desperation shot. Heck, I even dive for balls and try to put it back on lying position. :D

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PostPosted: 30 Apr 2013, 05:39 
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birding&table.tennis wrote:
...The recovery was very long and hard, with many weeks of intense pain, 3 months in a cast with crutches, and and long slow recovery afterwards. That injury ended my table tennis for 25 years.

Twenty five years later, in the fall of 2011, I decided to try to play table tennis again. I had assumed that I would be no better than a compete beginnger as I had been away from the sport for so long. However, I was wrong, and my skills were quickly returning. Playing table tennis, chopping back loops, was like a dream come true. I never thought that I would be able to do this again. However, after about 3 or 4 practices, I completely ruptured my right achilles tendon. My movement was essentially identical to the for my first achilles tendon rupture 25 years earlier, i.e., chopping high, moving backwards, followed by an attempt to retrieve a drop shot. I couldn't believe that I had done this again. At the moment of the rupture, I heard that old, familiar, terrible ripping sound from my ankle, and I knew what had done. It was a horrible feeling, and I thought that my wonderful return to table tennis had permanently ended.

Surgery was scheduled again. However, the day before the surgery, I came across the following article on the web. See http://www.ncbi.nlm.nih.gov/pubmed/21037028 . I work as an atmospheric scientist, and so I could not follow the medical terminology, but following the statistics was fine. Basically, this study showed that there is no difference in the outcome between surgery and the non-surgical option, as long as one follows through with physical therapy for the latter option. The authors examined both the rate of re-rupture and the range of various movements following a specified time period after the surgery. Furthermore, with surgery, about 1 in 15 patients developed very dangerous side effects. So, I called up my doctor, and cancelled the surgery. Fortunately, my recovery has been excellent. My achilles tendons probably haven't been this strong since I was in my twenties. And, I am playing table tennis again too, which is absolutely fantastic and a great joy..

[...]
Steven


Thanks for sharing this great story (especially the happy end), Steven. You're a true come-back chopper! It must have been hard when you were forced to stop playing at such a high level and at such a young age. How did you feel about that?

I wonder why you waited 25 years before trying TT again. Was it necessary because of your injury to wait so long? Or was it partly a mental thing?

The part about cancelling the surgery and chosing for physical therapy instead with a wonderful result is almost scary. It seems like those medical specialists tend to only see the remedy in terms of surgery (which is their job). They should know about those studies (saying that physical therapy has the same results) and they should give you both options...

I never had any severe physical problems, except for sore knees when I started playing again after a few years of 'paternity break'. At that time, I combined tennis and table tennis and it was a bit too much at once I guess. But it got better, I learned to rest when necessary and up till today, whenever I feel something on my knee, I start wearing a supporting bandage and that seems to help preventing worse problems pretty well.

I also think it is important to train vulnerable body parts (back, knees, achilles) by firming exercises. I have heard before (and experienced) that that cycling helps strenghtening the knees and abdominal exercises help preventing back problems...

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PostPosted: 30 Jul 2013, 22:22 
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so_devo wrote:
Hello Steven.

Yes, I think most regular forumites will most definitely read your posts from start to finish as they are clearly very well thought out.

Whether or not such injuries are oriented toward defensive players I have no idea. I do however concur with your appreciation of the physiotherapists approach to recovery, I had some horrible athletic injuries in my younger years and it has always been the physio who sorted me out..... In fact, as a child my parents were told I would not be able to walk properly or play sport at all..... Guess who sorted that out.....? Yup, physios. A 30 year athletic 'career' and a decent TT revival has followed.....


I am finally getting back to responding to all of the comments on my post about my achilles tendon rupture.

so_devo, thanks for your comment. Its incredible to read about the benefit that you have had with physio. I have had comments from many people on the benefit of avoiding surgery (when it is realistic) and instead opting for physical therapy.

