Climbing mountains & crawling down the hill

Hit a tree.  No damage to me or the bike.  Over the handle bars. No damage to me or the bike.  Stopped to avoid a tree.  Skin abrasion to my leg.  Yep, I am riding my mountain bike as much as I can.  Opted out of the clipless pedals…too much to think about with my limited coordination.  Bought a dual suspension bike and love, love,  love the feeling that I have more control.  This time last year I thought my bike days were over…..pretty much I do what I want to do…..except the one legged calf raise.  My guess is I healed long…any non-surgical suggestions? 

12 Comments »

  1. normofthenorth Said,

    May 28, 2012 @ 12:47 am

    I don’t know if you’ve been following my story, Alice, but I’m also stuck with a wimpy 1LHR, and I’ve been shocked to find that it’s made virtually no discernible difference to my competitive volleyball, on sand and court. I virtually never think of it when playing or bicycling or doing anything else. I do sometimes get a funny feeling along the OUTside side of “that” lower leg when I’m pushing hard. Nothing that slows me down, but it’s odd. (If I’d had surgery on that side, I’d wonder if they’d nicked something!)

    Meanwhile, if you DO find a solution, do share! My impression (still untested/unmeasured) is that my gastroc-AT connection is longer than normal, but my soleus-AT connection is normal. I.e., my calf strength with BENT knees seems more symmetrical than with STRAIGHT knees. (Of course 1LHRs are done with STRAIGHT knees.)

  2. Stuart Said,

    May 28, 2012 @ 2:34 am

    Good to hear from you again Alice and it is also good to hear that you are enjoying life. Can’t help with the heal raise but as long as it is not affecting what you enjoy then is may not matter that much just as Norm has said. BTW Norm, I have been doing the 1LHR with bent knees for some time. I found it helps the Soleus more.

  3. Gary Said,

    May 28, 2012 @ 7:20 am

    Hi Alice, I healed long, suspected as much after grinding it out in the gym for 8 months post ATR and couldn’t get more than 2cm calf raise and the calf was weeny. PT recommended seeing a sports med specialist who diagnosed it in a minute. Lots of tests but the defining test was to lie stomach down on bed with feet dangling over end. They naturally hung at different angles, it wasn’t subtle. However as you and Norm have found its amazing how much you can do on a compromised calf. I was fully back into my sports (although not running or doing anything explosive) and chasing the kids around. But the thought of never getting beyond, say, 60% calf strength and the strength imbalance impacts bugged me and so I had the achilles shortened 8mm 6 weeks ago, now FWB and looking forward to 2 shoes in a week. As the specialist said it was my call at the end of the day, many peeps would leave it. There didn’t appear to be any non surgical options, the only upside of surgery was that I could schedule it for our winter so I would be roughly ready for (late) summer activity. So no easy outs unfortunately, really tough one, it was an agonising call and I must admit to almost pulling the pin the weekend before surgery, so close was the call in my particular instance. Time will tell if surgery will work, if you read the classic “Tom healing long” blog its clear that while the surgery worked the road to recovery is long (sorry!) and 100% success is not absolutely guaranteed. So….its a pretty individual decision to make and I think you’ll know which way to swing it after more m-biking etc. Certainly explore all options meantime before even contemplating going under the knife, perhaps we don’t have all the answers with NZ being at the end of the world and all, and surgery is a hardcore step. Hope this helps?!

  4. Brian Hamman Said,

    May 28, 2012 @ 11:22 am

    Hi Gary,
    Healing long is always a worry of mine and I would be interested in hearing your thoughts about why you “healed long”. My physical therapists perscribed mild dorsiflexion exercises right after I got out of the cast 6 weeks post-op. I was set at neutral in my cast between 4 and 6 wks post-op and was able to to go to +4 degrees of passive dorsiflexion my first PT session a couple days after getting the cast removed. I was told to do towel stretches (both straight legged and bent at the knee) 3×30 seconds, at least once a day. My passive dorsiflexion is up to +10 degrees 2 weeks after getting out of the cast (8 weeks post-op), which is still 6 degrees shy of my “good leg”. My PT sessions are now starting to incorporate more aggressive stretching such as standing on an inclined board with foot dorsiflexed (must be at least 10-15 degrees) for 3×60 seconds. Do you and/or others on this blog think that I am doing too much stretching?

    On a slightly different note, I was told that the average person can do around 15 degrees of passive dorsiflexion whereas most athletes can do at least 20 degrees…this particular PTist said we athletes who don’t stretch enough keep them in business! :) They told me that I should get my bad foot back close to the same as my good foot (+16 degrees) before working on more serious calf strengthening exercises and/or running. The logic is that flexing thru a shorter angle will never give you the same power you could have if you practice flexing thru a larger angle….seems to make sense? The converse is also true: a tendon that healed long (too much dorsiflexion) will not have the same power as one the healed within the 15-20 degree dorsiflexion range? Gary: how did your dorsiflexion compare between your “good” and “bad” legs prior to your second surgery? Ok, enough for now, glad to hear things are going well after your 2nd surgery, best of luck to you!

