Kevin’s Blog - A Runner’s ATR Recovery

LOL wsfost02! I did the other foot this year because the pain was getting bad! My right foot feels soooo good 1.5+ years after getting it fixed. So when the pain gets bad enough you’ll be ready to do the other foot.

So good to read this. 2.5 years is a long time! What exactly did you have done?

I had bone spurs removed from my heal with AT detachment for 90%. Brutal.

I know what you mean about the first 6 months. I was off running for 6 months and I have been slowly running since April 2018. I just ran 12 miles this morning. Pretty much pain free. I have good days and bad days. I also need to have my other heel done as well, but the mental grind of having to do all this again is KILLING ME!

Hey Kevin
I stumbled upon your post today and then read through your blog to see why/how/when things went south for you.
First off, I hope things have improved for you since this post.
Second, your story sounds sadly familiar to me. I had ankle surgery last April (2016), and always felt like I was taking one step forward and two steps back, until I had surgery again this March.
I definitely understand your incredible frustration. I too wonder if I will ever be able to do many of the activities that I used to love. I also understand the emotional burden of saying “I’m fine” when you’re really not, because it’s easier and you’re so tired of saying the same tedious answer of why you’re not fine.
And I know what it’s like seeing others around you improve while you are stuck in a holding pattern.
They say misery loves company, so if it’s any consolation, know you’re not alone. It’s a struggle for sure. I truly wish you well. I don’t know how often you check in here, but I hope you will, with a progress report, whatever it may be…hopefully good news.

Alan - thanks for your comment. I appreciate it. Good luck on your recovery.

K

Hi Kevin,

Thank you for sharing your story. I watched all of your youtube progression videos - which is how i landed here.

I see that you have always been a fit male (major 6-pack at 40+ years), and your aggressive approach to rehab ended up being your downfall.

I am a fit 27 year old male and 2 weeks out of surgery. Please know that you have inspired me to “TAKE IT EASY” on the initial recovery phase - know that you have changed my life.

Although it is frustrating, I know you will eventually get to the point where you will be at peace. Hopefully it brightens your day knowing that you’ve changed a young man’s life today.

Thank you and feel free to email me.

Alan
BC, Canada

Kevin,

I ruptured my tendon on Jan 21, 2017; and have been in a cast since.

I understand share your misery and your pain. I have always lead an active lifestyle and now this has shaken me to the core.

Really sorry to hear about your slow road to recovery. But I really feel that you are a very nice person to be sharing your sound advice for a better recovery. Thank you. Hang in there, all is not lost.

This recovery is very up and down as you know. Try this:

Barefoot. 10 bilateral raises toes straight out. Very slow controlled motion. Hold at top. Immediately do another 10 with toes out. Another 10 toes in. Again, all very slow.

Do 3 sets straight leg, 3 sets knees bent. More if you’re able.

I just started focusing on volume and squeezing in slow controlled motion. It’s done wonders in two weeks. I hit them every other day. Truly, big change in size and strength.

This recovery requires we stay diligent. We HAVE to constantly mix it up.

Good to hear you’re making progress again. I was in the same boat last month. You’re absolutely right on time being a factor. That and mixing things up.

Just today I woke up, and like magic, had a tremendously higher amount of power and range in my single leg raise, in addition to more spring.

Time, and mixing things up.

I’ve never heard about “adhesions sticking together”. Are you having trouble with double leg or single leg raises - or both? I wish I could be of more help. At 5 months, I could do a single raise - barely, but still tight and sore everyday - and very thick.

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Jayant - everyone is different. At 10 weeks, I would think the average person would start to walk normally, but you will have to work with a physical therapist and your Dr. to know what is best for you. The one thing I can tell you is that you will deal with this everyday for the next few months - at least. I’m 27 weeks in and I deal with it every day. It’s getting better, but extremely slow. Be patient.

My repaired tendon is definitely thicker than the uninjured side, by quite a bit. Most of it is scar tissue buildup, as it is softer to the touch. I do plan to update my blog with photos sometime soon, and these will demonstrate how much thicker the tendon is.

I have spoken to colleagues and friends who have had this injury - they all have a thicker tendon.

Good to hear you’re doing better and that it’s tendinitis and nothing worse.

