In the pool - real progress - 9 weeks

Wow…..get in the pool guys as soon as you can, post surgery!

So my personal trainer at the gym encouraged me to try and walk up and down the pool a few times to see how it went.  It’s chest high, same depth all the way, 20m long.

When you’re at the stage where you’re just starting to walk in shoes, you’ll probably find it really difficult and hobble pretty badly but to the lack of stretch in your achilles.  You’ll get loads of exercises given to your by your PT but they’re pretty dull and not that rewarding in the early days.  Get in the pool and everything changes.  For the first length I was nervous and still hobbling but once I relaxed I was walking totally normally.  Full stretch, heel down first, step after step.  It felt incredible, a little sore of course but not painful. A really nice stretch feeling.  Even when I got out of the pool my gait was so much bigger.

Of course it stiffens up again but I’m in the pool everyday now and have even thrown in some swimming with a pull buoy (float between legs) so I don’t need to kick.  Feels great to finally be doing some cardio work. In just 6 days my wife says my walking has improved immensely.

I also saw my consultant yesterday and he doesn’t need to see me for another 3 months now which is great news at only 9 weeks. He says I’m ahead of schedule which is brilliant to hear, thanks to the accelerated protocol no doubt, and just need to keep up what I’m doing.  He did though recommend buying a pair of HOKA running shoes….I’d never heard of them but they have HUGE soles on them for ultra marathon runners.  Naturally I don’t intend to run any ultra marathons any time soon but he said they are wonderful in aiding recovery of any calf/achilles/tendo injuries.  Good advice….just on Amazon and take a look.

I also brought up with him the two words that terrifies anyone with an achilles rupture….healing long.  He made it very clear that it would take something incredible for me to heal long as I have had surgery.  Healing long is only a potential issue with conservative care. This is good news as I’ve been a little tentative with any dorsiflexion movements as I have those two words in my head, but not any more.  In his 20 years as a consultant he has never had a surgical repair on achilles rupture result in healing long.

Lastly for now, I’m sharing a great page I found with recovery tips.  I would whole heartedly agree with everything on this page - https://lauraopstedal.wordpress.com/2016/07/26/5-tips-for-optimal-achilles-repair-rehabilitation/

Until next time, from London.

Andy

Bye bye boot (8 weeks+3) and hello gym!

Hooray!

Man I really hated that boot…never got on with it at all.  I was hopeless at walking in it, never could get the whole rocking thing going depsite my physio trying to show me. So my leg was always out to the side….aagh the hip pain!

Still, I’ve now ditched the boot and am hobbling around in a pair of running trainers constantly.  Even round the house, trainers on ALL the time.  Naturally I gave them a good clean first!

I tried without the boot last week, exactly 8 weeks post op, it was actually totally fine but I kept using the boot when out of the house for a few days.  If anything, it’s a clear sign to others to be wary of knocking in to you.

My issue now is learning to walk again.  At the moment when I walk I turn by bad foot (right) out to the side.  This is BAD so avoid this if you can.  I have the hip/groin pain to show for it.   It’s very difficult to walk with my foot facing forwards as there is no stretch at all in the tendon yet so my leg doesn’t bend when I walk.  So for now I’m kinda shuffling along.  Bad foot forward, then good foot up along side, and repeat.  It’s not exactly walking but that will have to do for now.  Small victories….

In other news,  I have joined a gym.  This is major for me as I don’t think I have ever stepped foot in a gym before, literally.  Sounds daft as I’m nearly 40 but I’ve always exercised outdoors (running, cricket, golf) with the occasional swim at my local pool.  So turning up at my nearest gym to find out what all the fuss was about felt very odd, there are some machines in there I have literally no idea whether they are for exercise or chopping vegetables.  I struck gold though, as the first personal trainer chap I spoke to (hello Ian) ruptured his achilles 5 years ago!  You beauty!  He’s going to show me all sorts of exercises I can do and help me through the next few weeks……I couldn’t believe my luck.