Steven

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PostPosted: 30 Jul 2013, 22:34 
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RebornTTEvnglist wrote:
Hi Steven, this is a most interesting topic you have raised here for me. We have something in common. I ruptured my left achiilles tendon in 2008. Completely snapped it as you did. How did it happen? Chopping a ball from almost to the floor where I'd gone down so low I was totally on my haunches. It was in doubles and so I was pushing back up on my heels through my knees to get ready for my next shot. Something gave and I fell backwards. I thought I'd twisted my ankle, it was godawful pain! Being the fanatic I am though I kept playing. Not just the doubles, but the 2 other singles I had scheduled for the rest of the night. I played with my left foot barely touching the ground and without being able to take a single step in any direction. Needless to say I lost the other 2 matches, as well as the doubles we were in the middle of.

The next day I was off on holidays, and thinking I had just badly twisted my ankle I went off thinking I'll see a doctor somewhere if I really need to, or get some bandaging for it...or something. I hobbled around on the week's holiday and I did get some strapping for it. Over the course of the week it improved somewhat and so I figured my injury was getting better. When I got back I started a new TT season and I was bearing weight on the leg well enough, so I just kept playing. It was about 7 weeks since the injury and I'd been walking on it a lot and playing and while it had improved, I decided it should have improved more. So I finally went to see a doc and he ordered an Ultrasound on it. I went to the ultrasound clinic and the operator started scanning my leg and then asked me how I got into the clinic. I said I drove. She said, yes but did you then come on crutches or a wheelchair? I looked at her funny as she knew I'd walked into the scanning room. She said I had a 13cm gap between the two ends of my achilles and it was virtually impossible that I was walking. After this she went on got a doctor to verify what she was looking at and he was confounded that I could walk.

After that I had surgery ordered and I went and got it all stitched up and after 8 weeks in plaster and 6 months off TT with rehab I was fine again. When the surgeon spoke to me after the surgery though, he said one end of the achilles had started to attach itself to flesh inside my leg and was trying to knit there as its way of natural recovery. It never would have been as strong as the stitched up achilles, but I guess its what it had done to try to support the weight I'd been putting on it in the time it was broken.

I'm not sure if what I had inadvertently done was some crude form of the non-operative method referred to in your link, as they don't seem to detail what is involved in that method. But if it is, I reckon the rehab would be very hard as I know the exercises I had to do after the surgery to rehab mine would have been nigh impossible without the surgery (like heel raises on the left foot alone).

Thanks for raising the subject. Its always interesting to exchange experiences like this.


RebornTTEvnglist, I am so sorry for being slow in responding to your comment on my post. Before writing my post, I had read everything that you had written about your achilles tendon rupture. Of course it was all fascinating to me. So, I had been expecting that you would write something in response to my post.

Your experience sure is incredible. I sure don't have the ability to put up with pain like you. It is amazing that you could move around with 13cm gap between the two ends of your achilles tendon. I would have guessed that that would have been impossible, since you couldn't contract your calf muscles. Your 6 months recovery is impressive too. My recovery took about 12 months, and my would-be surgeon was impression with my recovery. He told me that my recovery could not have been quicker even with surgery. The attachment between your tendon and inside of your leg sounds sort of gruesome. My physical therapist told me that this re-connection involves stem cells, but I don't have the background to understand this. In a study of about 30 National Football League players that completely ruptured their achilles tendons, I read that an 11-month recovery is average. About 1/3 of the football players retired after their achilles tendon rupture, and the remaining 2/3 had much diminished careers afterwards. None returned to their former level.

My concern is that I completely rupture an achilles tendon for a third time. My physical therapist told me that the most outstanding risk factor for injuries is a previous injury of the type under consideration. I can't help but wonder whether I am at risk for another achilles tendon rupture.

Steven

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PostPosted: 30 Jul 2013, 22:40 
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Red_lion wrote:
Is there an indication if you are to rupture your achilles tendon or just realize it when it happened? Does rupture slowly develops or you will just experience it suddenly?


Red_lion, thanks so much for your comment. From what I have read, and from what my physical therapist told me, in most cases there is no advance warning that the achilles tendon is about to rupture. In other words, one moment one feels fine, and the next moment it is no table tennis for 6 to 12 months. Plus, the pain associated with this injury, especially after surgery (I had surgery following my first achilles tendon rupture), is absolutely terrible.