Seems you have some decent strength and range on the injured side. That does not look like you’ve “healed long:” at all. Try doing a seated calf raise with your knees at 90 degrees. If you can get your heel up as high as the other side, you probably didn’t heal long. Healing long precludes that sort of range of even being possible. It’s probably a strength deficit, like mine (I had the same fear a few weeks ago).

Based on what you’re saying, sounds like tendinitis. Based on how it looks, I’d also guess tendinitis. Tendon is probably getting worked too much. If it gets worse with activity, that’s pretty trademark tendinitis. But I’m no doctor.

From AOFAS…

“There is enlargement and warmth of the tendon 1 to 4 inches above its heel insertion. Pain and sometimes a scratching feeling may be created by gently squeezing the tendon between the thumb and forefinger during ankle motion. There may be weakness in push-off strength with walking. Magnetic resonance imaging (MRI) can define the extent of degeneration, the degree to which the tendon sheath is involved and the presence of other problems in this area, but the diagnosis is

Having to work with someone else (a PT) that isn’t really apprised of your situation can be frustrating, but they can also offer “outside of the box” thinking and a new approach.

In the course of my formal PT, I had to use someone else just once, but she did a fantastic job. A lot of it lies in how you’re able to articulate what your issues are, and what you want to do. Otherwise, they will simply just go through the motions with you.

How would you rate your pain on a 1-10 scale? And where specifically is it, right on the repair site (where that lump is)? Elsewhere in the tendon or calf?

You seem to be doing really well aside from your soreness/pain issues, so I wouldn’t let it get you down. Your calf size on the injured side looks great, and you’re able to SL raise, correct?

Perhaps I missed it in another post, but has your provider offered to do any imaging to see what’s happening underneath?

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.

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 concen

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

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.

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.

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.

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!

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!

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.

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 t

I’m doing squat jumps (2 sets of 10 reps), lateral jumps (jumping with both legs side to side) 2 sets of 30 seconds continuous and truck tire bounds (standing on one foot and leaping) - five leaps x 5. They are tough, but I feel good after having done them.
I still feel like I could benefit from hand massage of the achilles area, but it will be on a case to case basis according to the PT.
I don’t have much spring in my step when running, but I’m also running much slower than I’ve ever run. I’m jogging at 10-11 min pace per mile and I used to be running high 6- low 7 min pace, so my push off is hardly noticeable. I feel normal at the pace I’m at but it’s definitely still very weak. I can’t do a full single leg raise yet. That just comes with time - I believe. At 5 months you are doing phenomenal. My issue is that I’m still engaged in a lot of activity outside of PT and that’s been causing me to overdo it somedays. Keep doing what you’re doing with changing things up. Looks good!

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Good way to start each session. Since you’ve officially started plyos and are jumping (at least a little), how many sets and what exercises do they have you doing? I’m just curious. For me it’s been controlled squat jumping and(jumping on my toes with minimal knee bend (think jump rope without the rope). Also been doing some high-knee back and forth across the gym, focusing on lighter toe push-off. I am actually thinking of throwing in jump rope as an exercise starting today.

I’m in the same boat with Graston and have exhausted PT. Thicker and a bit swollen in the tendon just like you, but when I look at it from the sides it looks like there’s some definition (mostly on the inside by the ankle). From the back it is just a puffy mess and my calf is rather pathetic and unsightly when flexed. Long way to go on building that back up.

Don’t let it get you down. There are definitely days where you feel like you’re getting nowhere. After days I really push it in the gym I get really sore at night and in the AM. You eventually walk it off. Once you get it moving quicker and harder in the morning it’ll warm up and feel better. I make i

You’re basically where you should be, keep up the good work! You’re a week or two behind me and right where I was at that point if not better.

The single leg raise is a frustrating one, isn’t it? Try to do more assisted unilaterals. If you can hold onto something - anything - and try to do a raise with just the one, you’ll be able to decrease the support required over a number of days.

Stairmaster has really helped loosen things up for me and build up stamina and strength. I stay on my toes and walk for a few minutes that way, rest a couple, then do more. Wash rinse repeat.

