*Month 8 and 9: Agility is back. Still need more strength and flexibility. Hamstring/Sciatica. (Jan 17-Mar 8, 2017)
March 9, 2017 by agnesatr
Here is my vlog from month 8 and 9:
9 MONTH DOCTOR’S VISIT
I just came back from 9 month doctor check up. Actually, today exactly is my 9 month rupture anniversary, btw.
The doctor said that the achilles looks good and that I healed ahead of the usual surgical estimates. Thompson test returned almost same movement in my injured leg as in my non-injured leg. Ultrasound of the achilles showed much more organized tissue than last time, so that’s good to see. It was interesting to see the site of the rupture, which had more unorganized collagen than the surrounding areas. My doc mentioned before that it might take couple of years for the collagen to be organized. It would be interesting to see the ultrasound of the rupture site in couple of years to compare. So, as far as the achilles goes, I am discharged from the doctor! Most of the appointment was dedicated to my hamstring, which might now be actually sciatica pain. More about it below.
AGILITY: p90×3 and JUMPING ROPE
And here is my return to my pre-injury workouts.
Before this injury I worked out about 6 times a week doing P90x and Insanity programs. Some of them require quite a lot of agility. I was wondering at the beginning of this injury how long would it take me to get back to doing it again. I have been working out regularly from day 7 after rupture, but I started doing some of the workouts from my programs in month 5. Initially only the ones that did not require jumping, so things like yoga, upper body, lower body static strength, etc. At the end of month 7, however, I was cleared by my PT to do any jumping exercises as well, so I “jumped” right back to more explosive workouts form my programs. During first explosive workout, I remember, after 15 minutes my achilles was letting me know that it was feeling it. I managed full 30 minutes, but could feel my ankles and achilles until the next day. It was not a bad pain, but soreness you have, like you have not used bunch of parts of your ankles and achilles in a very long time. It felt sort of good, lol. Now that I have been at it for over a month, it is much better. Still feel it after the dynamic workouts, but not with the same intensity.
I also started jumping rope, as I mentioned in the last post. That has been great for ankles and calves! Once I forgot to set the timer and just kept going at it happily listening to the music. Well, I could not walk for the next 3 days, my calves were so sore. So, here is the proof, jumping rope really works calves!!! Now I monitor the time I jump though!
Here is a compilation of some explosive moves, just to show that we can get back to agility. My injured leg is still a bit weaker on push off (I do not notice it that much on two legs jumps), but it absorbs the landing pretty well. During single leg jumps I still feel weaker. They are getting better though.
PHYSICAL THERAPY
I have been going to PT once a week in the last 2 months. My physical therapist was splitting the time between my achilles and hamstring. For achilles, it was mostly working on regaining flexibility. I get Graston tool work done and some ankle mobilization. We stretch it with added resistance and then utilize the new, stretched out range of motion to do some calf work outs. Rest of the calf work is done by me at home at this point. I still do PT 6 times a week at home. It is pretty much same exercises as in my last post, but modified here and there. Still lots of calf raises, but all on an incline. Still lots of balancing and squats. Rest is taken care of by my regular workouts. On top of that hamstring rehab work…
I still get massage therapy done once a week as well.
Few changes since last time:
1) All soleus and gastroc stretches now done on a platform. DIY platform = styrofoam block + old shelf + wobbly cushion.
2) Added resistance to to stretches. I am using pull up assist that I attached to my bench. This stretch has worked pretty well in returning dorsi flexion thus far.
3) Stretches in lunges on incline with knee over toes. Just doing calf raises in the lunge position, moving whole body up and down. This works dynamically on dorsi flexion and also works nicely on calfs (and quads 
).
4) This is really good stretch for arch in the foot. Doing many calf raises, I always felt pain in the arch. This helps a lot with it. Being on the incline sideways and balancing works well in straightening the arch and also the inside part of the achilles. Initially I was getting spasms in my foot after 30 seconds of doing it, it was so bad. Now that’s passed and I do it couple of times 1 minute each time. I recommend this one to everyone. I was really grateful for my PT after he gave me this one!
CALF STRENGHT AND FLEXIBILITY
I hit a true plato in my dorsiflexion at 9cm. For the longest time, every time I came in for my PT, I was at this dreaded 9cm in knee to wall test (toe to wall measurement). With help of my PT and with stretching we were able to get it to 10.5cm-11cm, but it was always going back to 9. Finally, I think it was mid month 8, I was 10cm at the beginning of the session. That was exciting. haha The little things!
