*Month 5 (non-op): Calf Work/Running/Hiking/Yoga (Oct 15th-Nov 8th, 2016)
November 11, 2016 by agnesatr
I cannot believe it’s been 5 months already! Time definitely passes by so much faster now than in the first weeks. I guess there is less uncertainty now and much more work on muscles to get back to normal. This injury is for sure a true test of patience, as it takes such a long time to fully recover. It still seems like a long road ahead before I can be back to pre-injury level, but the physical therapy now is more or less like workouts, so it’s fun.
CALF AND TENDON
I saw my doc at the end of October and he did ultrasound of my tendon. The doc was really happy with how the collagen production looks like. Thompson test showed movement, but the notes state that it was not symmetrical with my healthy foot yet. Overall doc was really happy with my progress and said that he is confident to release me to all sports by month 6. I was bit skeptical about it because of the continuous risk of re-rupture and still not fully functional calf strength, so he said lets wait for month 9 for a full release. The risk should be smaller at 9 months than 6 months. I also know that by then PT should show bigger improvements in strength. I was told I can go skiing after month 6! This was the best news I’ve heard. I will probably wait until January (month 7), but lets see what snow do we get east of Seattle in December! Might be tempting…
As far as calf strength, it is improving for sure, but the injured calf is still much weaker than the healthy one. I can do single calf raises with no problem. I keep doing bunch of double calf raises and the eccentric calf raises. The problem is trying to isolate that calf and getting its engagement without involving other muscles in the leg. It’s crazy how the body just cheats and uses other parts to compromise for the weak ones.
STRETCHING
My PT started me on stretching from week 19. I read many blogs and protocols others have been put on and I always saw stretching introduced much earlier. My PT is not rushing this part and I really like his logic. He had me working pretty hard on strength from the beginning, but kept stating that there is no need for stretching initially, that stretch can be done at any point, but if I overstretch early on I could heal long and he will not be able to help me with that. I was totally on board with this thinking and so far it has worked out great. The lack of dorsi flexion has not hampered my progress of my other activities. The increasing strength allows me to progress nicely into sports already. Daily activities are becoming more normal. It is still hard to walk barefoot because of lack of dorsiflexion, so I wear my funky Skechers with higher heels and inserts, or put inserts in other shoes and I am fine. Leg is still crazy stiff in the mornings and I still walk like a robot when I get up, but few sets of pumps/inversion/eversion work with Thera Band and calf raises after I get out of bed tend to fix that.
I also found out that apparently I am rather on a flexible side in dorsi flexion in my healthy leg. I am about 16cm (when not warmed up) toe to wall in a “Knee to Wall Test”. When my PT tested my injured foot I was at 1.5cm. That’s 14.5cm of stretching to go! It seemed almost impossible in my head at this point, but I got measured this week and I am now at 7.5cm. Yay, getting there. My PT is happy that it is not stretching at alarmingly fast rate. It has been progressing nicely and steadily.
I can say one thing: working on my calf raises on the floor (not stairs) did not stretch my calf muscles. I got no dorsi flexion flexibility from it. Doing active stretching into dorsiflexion (from week 19) had immediate effect of 2cm stretch after first 5 days of stretching!
The stretches were so uncomfortable at the beginning. I cannot even explain the feeling of it, but it was weird uncomfortable pain even when stretching gently. Initially I was really scared of re-rupturing. My PT kept assuring me that this is normal feeling and I am not risking rupturing from gentle stretch at this point. My doc confirmed the same saying that explosive movements are more dangerous at my stage not the stretches. After a month of doing each of these stretches daily (3 sets of 30 seconds/3 times a day) the stretches are feeling better, but still a bit uncomfortable. I noticed that applying hot water bottle and/or doing calf raises before the stretch helps as it pumps some blood to the leg and warms it up some.
After I got cleared for stretching I tried to do yoga. I use p90X3 program and use yoga from that. The first couple of times I did yoga, the difference in calf flexibility was totally messing with my alignment. My hips felt out of synch and downward dog and symmetrical stretches were wacky. Now it is a little bit better. The improvements came with the increased dorsi flexion ability.
HILL WALKING / RUNNING / HIKING
Once I started stretching I started doing hill walking with max speed I could manage (with the permission from my PT). I am fortunate to live in a very hilly neighborhood, so I really can just come out of the house and can either climb up or down hill. I designed myself program of progression starting with 1 mile, then 2 miles until I got to 4 miles of continuous up/down hill walking. I use mapMyRun app to make sure I only walk on hills while training. I guess this is one way to get to know all the roads and paths in my neighborhood.