I think a lot of people get hung up on strength gains in this recovery because they’re doing the same thing over and over, and simply adding weight and reps without changing up how the muscle and tendon are hit.

I’m sure you know, but changing up your routines and adding different variations will help you past any plateaus. Change the angle of your heels and toes on calf press, do a set of full range calf press, then the next come down only half way.. Imagine board presses for bench. Stopping in different places and using a different ROM works dif

Hey Kevin, I am just a few weeks ahead of you, week 21. Be patient with your recovery. I can jog a couple miles now, but at week 17 there was no way I could have done that. My PT advised not to try jogging until I could do 3 sets of 25 single heel lifts. At 17 weeks, I could maybe do 2 pitiful lifts. But I really focused on working my calves throughout the day. Beanie had a good post w calf raise info. I also used the giant stepper at the gym to build leg strength, and would tiptoe on it in interval sets. Hang in there. I bet you will see some gains soon.

Kevin - hard to know what is happening here with you. PT 3 times a week at 4 months is quite a bit and I would have thought you would be tapering off and doing more on your own. It seems there is a need for strengthening and maybe you have reached a plateau. I would not expect a jog to be comfortable at your stage but walking should be easy enough for quite a distance. The soreness and swelling is quite normal. All I can say is stick with it and push on. Work on the eccentric exercises and do not sweat the single raise. Walking stairs and hills is good as well.

You’re doing great. Keep up the good work. I think you’ll hit a mile no problem in the next couple of weeks. I’ve been jogging about 2 weeks now, and since the first jog, I am at 2 miles. Jogging has helped immensely with general walking stamina and strength. Keep it up!

Well done Kevin and I am sure your goals are very achievable. Noticed your status needs updating. I think 2 shoes is most appropriate now.

I laughed when you said you are “shuffling” like a 90 year old man. Remind me of Fred Flintstone! Don’t worry, the “shuffling” will go away soon, and your strides will get longer. I also became physically stronger than I was before too (except for lack of endurance and the injured leg, which is coming back slowly). I want to start doing the classes at the gym to get more of a well-rounded fitness, besides the weight training and cardio.

You’re doing great. Running at 12/13 weeks is impressive, however light the jogging may be. I’m off to my last scheduled surgeon follow-up in a few minutes here, so hopefully I’ll have similar news and get the green light to attempt jogging. Funny how this injury can motivate people. Just keep plugging away with what you’re doing. Work that leg as much as possible!

Weeks 10 and 11 were tough for me too. Mostly dealing with soreness and concentrated pain low in the tendon where you’re not sure if you should push it. I noticed things get exponentially better throughout week 12 and into week 13. Keep your head up, and try to do as many raises as you’re comfortable doing, daily. Once you get past (power through) the initial soreness of doing lots of raises, you’ll notice a big difference from where you were in weeks 10/11.

Thanks for the post - the video is helpful.

What do they have you doing at PT, specifically? Looks like you’ve made some definite progress on gait/limp and strength. Keep the videos coming. I plan to add some to my site once PT starts later this week.

Awesome results and Video!

Kevin

nice summary video of your experience. the wound/scar looks nasty! glad it has healed!

thanks for confirming the discomfort/swelling prognosis (same as what i was told), it’s a shame, but this is out path!

yup, the key is in staying active without pushing it too much. today i managed to cut the grass and the tendon responded well and without much hassle.

i did my first driving at the weekend, and it was fine although a bit of a tired ankle by the end of 90 minutes.

suerte

It looks like you are doing great!!!! I am too lazy to ice mine, but when i wake up in the morning the swelling is usually gone, so no issues there. At 20 weeks, I can work on my yard with no problems, did lots of mulching this weekend. So if you keep doing this great, you should be able to expect similar progress.