This one actually is not worrying me anymore, I will get there. Stretching feels good now, so I do not mind doing it few times a day. It does not take much time, so I am ok with it.
Now, as far as strength, that is hard to truly measure. I know that single calf raises are used as one measuring statistics, but so many other muscles are used in calf raises and I think after doing 1000s of calf raises my body learned a bit how to compromise with other muscles, so that measure is not exact. But anyways, in month 6 I was able to do 60 single calf raises on the injured leg. In mid month 8 I did 120 single calf raises with healthy leg and then whipped up 120 with the injured one as well. I could do more with each leg, but decided to stop there. Saying that, they are not as easy in my injured leg as in the healthy leg. They require MUCH more effort. I actually was drenched doing the test on my injured leg.
I now do all (including bent leg) calf raises on incline and they are much harder. Still a lot more weakness raising from below neutral than from neutral. I feel a big difference in incline calf raises in my injured and non-injured leg. My numbers are also fraction of the ones going from neutral, so this is something that is still very much work in progress.
You can see above how puny my injured (right calf) looks in comparison to my uninjured one, lol. Where is my gastroc? I do not really worry about it. I just want the strength back.
WINTER SPORTS UPDATE
I have been doing quite a bit of downhill skiing this winter and the achilles is holding up nicely. It gets sore after couple of hours and I need to massage it during lunch time, but then it is back to normal for the afternoon runs. So, still not 100% back, but it is not slowing me down, which is great! I have the next 2 weekends full of of skiing, so am eager to see how the achilles will do in consecutive days of skiing on longer trails!
Snowshoeing had the same effect as skiing. I feel the achilles after couple of hours, but it is not to the extent that I have to stop.
HAMSTRING UPDATE and RUNNING
I mentioned in few previous posts that I injured my hamstring at the end of November while running. Well, I am still struggling with this thing… I tried a run in month 8 to test it and my hamstring flared up again. I vowed not to run again until I feel absolutely nothing in my hamstring. Lets see how that goes… My PT has been rehabbing my hamstring more than my achilles, it seems, and now I have a separate referral just for hamstring rehab.
On a positive note, during my trial run my achilles did really well. No pain, no after effects, ran with complete flat shoes for the first time and it was ALL GOOD! It was also so good to run, but what to do, got to wait a bit longer… Again, patience, patience…. If there was a pill for patience…
And today at my doctor’s appointment for achilles check up, my doc evaluated my hamstring problem as well and he thinks that it might be sciatica pain, so it will be treated as such in PT at the moment. Doctor has a plan of action for it, so I am hoping to be finally pain free in coming months! Crossing fingers…
LIFE AT MONTH 9
I still think about achilles every day, but that’s because I do PT every day. Because of PT it gets sore, calf gets sore, so it’s hard to forget it completely yet. A lot of time otherwise I do not think about it now. I had a bad slip on our floor in month 8 and I did not even think about the achilles, so I guess that’s a positive mental progress.
Now I think about my hamstring instead, since I have to give some feedback to my PT in our weekly sessions, haha. That’s my unfortunate side effect of this achilles injury.
Once more wishing everyone happy healing, lots of patience with this ordeal and as little setbacks as possible!
Man, this is great progress with nonop. Wish I found your blog earlier. Thanks for the videos. I am in month 6 nonop and will be starting running slowly. You got any tips?
Hi Sean,
Thanks. As far as running - my PT had me on “return to running program” initially at month 5. He made me run on a treadmill to check my running first. Then cleared me. The program is basically interval training with fast walking/running intervals. It had stages that started with stage 1 being: 1 minute fast walks and 1 minute runs 5 of each plus warm up and cool down walks. Once a stage was completed about 3 times and there was no pain, I was to move on to the next stage that either had more intervals or longer intervals. I initially wore gel heel inserts in my running shoes to not strain my achilles too much while running. It was getting a bit sore, but the soreness was short lived. Stretching after and using foam roller on calves was helping with that. The point is to ease into running. Do not overdo it. I was doing hill walking and some speed walking before I started running as well. Good luck with it and hope you are doing well in your recovery so far!
Well done on your return to explosive movements! Sorry to hear the hammie is still being a pain - hope the new plan gets it on track!
It’s interesting how different we all are. I’ve never had to work on stretching, but strength is still very much a work in progress! I can’t imagine doing 120 single leg raises!
I’m at 7.5 months post injury now - back running and doing some intervals - gradually working up to full speed. I’m doing heaps of skipping, jumping and balance work to get ready for my return to netball in a month. I sure appreciate everything I’m able to do now!