In my case, before the injury, I felt absolutely fine. However, at the moment of my injury, I heard that old a familiar sound that resembled the ripping of an elastic band. I knew immediately what I had done. It was a terrible feeling. I had thought that my return to table tennis was over, and that I could never play again. Fortunately, that is not the case, and I enjoy every time that I play table tennis, even when I have a bad day.

Steven

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PostPosted: 30 Jul 2013, 22:44 
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Red_lion wrote:
RebornTTEvnglist wrote:
I think its usually only sudden Red. However, I do know you can experience pain or stress in your achilles. Whether this is a precursor to it rupturing I don't know. I guess its possible, but I think you still have to stretch on it really hard to rupture it. I can sure tell you, reaching for that shot in desperation to win a SINGLE point that may risk snapping it is certainly NOT worth the point!


Thanks Reb for the share. I believe, a real TT player will always reach for that desperation shot. Heck, I even dive for balls and try to put it back on lying position. :D


I certainly agree with Red_lion, that it is difficult to avoid going for desperation shots. To avoid this problem, I play no games now, except for friendly practice games of doubles. I know myself well enough that if play a match I will be tempted to reach for balls that put my achilles tendon at risk for another rupture.

Steven

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PostPosted: 30 Jul 2013, 22:50 
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RebornTTEvnglist wrote:
I think its usually only sudden Red. However, I do know you can experience pain or stress in your achilles. Whether this is a precursor to it rupturing I don't know. I guess its possible, but I think you still have to stretch on it really hard to rupture it. I can sure tell you, reaching for that shot in desperation to win a SINGLE point that may risk snapping it is certainly NOT worth the point!


RebornTTEvnglist, I think that I have read of cases where that was an advance warning of a pending achilles tendon rupture. This has involves people with achilles tendonitis. In one article that I read, the authors stated that people with achilles tendonitis are at an increased for an achilles tendon rupture.

The biggest risk factor it seems is playing table tennis (or other sports like badminton and basketball) with a full effort after a long period without physical activity. A weak achilles tendon puts one at much greater risk for an achilles tendon rupture. This is what I did, as I was away from table tennis for 25 years, and then played all out in a practice match. It sure felt foolish afterwards to get such a serious injury due to try hard to reach a drop shot in a friendly practice game.

Steven

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PostPosted: 30 Jul 2013, 22:52 
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Justas wrote:
Interesting topic and I must admit that I had a totally opposite experience than you guys. I've had this type of injury on my football match, just maybe not as severe (I didn't need a surgery). My recovery was very long.. I think I've started to practice football only after 7-8 months and I had to wear protective gear. Almost after every match my ankle hurt, and It was very easy to renew the pain even when not expected.

After I came back to table tennis these problems were gone pretty soon. Now my ankles hurt only on very rare occasions. So at least for me table tennis and it's movement helped to strengthen ankles once again.


Justas, I am glad to read that your ankle is in good shape and that all is well with your ankle and playing table tennis. It sounds like you didn't completely rupture your achilles tendon, i.e., a partial rupture. Nevertheless, as you write, a partial tear can still be an awful injury. Steven

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PostPosted: 30 Jul 2013, 23:13 
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Comeback Chopper
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Pipsy wrote:
birding&table.tennis wrote:
...The recovery was very long and hard, with many weeks of intense pain, 3 months in a cast with crutches, and and long slow recovery afterwards. That injury ended my table tennis for 25 years.

Twenty five years later, in the fall of 2011, I decided to try to play table tennis again. I had assumed that I would be no better than a compete beginnger as I had been away from the sport for so long. However, I was wrong, and my skills were quickly returning. Playing table tennis, chopping back loops, was like a dream come true. I never thought that I would be able to do this again. However, after about 3 or 4 practices, I completely ruptured my right achilles tendon. My movement was essentially identical to the for my first achilles tendon rupture 25 years earlier, i.e., chopping high, moving backwards, followed by an attempt to retrieve a drop shot. I couldn't believe that I had done this again. At the moment of the rupture, I heard that old, familiar, terrible ripping sound from my ankle, and I knew what had done. It was a horrible feeling, and I thought that my wonderful return to table tennis had permanently ended.