Nice videos, Kevin! I’m glad you are recovering so well.
Happy Healing!…………. Manny

thanks Kevin. today i had another PT appointment and i’ve been cleared for stationary bike (with an almost identical objective as yours).

the PT was surprised by the flexibility and progress, so recommended i continue with my regime (theraband exercises, ROM, raises and extensions in the pool) plus start swimming involving the affected leg (gently) and using some weight lifting for the quads and the harmstring as i did have almost 2inch lose of calf muscle and the rest of the leg is weak.

the PT reckons that the swelling will be months before it goes to normal and that the stiffness when cold or resting the tendon may never go away, so i was recommended to keep moving the foot/curling toes when working or resting in order to aid recovery.

thanks for your answers and good luck too!

suerte

i was told to stay vigilant till the 12 week to give the tendon extra time to recover and i was told not to engage in any salsa dancing for longer than a few minutes till further notice! which is a shame, but there is no point in pushing myself stupidly.

mibball,

I’be been in the gym doing everything not involving my left leg. Exercise is good for the circulation of injury, overall health, well being, and mental state. As far as rehab, I haven’t gotten in the the pool yet, but I will this week. Right now, in addition to the things I mentioned above, I’m doing hip extension work on the ground, proprioception (balance), light squatting to a chair (just a bar), assisted lunges (TRX), and a ton of core work.

Kevin,
You are absolutely correct. Can’t risk a re-rupture loading too quickly…it’s a fine line and you need to listen to your body. You are an athlete, so you know the difference between sore and pain. The 3 month mark is really when the tendon ready to be pushed, and until then, slow and steady progressions. Just to give you a sense of my background, I’m a strength and conditioning coach (NSCA, CSCS), and work with high school, collegiate/amateur and professional athletes. My PT is a friend who consults with NFL, NBA, NHL teams and has worked with EVERY big time athlete on one level or another (he’s been featured on 60 Minutes twice). My surgeon is a team doctor for various US Olympic teams and other national teams. I’m very luck to have this kind of treatment and access to such pros. Feel tap into my resources as you move forward. I’ll do my best get you info if you want it.

reyrey,

Good stuff. You’re lucky with how little you atrophied. Might I ask what your exercise regimen is aside from heel raises, bandwork, and walking 1/2 mile a day? You doing anything in the pool? Stationary bike?

I had surgery 2/2 and am of the same mindset. Play in lacrosse and basketball leagues all year.

I am 10 weeks post-op and am almost able to do heel raises on solid ground, but not quite. I started in the pool a couple weeks ago and am into the shallowest point and comfortably doing raises (3′ - I can’t imagine this depth of water is even taking much weight off).

Otherwise I ride the stationary for 35min + daily now, and do several sets of heel raises in the pool every other day.

Thanks

to pozaicer - I am on a standard stationary bike and i’m able to pedal with some light resistance - not standing up at all obviously. I’m consistently biking about 10mls - every stationary bike is different so that probably doesn’t mean anything. I just go until I break a sweat and then go on to core, ROM and then the pool. Good luck. Thanks for your comments.

kpeters - keep me posted on that heel bone pain. I have the same pain in that (I believe the calcaneus bone) when I attempt to walk normally off my toes. Don’t push through pain at this point though. Your Dr will have the final say on that but from what everyone has told me - sharp pain at this early in the game is not good. It’s not a ‘no pain, no gain’ injury. Let me know what the Doc says. Thanks. Good luck.

reyrey - I have the same mentality. I’ll stay in a gym for several hours and be up everyday at 5am if I knew it would help me improve faster - but - I was told the tendon is still healing at this point and to not push it too much until we get further down the road (when that is exactly I’m not sure ). Just be careful! I wouldn’t push through any

Yes, the medical community is split to a degree. However, A LOT has to do with age, pre-rupture condition, post surgery goals, other contraindications, etc. The post ATR data is pretty conclusive in that outcomes are better the sooner WB and mobility occurs (how quickly that happens differs from case to case). In my case (ATR surgery on 2/24/16), I was out of the cast and 50% WB 10 days after surgery. I was taken out of the boot completely on 4/1/16 (5 weeks post-op). My PT does not even want me to work on ROM because i’m already at 13 degrees dorsi-flexion (no overstretching). I’m purely working on bilateral heel raises, band work, walking 1/2 mile daily (strengthening). I also only had 5mm atrophy comparing calfs. I’m walking with only a slight limp, and I literally feel stronger everyday. My mindset the day after my injury is/was I’m going to beat this and get back to where I was, pre-injury.

The bottom line is that if you want to have world class outcomes, you need to work at it like a world class athlete.

I told my surgeon & PT out of the gate what my expectations are and told them to treat me like an athl