RTP Case Study Breakdown: Achilles Rupture with Rachel Dincoff

Achilles ruptures are one of the most devastating and compromising soft tissue injuries that an athlete can sustain. These often require extensive rehabilitation and a difficult return to play (RTP) process that can take several years to fully restore. Rachel Dincoff is an elite discus thrower who is currently training for the 2028 Los Angeles Olympic games—following her All-American career at Auburn University, Rachel has competed at the highest levels of her sport, including the 2020 Tokyo games.

While training for her spot in the 2024 Paris Olympics, she sustained an Achilles rupture in training which derailed her goals for the Paris games. Moreover, due to several complications with her injury, she would go on to have three separate procedures in an effort to repair her Achilles. Safe to say, it’s been no easy path.

Initial Intake: Subjective Understanding, Objective Knowing

I had the privilege of being introduced to Rachel about 9 months after her last surgery. At this point she had regained most basic functions and was relatively pain free, but there was still quite a bit of ground to cover. Between myself and a handful of other individuals, Rachel had assembled a great team in place to attack her recovery from all angles.

My role in the team was developed around providing hybrid applications of soft tissue therapy and restorative strength training applications—our initial goals were to improve the local tissue quality and circulation, restore proprioceptive acuity, and improve isolated strength, capacity, and function.

This hybrid role of soft tissue therapy and strength and conditioning has provided me with a wide skillset for working with injured athletes. While this versatility has been widely beneficial for me, it can also create some interesting challenges in programming. In addition to my role within the team in place, I determine my work priorities based on criteria and information received during our initial intake process.

My athlete evaluation and assessment process utilizes an array of inputs that I collectively look at as gathering “a subjective understanding, with an objective knowing.” In other words, I want to understand the athlete for who they are and what got them to where they are, but also know what their physical capabilities are and where those capabilities are in relation to where they need or want to be. The subjective understanding is gathered mostly from my athlete intake (interview), which allows me to get to know the human as much as the athlete. Additional subjective inputs include movement evaluation, tissue quality, and reported pain levels.

My athlete evaluation and assessment process utilizes an array of inputs that I collectively look at as gathering ‘a subjective understanding, with an objective knowing,’ says @danny_ruderock. Share on X

The objective criteria, which is predominantly collected through Hawkin Dynamics force plate diagnostics, provides me with clear confirmation on where the athlete is physically, and therefore helps to guide and confirm decision making and planning.

Local Strategies & Global Re-Integration: Force Follows Stiffness

For injured athletes, I organize my training approach broadly by viewing it as working from isolated to integrated. With significant injuries such as Rachel’s, we need to have a direct and local application for improving the injured site. For me, this is where the manual therapy and soft tissue applications have become tremendously valuable. With the local strategies, we want to consider these being primarily focused around improving local sensorimotor function (nociceptive downregulation, proprioceptive acuity), improving local circulation and fluid dynamics, and addressing structural items such as scar tissue formation and trigger point formations.

For injured athletes, I organize my training approach broadly by viewing it as working from isolated to integrated, says @danny_ruderock. Share on X

While these may be things that contemporary strength coaches scoff at, it’s important to recognize the significance of addressing the tissue and adjacent qualities. For instance, disproportionate scar tissue formation can promote a mechanical phenomenon known as stress shielding. Stress shielding, which Dr. Keith Baar has spoken about in great length, is when a stiffer material resists applied loads to protect surrounding tissues from excessive force. A good heuristic for understanding this is thinking about it as “force follows stiffness.” When there is incompatibility across local tissues—for instance the medial and lateral aspects of the Achilles tendon—we will get disproportionate loading across those fibers. This can reinforce pain sites, compensation patterns, and ultimately result in overloading certain areas while concurrently underloading other tissues.

But repairing the isolated site isn’t the complete solution, as we then need to consider how the injured area is re-integrating back to the body. This is where the global strategies are applied, which for all intents and purposes, are developed from conventional strength and conditioning principles. While I find tremendous value in the local strategies and soft tissue applications, we cannot ignore the fact that all major adaptations are going to be found in high force loading and high velocity movements.  That is to say, we utilize the soft tissue applications primarily for the sake of creating an optimal window for loading, but then we follow it with just that: apply high force loading.

While I find tremendous value in the local strategies and soft tissue applications, we cannot ignore the fact that all major adaptations are going to be found in high force loading and high velocity movements, says @danny_ruderock. Share on X

In addition to high force and high velocity movements, these global strategies will also speak to the fascial-based concepts I’ve ascribed to over the years. In a simple sense, this is how I view “re-integrating” the injured area back to the body. The soft tissue work is important, high force and high velocity loading are essential, but if we never re-connect the anatomy, we are going to leave a lot on the table.

The heuristic here is to “load patterns,” which is a concept I’ve adopted from Stu McMillan and ALTIS. A quick background on this if you’re unfamiliar with this model, our shapes are the primary positions we observe in sport and patterns are “the connection of shapes in space and time.” The signatures component, which I’ve added, is the individual or unique expression of patterns, typically with regard to injury. So, from this lens of shapes, patterns, and signatures, loading patterns is akin to fascial-based loading, which in my belief is extremely important and often overlooked in RTP models.

To see more on how we approached Rachel’s situation, including her movement breakdown, our programming, and force plate diagnostics, be sure to check out the latest module for the SimpliFaster RTP Case Study Series here!

Since you’re here…
…we have a small favor to ask. More people are reading SimpliFaster than ever, and each week we bring you compelling content from coaches, sport scientists, and physiotherapists who are devoted to building better athletes. Please take a moment to share the articles on social media, engage the authors with questions and comments below, and link to articles when appropriate if you have a blog or participate on forums of related topics. — SF