Great to hear your good progress Nicola. Looks like you are on your way back to netball. You should share a video from your first game/practice next month.
It’s so exciting to be getting back to the sports and I surely understand appreciation for being able to do things again.
Yes, it does not seem there are 2 recoveries that are the same. Did your dorsiflexion come back to the same as before injury? As far as sl calf raises, I somehow doubt that it is my calf doing all this work. Doing them now on incline is much harder for me, so I definitely found a weakness and mess around with variations of calf raises on the platform to activate that calf some more.
Good luck with working on regaining strength and crossing fingers for your smooth return to netball!
I’m not sure what my dorsiflexion was pre injury but my injured leg has only slightly less than my right leg now. It doesn’t inhibit my range of motion so I’m not targeting it. My main focus now is balance/landing work, to prevent any new injury on my return to netball. So many different options for calf raises isn’t there! I’m finding isometric holds are getting my calf working atm
Thanks. I tried few intervals last weekend. My tendon was sore after few intervals, so I stopped to massage it. I might need to look at some heel inserts. It was great overall, but my pace sucked. Gotta work on it.
Nicola - that’s really cool that at least dorsiflexion is not your worry with the recovery!
I am still not at the same dorsiflexion as my uninjured leg, but actually I do not notice much difference in life now. Feel it only in things like deep squats. Was told by my PT now not to aim for the same dorsiflexion, only for comfort. I think I am almost done. Yeah, thankfully there are many options for calf raises. They can get boring, so variation helps… Once more, good luck with strength/ankle work for netball. I found that doing very quick pumps with full range of motion on incline get my calves fired up. I do them on 2 legs, but make sure I apply slightly more weight on injured leg. I do as much as I can until I feel the burn in injured leg. Everyones calves seem to react to different things though. I cannot remember if you did or not, but try jumping rope. Great calf burn if done for longer time. Works nicely on ankles too.
Sean, glad you tried to run. Hope the achilles gets better with time on your intervals. Ya, the pace is something that will come back with time once the leg comes back to normal. Do give heel pads a try, or running shoes with elevated heels, or both.
I have been running and it’s been going well. Pace is improving. Tendon still is tight though. I got some heel inserts that fit in my running shoes as per your suggestion and they are helping. My achilles is still getting tight in the mornings. When did your achilles tightness disappear completely? Thanks, Sean
Sean - Glad to see your running is going well and that the inserts are helping. With time, as your tendon stretches out, you will be able to get back to flat running shoes. Did your physical therapist start you on some type of stretches yet? My PT started me on static and then passive stretches in week 19 and it took a while to get back to “normal”. I was stretching 3 times a day at that time. I am now 10 months and 1 week and I do not stretch and do not feel any tightness in the tendon. Now I only stretch calves as part of regular, after workouts stretches. Everyone is different, but for me it was about 9.5 months before the tightness was gone completely - and I mean I feel no tightness at any point during the day. Saying that, starting month 8, I was able to exercises/run in completely flat shoes AFTER I did some dynamic calves stretches.
In the morning what was helping me was just doing few sets of quick double calf raises on a step right after getting up. That warms up the calves and also stretches them a bit. You will get there just work on it regularly.
That gives me hope. Yes, I have been told to do stretches in pt and at home, but the flexibility is coming back slowly. I will try to intensify my stretches with resistance. Thanks again for your tips. Helps a lot. I hope you’re hamstring is getting better. I had sciatica pain in the past from running. No fun…
Sean - yep, the resistance stretches helped me a lot, but do try doing them on an incline (to increase dorsiflexion) with resistance. These helped me a lot. Also, I was told to do some calf raises and calf exercises right after the stretches to get my brain used to using the new range of motion.
And yes, the sciatica is no fun. It’s getting better, but it is still there, so still working with pt on figuring it out. Did you figure out the cause of yours? Mine also started with running…
I tried resistance stretching and doing calf raises after and definitely feel a better flexibility. I guess it makes sense to work the calf after the stretch as well. I will try to add the incline to the stretch as well and see how it goes. Thanks for the tip. Good idea with the diy platform, by the way. As far as sciatica, mine was pretty straight forward - back issues I had in the past. Took a while to fix in the rehab. Keep at it.
I talked to a soccer friend who had ATR 2 years ago and she said that walking barefoot on the beach really helped her work out some final kinks. Not sure if you have a beach nearby - LOL! I’ll have to see if she was walking on the loose sand or the wet packed sand. If it was the loose sand then you just need to find a sand volleyball court or a sandy kids playground area to walk in.