Once I got to 4 miles I decided to go on a proper hike into the woods. I searched for a short 4 mile hike, packed up my cameras and tripods and went for it. I wanted to do it alone to pay attention to my tendon and just enjoy the nature. Oh my! What a pleasure to get back to what you love! I so missed hiking this summer. My heart still beats faster remembering the feeling of being back in the woods for the first time. I honestly thought I would not be able to hike this year, so being able to do that in less than 5 months after rupture was amazing to me! Let me just say, the joy of being out there and being able to use both legs justified all the daily sweat put into PT!
As far as tendon, it was tight, similarly to when I walk hills, but manageable. No pain as such. I had to stop few times to roll my ankle to loosen it, as it gets stiff with fast walking. Achilles was feeling fine after the hike, so that’s encouraging.
In week 20 I got cleared to slowly start running!!! I so did not expect it when I showed up for my PT appointment that day. My PT told me to get on a treadmill and I was like “what?!”. The test run went well enough that I got cleared for “Return to Running Program”. It is a program with progress stages that involve intervals of running and walking. I do each stage 3 times before moving on to the next one. I am now on stage 3. It feels amazing to run again. I never liked treadmill running, I prefer running outdoors. I do not call myself a runner as I do not do many long distance runs, but I do like to clock few miles as a warm up before my workouts. Being able to feel the speed and wind on my face was great. My pace is not the same as pre-injury pace yet, but I am averaging 8.5 min/mi on my run intervals. Some intervals are faster, some slower. I honestly care more that my achilles is feeling alright after runs. The difference in dorsiflexion does show while running. My hips are not in synch for sure. On couple of the first runs outside I felt like the lower body was someone else’s. It felt so strange and foreign. That is getting better now, but I still feel difference in my stride. I try to do 3 runs a week, which means I had to give up my hill walking for the time being not to overload the tendon.
PICKLEBALL!!!
Return to the crime scene - lol. I signed up my hubby for our meetup pickleball event and said I would tag along to see everyone and watch the games from the sidelines. My PT did not want me to play yet because of all the sudden moves and side movements. I was a good patient and did not play, but I did hit the ball by the net with hubby. Just some volleys. It was really nice. I got some frustration out while I was at it, lol. I also got to talk to a player who was across the net from me when my rupture happened in June. Apparently I was returning a ball from him when my tendon snapped. I could not remember that bit. He said though that he can remember it well though. I can imagine, as I collapsed right after! Was probably quite a site. The positive from that outing: I do not think I have mental block to come back to playing racquet sports. As I was hitting I was fine mentally. I just knew my limitations now, so tried not to run, but if I was cleared for it, I would go for it. That’s good to see. I was not sure how I would feel.
PHYSICAL THERAPY
Best for last.
My PT appointments are still 2 times a week, but I have home PT to do every day. Now I do about 2 hours of PT a day. It is crazy how much time it takes. I can see improvements, however, so I keep going. My PT involves pretty much all lower body muscles, so it is like doing your leg day every day. Because of that I realized I need 1 day of rest a week. I saw that I was burning out with the addition of running/hill walking on top of all the PT exercises, so now, I schedule massage therapy at the end of the week and take the next day off. This seems to work best for my calf/hips/hamstrings/gluts muscles. Without that day off my gluts and hamstrings were hurting all the time. It is more manageable now. So again, balance. This one is not easy for me…, but I am learning.
As far as exercises, they are not so much different from previous month, but variations are added.
- Single calf raises (straight and bent legs) - messing around with different styles and started doing them on stairs. Backing off to floor when tendon is hurting after.
- Double calf raises (straight and bent legs) - doing them with weights on stairs and backing off to floor when tendon is hurting after. Doing some with my toes placed inwards and outwards as well.
- Eccentric calf raises (straight and bent legs) - doing them with weights on stairs and backing off to floor when tendon is hurting after.
- Balance exercises - bunch of different types of standing on one leg with skaters, or bands, or kicks, or yoga balances
- Ball bridges (double and single leg)
- Lunges - doing straight, angle, back - basically any types I knew before with additions of leg raises. Also doing lunge to calf raises.
- Squats to calf raises
- Side bridge clams
- Side walking with bands
- Double leg jumps (single are still hard and do them only during PT appointments)
I am now daily massaging my calf with a tennis ball to get some of the knots out. The calf is getting pretty stiff from all the work and I sometimes feel it in tendon. Massaging out the calf muscles really helps with it. I do foot rolling on tennis ball as well as foot gets sore from so many calf raises. Rest of the muscles - using foam roller.