His advice for first exercises, apart from static bike that i have at home, is to walk up and down the swimming pool.  It doesn’t go beyond chest height so I can do entire lengths back and forth.  I haven’t tried it yet but might give it a go tonight.

I’m up to 12 minutes on my static bike now, 3 times a day.  The leg gets a little sore towards the end so 12 minutes is fine for now.  It’s a start….

So for the next few weeks it will be lots of pool work, bike at home and lots of physio exercises…..a little boring but patience is a good trait to have here.

Until next time,

Andy

Major progress - read this guys

Greeting from London….naturally it’s raining :)

It’s only been a few days since my last post but I wanted to get this post in asap having read the comment from iasablan and ty620 who are both on a similar timeline to me.

It’s quite a lengthy post this, but worth it, this will shave weeks off your recovery.

I saw my surgeon on Saturday who is very experienced in ATRs and is involved in all sorts of studies on the matter and he talked me through a study which compared the results of loads of trials on the subject of post surgery treatment.

The full report is available here but you’ll have to buy it ($35), http://www.sciencedirect.com/science/article/pii/S0020138314003155

My surgeon gave me a copy so ask your surgeon. It’s a long read but well worth it.  I summarise like this:

There have been lots of trials over the years that compare different types of treatment for ATRs.  This study from 2014 put together all of those trials to try to come up with a definitive approach that led to a faster return to pre-rupture activity but also keep re-rupture rates low.

So the trials covered groups that took the more ‘traditional’ approach of NWB for 2-3 weeks in a cast, then PWB for 4-6 weeks in the boot, then FWB followed by the usual physio etc.  The sort of approach you’ll read a lot about throughout this website. Throughout those 6 weeks there is absolutely no movement of the ankle, referred to in the report as non-mobilization.

Groups in other trials studies were treated with a far more aggressive approach. FWB immediately……yep, straight away from surgery, FWB.   I can’t quite imagine what that would feel like but that’s what they did.  Still in the cast for 2 weeks, still the boot after that, but no crutches.  FWB straight away…..madness right?  These people were fixed in plantar flexion (toes pointing down) in the cast for 2 weeks but allowed mobilization after that.  They could have up to 30 degrees of dorsi flexion (pulling your toes up) whilst having the boot on/off.  After 6 weeks the boot came off.

Well the results are incredible….I’m quoting here:

“ALL trials found mobilization to be superior as it shortens time to return to work and sports significantly”

“This combination (FWB with mobilization) was most beneficial. Patients showed significantly higher satisfaction, less use of rehabilitation resources, earlier return to pre-injury activities and further demonstrated significantly increased calf muscle strength, reduced atrophy and tendon elongation

No study found an increased re-rupture rate for the more progressive treatment.”

At the end of the document it gives a recovery protocol.  I don’t know about you guys, but the protocol I was given by my physiotherapist was 6 pages long, full of all sorts of information I felt I didn’t need.  This protocol from this study is just a few lines long and is split into 3 categories: ROM (Range of Motion) and ORTHESIS (that’s the posh name for the boot) and WEIGHT BEARING

ROM:
Week 0-2      None
Week 3-6      work up to 30 degress DF/PF
Week 7           Free movement

ORTHESIS
Week 0-2      Fixed in a cast, PF
Week 3-6      Occasionally off, work up to 30 degress DF/PF
Week 7          Off

WEIGHT BEARING
Full weight bearing throughout

So, how does this play into my own recovery, I am currently 4 days into week 5.  My surgeon made it clear to me the best advise is to listen to your body.  If you go FWB, be prepared to take it easy to begin with, don’t just start walking everywhere thinking you can get back to normal everyday activities.  I am FWB, ditched the crutches as soon I came out of seeing him.  However, I am not going mad.  Round the house is easy enough, and if it hurts I can sit down for a few minutes.  No trips round the supermarket just yet.