Surgery was scheduled again. However, the day before the surgery, I came across the following article on the web. See http://www.ncbi.nlm.nih.gov/pubmed/21037028 . I work as an atmospheric scientist, and so I could not follow the medical terminology, but following the statistics was fine. Basically, this study showed that there is no difference in the outcome between surgery and the non-surgical option, as long as one follows through with physical therapy for the latter option. The authors examined both the rate of re-rupture and the range of various movements following a specified time period after the surgery. Furthermore, with surgery, about 1 in 15 patients developed very dangerous side effects. So, I called up my doctor, and cancelled the surgery. Fortunately, my recovery has been excellent. My achilles tendons probably haven't been this strong since I was in my twenties. And, I am playing table tennis again too, which is absolutely fantastic and a great joy..

[...]
Steven


Thanks for sharing this great story (especially the happy end), Steven. You're a true come-back chopper! It must have been hard when you were forced to stop playing at such a high level and at such a young age. How did you feel about that?

I wonder why you waited 25 years before trying TT again. Was it necessary because of your injury to wait so long? Or was it partly a mental thing?

The part about cancelling the surgery and chosing for physical therapy instead with a wonderful result is almost scary. It seems like those medical specialists tend to only see the remedy in terms of surgery (which is their job). They should know about those studies (saying that physical therapy has the same results) and they should give you both options...

I never had any severe physical problems, except for sore knees when I started playing again after a few years of 'paternity break'. At that time, I combined tennis and table tennis and it was a bit too much at once I guess. But it got better, I learned to rest when necessary and up till today, whenever I feel something on my knee, I start wearing a supporting bandage and that seems to help preventing worse problems pretty well.

I also think it is important to train vulnerable body parts (back, knees, achilles) by firming exercises. I have heard before (and experienced) that that cycling helps strenghtening the knees and abdominal exercises help preventing back problems...


Pipsy, my first serious injury was a back injury. I first injured my back was I was 17 years old, about 2 months before the 1975 World Championships. Fortunately, I was able to compete in the world championships, which was a dream come true for me, but another back injury a few months after the world championships completely ended my competing internationally. My doctor told me that a disk was out of place, and my days on the Canadian national team were permanently over. That was rather depressing, but I knew that I had to be more serious with my schoolwork . So, I switched from being a table tennis player to studying physics at university. As I loved studying physics, no longer competing seriously in table tennis wasn't that bad. Plus, after a partial recovery, I was still able to play table tennis, albeit at a lower level.

My first ruptured achilles tendon occurred just after I finished my PhD in 1987. This was tougher than no longer playing on the national team, because I couldn't play table tennis at all.

My reason for not playing table tennis for 25 years was based on a mistake. After recovering from my achilles tendon rupture, which took one year, I re-injured my back. This back injury kept me out of table tennis for three more years. So, I was away from table tennis for four years. After three years of this back injury I saw the right physical therapist. Within 2-3 weeks my back problems were resolved, and I have never had serious back problems since then. WIth 4 years away from table tennis, I had mistakenly thought that my table tennis skills were completely gone. I played with my wife and daughter a few times over the years with poor rackets that lacked sponge. I wasn't any better than them, i.e., a complete beginner. I should have tried to get in better shape and use a proper racket. I would have realized that my skills were not gone. Then, after 25 years, I read the obituary of Dick Miles in the New York Times. I knew Dick Miles, and was saddened about his passing. At about the same time, a friend of mine told me that a tournament was being held in my home town. I went to watch the tournament and took with my racket. When I got the chance to play a bit, I found out that I could still chop back loops, that my skills were not gone! My love for table tennis had instantly returned. Unfortunately, a short time later, I completely ruptured my other achilles tendon.

One thing that you might find to be interesting is that my would-be-surgeon told me that in Europe most surgeons would have recommended that I don't have surgery, in contrast to the US, where most surgeons prefer surgery. He attributed this to cultural differences. He said that he prefers surgery because that way he knows what is happening inside his patient's leg.

Steven

_________________
Butterfly Joo Se Hyuk
Butterfly Tenergy 80-FX 1.9mm
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Returned to table tennis September 2011
Canada National Team Member, 1973-1975
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1972-1987
Brickell Balsa/Birch 3-ply Blade
Yasaka Mark V 1.5mm
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