Glad to say no recurrance so far of the problem behind the knee. Driving my car now feels as though I have never been away from it. I am seeing my sports physio about every 2 weeks. The physio sessions focus on gauging progress, updating the workout sessions, deep soft tissue massage and manipulation/articulation of joints.
I have continued the gym workouts, but have not gone back to the hydrotherapy (largely due to practicalities/ convenience rather than any aversion to more hydroptherapy). In addition, I am doing 2 legged calf raises and short walks wherever I can fit them in. The objectives at this stage are to improve muscle strength, gait re-education, proprioception, and general body conditioning.
For these 2 weeks only, I targeted 6 gym workouts in each week with 1 day in between to allow the achilles tendon and other muscles a rest. [Note: this is not sustainable and I will drop workout frequency to 2 or 3 days on with 1 day off for Week 18 onwards]
The gym workout for Week 15/16 was as follows :
- static bike 2 x 5 min
- rowing machine 2 x 5 mins
- cross trainer 2 x 5 mins
- wobble cushion for balance 5 mins
- resistance settings for machine were low at the start and progressed to medium by the end of week 16
- leg extension machine - 2-legged & single legs 3 x 7 reps
- weights on leg extensions kept low for first 2-3 sessions, then set high enough so that final reps induce fatigue in muscles.
- use hand massager daily and home ultrasound 3-4 times a week
The gym workout for Week 17 was as follows :
- static bike 5 min
- rowing machine 5 mins
- cross trainer 5 mins
- treadmill (walking only) 15 mins
- wobble cushion for balance 5 mins
- resistance settings kept at medium, short higher resistance peaks and inclines added.
- leg extension machine - 2-legged & single legs 2 x 10 reps
- leg press - 2-legged & single legs 2 x 10 reps
- leg curls 2-legged 1 x 10 reps
- seated long row (i.e. weighted) - 2 x 10 reps
- weights kept low for first 2-3 sessions, then set high enough so that final reps induce fatigue in muscles.
- use hand massager daily and home ultrasound 3-4 times a week
Continued driving as described in week 13. I have had no issues with ATR leg or use of the vehicle.
Did 5 hydrotherapy sessions of 30-40mins each in the learner pool. The sessions focussed on walking normally with some 2-legged heel raises also built in. As I progressed through the week I began pushing harder in the sessions, until on the last session of the week something gave. As I was walking through the pool trying to induce that push off from the toes, my ATR leg gave way mid stride and I got pain behind the knee just below the crease. I stopped the session and went home.
Looking online it appeared the problem was either gastroc or possibly popliteus muscle. The action of attempting a heel raise triggered the pain at the back of the knee. Managed to contact my sports physio who advised it was probably gastroc and would most likely clear up after a few days off from the rehab workouts and applying RICE. I followed the advice and additionally treated with my home ultrasound therapy equipment.
Week 15
Steadily over the next 4 days the knee pain went away with rest, so I then started my gym workout programme. I started in the gym with 30 min sessions comprising static bike, row machine and cross trainer, each for 5 mins twice around. I noticed that walking down stairs now felt normal.
Finally started to drive at beginning of week 13, despite there being no prospect of a single-leg calf raise anytime soon (my Consultants benchmark for driving). Had no issues with 20-30min journeys in my manual vehicle. However, I had a couple of longer journeys to do of 1.5 to 2.5 hrs, so have used an automatic vehicle with cruise control for most of week 13 & 14 to help ease back into driving. A bit of tiredness after longer journeys, but no other issues with ATR leg
In week 13, focussed a lot on calf raises and improving push off with toes when walking. Have used a single trekking pole on the ATR side when walking to assist the push off retraining.
Finally at the end of week 13, I started hydrotherapy. At this stage it is simply walking for 30-40 mins focussing on walking gait to get the heel strike through to involving the toes working. I am using the learner pool at the local leisure centre (its about 0.75m deep). Ideally I would have transitioned from a 1.2 to 0.75m depth, but the main swimming pool depth is not graduated and is too deep for walking.
My balance and the limp are improving, but the limp remains clearly noticeable.
Continued with largely the exercise regime outlined in week 10 with :
*walking to strengthen, concentrating on heel strike and toe push off
*2 legged heel lifts with fingertip support and progressively loading the ATR leg
*balancing on each leg to rebuild proprioception
*balance exercises with eyes closed - not very successful with this
*static bike with increment in tension
*ROM with heavy duty band
*Squats
*Quad squeezing exercises
I have also seen my private sports physio who is strongly advising that I continue protecting the tendon from lengthening. So I have pulled back on passive stretches, and have stopped doing any barefoot walking. Sports physio has added quad exercises to my regime and reiterated hydrotherapy. Haven’t managed to do any hydrotherapy yet, I must start that soon.
By the end of week 12, my ATR leg strength & co-ordination are showing good improvements plus I now have less risk of damaging the repairing tendon in any car incident. I have no doubt I can safely use all the controls in a vehicle. So I went out to a large empty car park for a practice drive and found I had no issues. I think I will start driving next week.
I still haven’t driven (see Week 8 dilemma). I will monitor strengthening progress over the next 2 weeks and then decide. Rehab focus this week has been on :
* walking to strengthen and improve walking gait
* 2 legged heel lifts with fingertip support and progressively loading the ATR leg
* balancing on each leg to rebuild proprioception
* static bike with increment in tension
* ROM with heavy duty band
The referral to my local Physiotherapy Unit was finally confirmed and late in the week I went for my first NHS Physio session. It was a good session. The physio assessed my current capabilities, massaged along the tendon, was happy with my existing exercises and suggested some further activities to progressively add in, e.g. :
* balance exercises with eyes closed
* gentle passive stretches
* sitting on posture ball and balancing on 1 foot
* hydrotherapy
I have continued the gym workouts, but have not gone back to the hydrotherapy (largely due to practicalities/ convenience rather than any aversion to more hydroptherapy). In addition, I am doing 2 legged calf raises and short walks wherever I can fit them in. The objectives at this stage are to improve muscle strength, gait re-education, proprioception, and general body conditioning. 
Looking online it appeared the problem was either gastroc or possibly popliteus muscle. The action of attempting a heel raise triggered the pain at the back of the knee. Managed to contact my sports physio who advised it was probably gastroc and would most likely clear up after a few days off from the rehab workouts and applying RICE. I followed the advice and additionally treated with my home ultrasound therapy equipment.
Finally started to drive at beginning of week 13, despite there being no prospect of a single-leg calf raise anytime soon (my Consultants benchmark for driving). Had no issues with 20-30min journeys in my manual vehicle. However, I had a couple of longer journeys to do of 1.5 to 2.5 hrs, so have used an automatic vehicle with cruise control for most of week 13 & 14 to help ease back into driving. A bit of tiredness after longer journeys, but no other issues with ATR leg