In my experience, the only part that actually hurts and bothers me is the actual wound site rather than the tendon itself.  I am getting zero pain from actually inside my leg, it’s all on the surface.

JUST TO BE CLEAR….when you are FWB you should always be doing it IN the boot.  I have not had the all-clear to put my foot on the floor without my boot yet.  I expect that to happen in the last week of August, my surgery +7 weeks.  At that stage I’m going to put shoes on and get around the house.  Something backless, Crocs maybe, so as to not rub on the scar.

The more I read about this aggressive, accelerated approach, the more I am convinced it’s the right way.

Speak to your surgeon but I would advise getting FWB as soon as you can. As long as you listen to your body and rest when it hurts, get on your feet, get weight through it.  Walking in a boot is tricky, I’m not very good at it yet, but it feels great to be getting around without crutches. The other benefits are I’m using my legs properly so muscle atrophy should stop, my hips/shoulders/hamstring/hands aren’t aching from all the crutch work.  The only bit that is sore is the ball of my foot, those wedges are hard, but if this shaves weeks off my recovery I can live with a sore foot.

Sorry for the long post but I hope this helps,

Andy

One small step for man…

27 days post op….

So it’s been 9 long days since my last post.  I’m currently in an Aircast boot with 3 wedges

It’s been a very interesting few days though, as my consultant has changed the protocol I’m on for my recovery.

I was on the standard recovery protocol where I would normally still be NWB for another 2 weeks (eugh).  However my consultant has said that because there is no swelling, no bruising and no pain I have moved to an accelerated rehab protocol.

So this means that I allowed to be PWB with 1 crutch….what a life changer!  It was SO difficult at first to commit to lifting my good foot off the ground to put pressure through my injured leg.  Knowing that as soon as you lift that foot off the ground you’re putting weight through your repair site is very daunting. At first I kind of dragged my good foot about an inch across the floor but eventually you just have to commit, push your repaired foot into the ground, grit your teeth and lift that good foot off the ground.  And it was so great….

Within a few minutes I’m walking around the garden with just one crutch, Neil Armstrong’s voice in my ears!  Happy days, it felt like such a huge leap forward in my recovery.

It’s really important to have the crutch on the other side to your injury, so I have injured my right leg, the crutch is in my left hand and they move together, then the good foot moves forward.

This has literally changed my life.  It seems so simple but I can now carry things, pick things up, get something from the fridge, such simple tasks but things that make life so much easier.

The protocol I’m following is here, http://www.pauldefrinomd.com/pdf/pfd-achilles-tendon-repair-postop-protocol.pdf

It does say that from week 3 onwards (I’m currently 1 day short of 4 weeks) that I can be FWB but that seems a step too far for me so I’m sticking with one crutch for now.

There are a couple of other things it says that I am not doing.  It says I can sleep out of the boot but I’m not going to for a couple of weeks yet.  I’m so used to sleeping in the boot (leg elevated on pillows) that I may as well continue, why have it out of the boot and risk pain or re-injury?

Also, I’m still bagging my wound for showering….I’m really not sure why tbh.  I just don’t have confidence yet in getting my wound wet, probably a bit over protective but so be it.  I also still sit on a stool to shower, there seems no point risking slipping over until I have more strength.  Don’t rush these things….

So how does this change the next couple of months?  Well, originally I was looking at being out of the boot and into shoes at around week 12-14 (first week October) but now I am looking at week 8-9 (end of August), that is a huge difference!

So, how to get yourself into the accelerated protocol?  Here are my 3 top tips!

1. Elevation, elevation, elevation.  I literally had my foot up the entire time, unless I was using the bathroom.  Bed, sofa, repeat.  For 2 weeks.  Man it’s dull but do your best to get through it as you will shave several weeks off your recovery. In my case it’s taken 4-6 weeks off! Thank you Netflix.

2. Rely on friends and family.  Don’t be afraid to ask for help.  I had someone make me a sandwich each day for lunch, simple things like that would take me 20-30 minutes in the kitchen which is time your leg would be down.

