20-21 weeks Post Op

Stalled out –

7/5/16 - I haven’t been seeing much progress this past month. I have my monthly visit with the surgeon and I have little news to report to him. I’m doing the same amount of running I was the last time I saw him. Told my PT  I’m frustrated with my progress - or lack of. We are going to try to do a little more w/ running farther and get cleared to run outside / off treadmill. I am approaching the 5 month mark so I should be able to do more. I told her that I’m worried about doing too much again and I don’t want to extend this recovery any longer than it has to be. I’m worried about the discomfort and pain I feel before and after working out. She believes I’m unnecessarily holding back due to my discomfort and that it’s only just that: discomfort. I told her that I have NO problem pushing through any pain – but I need to be sure that it’s not going to cause me to go backwards. I’m ready to push forward and do more, so hopefully that in turn will break me through this wall. I’m still sore in the AM and PM and I’m icing it every night and keeping it up for about 20-30 mins. It still looks swollen and it’s not pretty! I’ll report on the DR visit.

7/6/16 -Dr. visit:  The surgeon has a different take – pull back. He looked over my Achilles and told me it’s too swollen and I must be doing too much. No more running until it looks better. WTF!! This is really frustrating now. Now, I don’t want to do anything. The PT routine got old two months ago and I was going with the motivation of getting better. Now he’s telling me that I have to go back to what I was doing over a month ago? I cancelled my PT for the rest of the week and I haven’t re-scheduled for next week yet. I need a mental break (and apparently a physical one too!!) from the monotony of PT – The physical therapy that seems to only be hurting me - ?!

My PT and surgeon are clearly not on the same page with me. I’ll talk to my PT next week and go from there. VERY frustrated.

New video:  https://youtu.be/EGbv20TXWFw

10 Responses to “20-21 weeks Post Op”

  1. Frustrating. I’m curious what your routine looks like, by the day/week, in terms of on/off/rest?

    I alternate between heavier, strength-building days on the calf and stamina days (jogging), which means I get usually 4 days a week of dedicated, heavier strength-building for the calf along with plyometric movements now. I consider jogging days rest days.

    Sometimes a nice break is very much needed. In the last two months I’ve taken a one-week break, and a 4 day break more recently, not having done ANY sort of exercise or activity targeting the injury. It’s real easy to burn out on PT and plateaus are very normal. The rests are refreshing.

    I felt “stalled out” right where you were a couple weeks ago. Now I’m feeling very much “over the hump” and have been incrementally adding on more intense movements and exercises. Since doing more exercises that put me up on the balls of my feet (jogging up stairs on my toes, lunges, burpees, limited jumping), I’ve noticed an exponential increase in ability and feeling of well-being. I’m getting some spring back, albeit still very limited, and it’s done wonders for my morale.

    You’ll break through the plateaus, you just need to rest up a little bit and then change up your routine. This recovery is very, VERY up and down for everyone. How would you describe your discomfort? Is it actual discomfort, or pain, as in something feels like it’s not right and the tendon itself/repair site is feeling the pinch (and mentally you feel like it’s going to break open at any point)?

    I have only had two instances really in the gym where I’ve started to feel some light pain coming on (pinching within the repair site) and it was about a 2/10. I packed up and went home each time that happened. The next day I was fine.

    I’d listen to the MD over the PT. Increased and prolonged swelling is usually an indicator to back off and that something *could* be wrong. Then again you know your body best so do what you’re comfortable with.

    What’s the tendon feel like when you pinch and palpate the repair site between your fingers. Is your tendon getting any more pliable or is it still pretty hardened? How’s your dorsiflexion?

    Good luck!

  2. I’ve added a photo and a video. It’s clearly still swollen. I’ve had discomfort ranging to pain for weeks but it doesn’t get worse when I’m working out. However, it’s not getting better and I’m not improving at all. According to the surgeon, I’m doing too much and not giving my body time to recover. Hence, I’m continuously swollen and feeling the pain/discomfort constantly. The main pain is in the calcaneus (lower heel). I point that out in my video. Surgeon said my range of motion is good but the area is more swollen than he’d like to see at this point.
    I’m not going to PT until late next week at best. I’ll start back at the gym to lift weights and swim, but I’m laying off any achilles work. I appreciate your comments and concern.

  3. 1kilo I had a look at the video and your tendon doesn’t look too bad overall except that lump where you say it is sore to press as well. I think sore to press is a bad sign so I agree with your Dr about resting it until that soreness goes away. Have you been getting any massage or release done on your calves and on the bottom of your foot? One thing I’ve noticed is that I have to release my calves and plantar fascia a lot more than before because otherwise my tendon pulls tight and my heel starts to feel sore. Tight hamstrings can also cause this. I have bought one of those sticks and I roll out the calf every few days, I use a golf ball on the bottom of the foot and I use my hands to do cross friction into the calf muscles. I’m just wondering if your other muscles tightened up as you did more exercise and then this pulled on the achilles and is causing it to be over stressed? I’m sorry for this frustrating point that you’ve reached and I really hope things come right so that you can start running again. Good luck!