A NOTE: I feel it is so important to have a PT one trusts. I am fortunate to have a really good one on my side. He pushes me most of the time, slows me down when I overdo it and is up to date on anything new that comes out there as far as exercises go. I like it that he reads up on new things and is interested in research that is out there. I am curious about new studies myself and keep reading up whenever I get a chance too, so knowing my PT is into it is really assuring. Just a note to all, find someone you trust. With this injury requiring such a long recovery, it is important to find someone that you trust!
So, month 5 was cool. I got to run, I got to hike, I got to hill walk, I got to do yoga, I got to hit some balls in pickleball. I am so grateful this leg is healing and that I am able to do more and more. It just shows that a lot of hard work and help from physical therapy pays off. Step by step getting better. Still long way to go, but now I definitely see the light at the end of tunnel!!! Set backs happen. I overdid it one week and we had to slow down the following week, for instance. That’s part of the process to learn to listen to your body as well.
Hope it serves as encouragement to some that either chose non-op route, or are recovering from surgery and are just starting PT. Keep at it, listen to your doc and therapist, work hard, learn to listen to your body and the results will come with time! Happy healing all!
Question to all - anybody here that is >>really flexible<< in dorsi flexion? If so, how long did it take you to get your full dorsi flexion flexibility back? I still have ways to go, but am wondering about other’s experience as far as timeframe from when stretching was introduced to you.
At 11 months, dorsi-flexion is still not 100%. But it’s good enough that I don’t notice the difference unless I’m actively doing a comparison. It probably hasn’t changed much since 8 months. Using the knee-to-wall test, it is at about 12 cm versus 15 cm for my good leg.
I didn’t do much stretching during my rehab/recovery. It was really the massage therapist breaking down the scar tissue that lead to improvements in flexibility.
Another great post, btw.
Hey there, it’s always great to read your post since you are also non-op and you are a couple months ahead of me. Your posts always give me a heads up in terms of what I should expect next in my recovery.
Keep up the great posts and good to hear your life is getting more and more normal
Great to hear about your progress! It must be so exciting to run and hike again. I’m so impressed by how much rehab you do!
My update: I’ve just passed 3 months post ATR and just this week finally can walk without much limp.!!! Pool walking and using my crutch to force good form has been key. I still use my raised shoes first thing in the morning and thentransfer to flat runners. Barefoot walking Is still very hard (but going to be necessary for summer!).It’s wonderful being able to start walks around the block , gardening etc again (didn’t miss vacuuming etc though!) My rehab is still focused on walking, biking, and strengthening the other leg muscles. I did start on the cross trainer this week, which was interesting but I never used it before my injury so I cannot compare! I have already got 1cm (of 4cm loss) back my calf. Hopefully my physio will give me the all clear for some calf strengthening soon. You are right that time flies as this injury goes on!
Hope your next month goes just as well
Agnes - I think a lack of dorsi flexion at 5 months is a good sign you have not healed long. I had surgery and struggled with dorsi. Still not as good as the other leg but that could be because the surgeon cut me a bit short. It does not affect anything I do though and I only notice if I am stretching or squatting. As mentioned above, it may take at least a year to get it feeling normal in flexion. You may also have some scar tissue around the healed area which will need to break up and that generally helps with the flexion. Deep massage may help and you cannot do any damage with it at your stage.
Simon - Thank you for your comment. It’s good to hear that you managed getting to 12cm. My PT started working on my tendon as well now. Pretty painful, but he is able to get me 1-1.5 cm in a session. It shrinks back, but hopefully with time it will become more permanent. It’s encouraging hearing your story.
Stuart - Thank you for sharing. For sure I am glad about lack of dorsiflexion at this stage.
I was just curious about others with quite a bit of flexibility and their stories on stretching progress. Do you still do daily stretches after all this time, or just do them when you feel more tight then usual?
elyliu - I am glad you enjoy the updates and I hope you are progressing well. I need to catch up on blogs to see what have you been up to in the last month.
Thank you for the update Nicola. I have gotten behind on reading, which is a good sign ’cause things are getting back to normal.
Glad to hear about your progress with walking and calf size! It’s been a month since your comment, so I am sure you have progressed much since then. Hope things have been going well and that you are doing some calf exercises now. I am so jealous that you guys are having summer.
I am looking at snow outside.
Agnes - Usually I stretch when things feel tight. Most of the time it is good as we live in the mountains and do plenty of up hill walking which works the same. Lately we have been building again so there has been lots of ladder work so things feel pretty good. It is probably more of a problem in winter when activity levels are lower.
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