3. Sleep with your leg up for weeks on at least 2 pillows or a pile of towels.  I’ve been doing it for 6 weeks now (since injury date) and the swelling had gone within a week of surgery.  Get that leg up and keep it up!  You might find your knee or hamstrings hurt when your leg is up so support that area too, and a rolled up towel between your knees when lying on your side helps loads.

4. Don’t be tempted to stretch that tendon when your boot is off.  The urge to pull those toes back and watch the tendon move is huge.  Keep that foot still until you are told to exercise.  Trust your surgeon and physio experts.

I have another consultant appointment on Saturday for assessment, hopefully another wedge removed and approval to start some serious physio!

Will update in a week or so.

Over and out,

Andy

Greetings from the sofa in London!

Leg elevated, typing from the sofa :)

You’ll already be able to tell from the word ’sofa’ that I’m in the UK, sunny London to be precise.

Full ATR playing cricket (Google it!) on June 17th 2017.  I’m now 18 days post op and all going well so far.  Had a the cast for 2 weeks and just got my boot at the weekend. Surgeon very happy with the wound, stitches out etc and start physio this week on day 20.

Some stats:

Male, Nearly 40, relatively fit, runner, golfer, cricketer.

I won’t rattle on about how I did it as you’ll all have read the same kind of thing hundreds of times, needless to say it popped, full rupture, it hurt and it got repaired by a surgeon two weeks later.

I wanted to blog my recovery mainly for people that do their ATR playing cricket as there don’t seem to be many (if any) blogs about getting back on to the cricket pitch.  I’m a wicketkeeper so that means squatting right down about 300-350 times a day on match days plus hundreds more times during the week.  The pressure this puts on the achilles is huge, plus lots of explosive pushing off for running up and down the wicket, it’s a wonder it doesn’t happen more regularly.

I’m in the ‘doing nothing’ stage which I find mind numbingly dull.  I’m lucky that I can work from home so that keeps me busy plus we have just had Wimbledon so that made the days go faster.

I would say the trickiest parts of recovery at the moment are firstly sleeping and secondly resisting temptation to stretch my heel around when the boot is off.

Sleeping…..wow, that’s not east in this damn boot.  My tips would be to take off the plastic front cover (you only really need that for protection during the day) and loosen the bottom two straps.  Seems to work for me, plus I am carrying on with keeping my leg rested on 2 pillows at the end of the bed to keep the leg elevated above heart level.  Sleeping like that for over a month now has definitely helped with swelling which has already gone just about completely.

Temptation to stretch…..when the boot is off (heavenly!) I am constantly fighting the temptation to pull my toes back, push them forward.  Doing nothing with it takes a lot of concentration.  I have words of my surgeon ringing in my ears “you’ll be tempted to move it….DO NOTHING”……yes sir!

I’m on 4 wedges at the moment, consultant fitted the boot with only 3 but that was agony on my achilles so he put another one in there.  Going back in 2 weeks to be assessed and probably down to 2 or 3 wedges.

I’m keen to start exercising it but resisting so far apart from PWB on 2 crutches up and down the sitting room.  I can put a fair amount of weight on the foot so I’ll take that as a small victory.

That’s what I read a lot about, small victories, setting targets that are achievable, going about your business to achieve them and nothing more at this stage.  Patience I think they call it :)

Looking forward to phyiso this week although it’s early days so we are mainly going to discuss the next 6 months, layout the protocol so I can start to set myself those targets.

Atrophy…..my right calf muscle has all but turned to jelly :(  I’m finding it hard to come to terms with that but not a great deal I can do about it.  I live in a fairly idyllic village so can always find a good excuse to go for long walks, that’s my plan once given the go-ahead.  On the lookout for an exercise bike too at the moment, seems like a sensible thing to do having read many blogs on here.

I’ll update again in 2 weeks once had my next review with the surgeon.

From London, UK.

Andy