  4. beanie, Interesting point about achilles being over stressed. I’ve the same problem with swelling. I’ll give myself a rest today and see what it looks like tomorrow. My pt went on holiday so have done 2 appt with a new one. She really stresses me out and talks about single rise all the time and asking why I can’t do it! Also, I’m told not to go running before I can do a single, anyone know why? I did some running last week, slow and a few min, and it felt good to push off with your foot.
    1kilo, keep posting and good luck!

  5. chinaexpat I think the reason your PT wants one single leg raise before you run is because the force generated when you “toe off” the ground during running can be as much as three times your body weight. When my OS discharged me he told me that I shouldn’t be afraid to do anything but I had to be aware that while my calf was still weak there would be less buffer for my achilles and it would take more of the force applied than if my calf was strong. So if you start running quite hard and yet you can’t lift your own body weight onto your toes with the injured leg then you will be putting a lot of force (strain) on the achilles.

    That said though, I believe that gentle jogging and using intervals (jog-walk) helps to build the calf strength, so I don’t think you have to wait for the single leg raise but make sure to listen to your body and if your tendon is getting at all sore then rest.

    An excellent way to build calf and tendon strength is to go up onto tip-toes with both legs, then lift up the “good” leg and try to hold on tip-toes with the “bad” leg for 1sec and then slowly lower trying to take at least 2sec for the lower. If you can’t hold or lower slowly at first then support your body weight by holding onto the back of a chair or a table or cupboard handle. You want to build this so that you can do 3 sets of 15 with no support. I’m pretty sure that if you’re persistent with this exercise then you will find you’re able to do a single leg raise too.

    Good luck!

  6. Beanie, thanks for your input. I’m not really running but more jogging and it looks good and feels good while doing it. Also not jogging for a long time.

  7. Beanie,

    Absolutely correct on “up on two, down on one.” I saw exponential gains in strength when I started focusing on these more.

    As to the OP’s video, that little ball of inflammation just *looks* painful! That’s really unfortunate this is happening to you. Otherwise, your calf looks pretty good. I can barely tell a difference from your uninjured side. Looks like you’ve got a decent amount of strength there too.

    Definitely rest up and ice, ice, ice.

  8. What’s your status? Any progress? Let us know!

  9. I am just 3 weeks post op, but I have done a fair bit of researches. A lot of people have trouble with single legged heel raises. There is a missing link between two legged and single legged heel raises. Say if you are 160 lbs, two legged heel raises give each leg 80 lbs of loading. Then most people go straight to single legged heel raises, which give your bad leg 160 lbs of loading without any progressive loading between 80 to 160 lbs, of course there is no progress. A more sensible progressive loading would be 80 lbs x 50 reps x 3 sets, 85 lbs x 50 reps x 3 sets, 90 lbs x 50 reps x 3 sets and work your way up to 160 lbs. Why 50 reps? A few folks over bodybuilding forum has good hypertrophy with high reps. Also progressive overload from 80 lbs to 160 lbs is very different from 160 lbs negatives single legged heel raises (Eccentric). Eccentric exercise will elongate the calf muscles. The calf + achilles works as a unit, like the suspension in a car. Once the achilles healed, it doesn’t stretch. It’s not a rubber band, it’s more like a rope. But we don’t want weak and elongated calf muscles. I would think a simple concentric heel raise with progressive loading is the best way to go.

    The key is high reps (50) x 3 sets, explosive and keep the weight on the big toe.

    I think most PT is a joke because they use the same protocol for 20 years old athlete and 80 years old.

  10. Petery - the eccentric loading of the calf has been shown to strengthen the muscle group and it also helps to align the collagen forming in the damaged tendon. It has also been shown to aid the recovery of tendonopathy in people who have not ruptured. The going up is less important than the going down. Going up on 2 using more of the good leg and then transferring weight to the injured side for the slow going down. The amount of weight transfer can be regulated as well with the good leg and increased accordingly. Doing this with a straight leg works the gastroc group and a bent leg the soleous. There is a place for concentric exercises and maybe explosive but not early in the rehab. My father ruptured his AT in his 80’s and his rehab was much different to mine due to other balance issues from injuries. I would say though that what works for a 20yo will work for most other age groups if the patient is in general good health and fitness. Age has been shown to have very little to do with how we heal from this injury. The majority of people presenting with an ATR are in their mid life anyway.

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