    Thanks,
    Brian

  5. normofthenorth Said,

    May 28, 2012 @ 11:46 am

    Good discussion, all. I’ve recently posted some notes on the downside of healing SHORT– which I did post-op on ATR #1. My current podiatrist thinks it’s the scariest thing I’ve got going in either leg(!).

  6. Brian Hamman Said,

    May 28, 2012 @ 12:15 pm

    Norm,
    Where can we find your notes about healing short?
    Thanks,
    Brian

  7. Gary Said,

    May 29, 2012 @ 4:26 am

    Hey Brian (and Alice, sorry don’t have my own blog!), indeed this is a good but curly question. Whilst I had the usual stretching exercises prescribed by the PT at about 8 weeks I really don’t believe that was the cause of healing long. I understand there are many potential reasons for healing long, but its usually very difficult to identify exactly what the cause was. I would also qualify that this condition is fairly uncommon, from what I can make out. However, having said all of that, in my case I’m pretty sure I know the culprit. I believe the wheels were set in motion the very first time I visited the ER with the ATR. I went for non op - seemed like a no brainer - so they put me in a cast. The local hospitals procedure for this is to sit on a bed and let your foot hang naturally, toes down, which is ironic as of course you have no control and the foot does indeed hang where it wants to. The nurse made a comment that has always stuck in my mind “you don’t have much droop do you”. Thought nothing of it at the time but on reflection I wish we had forced my foot down a little more as I believe the ends of the tendon were some distance apart when cast. Unfortunately the ultrasound people had gone home for the day so we didn’t know exactly what was going on in there so I’m putting two and two together in coming to that conclusion. But giving it credence is the experience of a lot of non op friends and colleagues at another NZ hospital who experienced a much more scientific approach involving tape measures and comparisons with the other side and forcing the feet down before casting. And another friend just today in fact reported he has healed long, after being treated at my hospital. Hes actually a lot worse than me, after 5 mths he can’t get a 1mm calf raise going, he’s back into MTBing and SUPing and says he doesn’t fear tweaking the AT cos its so long its almost immune to that sort of injury -a perverse upside I guess. So yeah, kinda angry about how the local hospital is potentially treating ATRs non operatively, I’ll tell anyone in the local med profession this if they’ll listen. Holding me back from taking it further is the knowledge that its just so hard to know definitively what the cause could be so even though I’m pretty much convinced what happened to me there is that element of doubt. Unfortunately the only way that we’ll detect if theres a problem going down locally is after some years of data collection pointing to a disproportionately large representation of “healing longs”. I sincerely hope that doesn’t happen.

  8. normofthenorth Said,

    May 29, 2012 @ 2:25 pm

    If you go to my generic blog site — achillesblog.com/normofthenorth — I think it’s the top part/link, because it’s the newest. (If not, pls ask again.)

  9. normofthenorth Said,

    May 29, 2012 @ 3:21 pm

    Gary, you may well be right, but you’re also right to have doubt, IMO. The UWO folks gave everybody 2cm of hard rubber heel wedges in the AirCast. (I accidentally got 3 cm, and I think I’ve healed a bit long, so keep that doubt!) Casting in “gravity equinus” used to be standard, but now it’s definitely Old School.

    The first of the (still 4) modern non-op/op studies using fast protocols was done in NZ. Details in Wikipedia or my blogs, etc. One of the NZ ATR gals from ~18 months ago (bronny) got a copy of the study from the chief author, IIRC. He might help you fix your hospital, if you’ve got the energy for it. Many NZ hospitals already stay close to his (v. successful) 2007 protocol, I think.

  10. normofthenorth Said,

    May 29, 2012 @ 3:23 pm

    The only study I’ve seen of the rel betw pf angle and ATR “gap closing” was done on cadaver legs. IIRC, they found 20 degrees was usually pretty good. (It’s online somewhere.)

  11. Gary Said,

    May 30, 2012 @ 3:17 am

    Hi Norm, not sure why the ref to heel wedges? We get about 3 cm in our moonboots too. Aware of Bronny and Twaddle, I mentioned them a few weeks ago, Bronnys doing well (its a very small country). Yes even the local hospital is kinda following Twaddle protocol, although a more basic and slower version - theres a “yellow brochure” that everyone follows.

  12. normofthenorth Said,

    June 2, 2012 @ 3:56 pm

    Gary, the height/number of heel wedges in a fixed boot (like UWO’s AirCast) sets the ankle angle, just like the angle of your cast. More pf angle (either way) brings the torn AT ends closer together, apparently to the point of overlap.

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