A TWIST IN THE RECOVERY
Posted on January 26, 2009
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Been having some really bad sural nerve numbness and pain, so went to see my friend the sports med doc today (due to logistics, location, our relationship, he didn’t do the surgery, though he wanted to). Anyway, he was the one who 1st diagnosed the partial tear and put me in the boot so I could go on vacation before the surgery. He asked me to come in today because he knew of my nerve issues and wanted to ensure it wasn’t the size of the boot contributing to the problem.
Now, keep in mind that he is a sports med guy and an asst team doctor for a major league baseball team. The guy who did the surgery is also a reputable surgeon at one of the premier ortho hospitals in NYC (and partners with a close family friend). Anyway, my friend the team doc takes one look at my incision and is shocked at the length, particularly considering that we knew it was only a proximal partial tear going in. He’s very concerned about the amount of atrophy (I was in the boot almost 4 weeks before surgery due to vacation and the holidays) and was shocked to learn that my surgeon recommended non-wt bearing for another 2-3 weeks after getting in the boot and no therapy for a week or two after that. Given my age (40) and the fact I’m active and athletic, he feels I should be wt bearing in the boot NOW. He admits he is aggressive, but he believes given my extensive atrophy, swelling, edema and nerve entrapment, I need muscle stimulation and ultrasound 2-3x/week NOW, along with active motion and PWB with the crutches progressing to full wt bearing in boot in next 2 weeks. He fears i will never regain sufficient strength and will have “zero” calf if I wait much longer for therapy and that scar tissue and disuse will perpetuate my weakness, stiffness and nerve issues. In fact, he had his staff PT give me a gratis 15 minutes of stim and ultrasound and, i have to admit, it really made the leg feel much better and improved my circulation to the lower leg and foot. The PT actually commented that in her opinion my surgeon was treating me like i was 65 instead of 40!
So, now I’m torn. I’m going to dicuss with my surgeon my feeling that he is being way too conservative, particularly given the substantial atrophy and nerve issues, but I wonder which protocol makes more sense. Or maybe they both do. Any similar experiences or advice?
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Andykap68: I had almost the exact same thing happen to me with my rupture surgery. I had my surgeon who was treating me like I was 60 and I had a (friend) sports med ortho who is a team physician for several pro sports teams step in and tell me that he would take over my case for free because the treatment protocol I was on was old and was why Achilles ruptures “USE TO” be career ending injuries. I went with my friend and it was a great decision for me. He had me cut out of my hard cast in less than 24 hours and on a rehab table shortly after. I would have lost so much had I sat there and rotted in that hard cast for 10 weeks and then the boot(still non-weight bearing)for another 4-6 after that. My new surgeon for my other Achilles surgeries NEVER even put me in a hard cast. I have to take my foot out of the boot 24 hours after surgery and start slowly and carefully rotating my ankle. I did this on my second surgery and my recovery was a piece of cake. It was amazing. I go in for surgery on my other Achilles in 2 days and that will be my protocol then as well. The problem it sounds like you might have is that your surgeon is a family friend and that might be a little awkward but I would switch to the sports med guy in a minute. By the way, I am 40 too. I don’t think Achilles ruptures are career ending anymore. They are perfecting the recovery all the time.
Well, I’m 67 and sure as hell don’t want to be treated like I was 40! I’m sure you have checked out other blogs and have seen that the treatments vary so much from one person to another. In my case, I’m very happy at the treatment I’ve received and am pleased it hasn’t been agressive. In this way I’ve been able to recover much more quickly than might otherwise have been expected. An, yes, you can still be athletically active at my age - but only if you are extremely lucky and - like me - GOOD!
Denny: I work at a retirement home and have 87 year olds who are still very athletic. That is how I want to be. I am sorry if how I responded to this post was offensive. My understanding is that there is a different protocol for rehab from ANY injury or surgery partially based on age because the younger you are the quicker you heal. Certain things that are needed at 67 are not needed at 40 or 17. Again sorry if my response was offensive and it is good to hear that you are healing so well.
Thank you both for the replies. Spoke to my surgeon and he was very cool about it. Wants me not to wt bear for another week or two (of course, while I’m on the phone with him I drop the phone, stumble to retrieve,it and fully foot plant on the boot!) but was ok with some early non wt-bearing therapy/ultrasound/stim and faxed me a rx. Just feels right to me to start something.
I didn’t mean anything by the “40, not 65″ comment. The therapist was simply pointing out that at the rate I was going a 65 yr old lady with a torn rotator cuff she was treating was going to progress faster than me. She thought I needed to be more aggressive at my age, especially given the amount of atrophy and the nerve issues. But I agree, Denny, the thing that has amazed me has been the wide diversity of “protocols.” That’s what made me so uncertain and anxious when two sports docs I trusted gave me such divergent opinions. I don’t want to do anything stupid and re-rupture or hinder my progress. But for me, having been in that boot for 4 weeks pre-op to begin with, I was really concerned about waiting another 6 weeks for any therapy, especially since I need to be on my feet a lot for work. I hope a healthy compromise will suit me right!
Peace, fellas, and may your recoveries be speedy and full.
Hey, Andy. I totally get your concerns. Almost every other injury has generally accepted protocols. But not this one. I have experiences with three doctors and three protocols! I’ve been through three doctors during my…adventure. The first one moved, I didn’t think the second one had enough experience with my re-rupture and I love the third. And they are all at the same ortho clinic.
The first two were young docs and very aggressive. The third is old school and took a very conservative approach which I was in agreement with. I was in PT after two weeks the first time around. Then I re-ruptured. The third doctor had me in the boot for thirteen weeks. I did a lot of the ROM and Theraband at home. When I got out of the boot, he didn’t see any need for PT. I was on my stationary cycle for two months every day.
I’ve been doing self rehab and it’s coming along great. I was basically in a splint or boot for twenty weeks and I had MASSIVE atrophy. But my muscle is coming back very nicely with my daily walks and heel lifts. Oh, and I am around 40 as well. Early and aggressive PT prevents the atrophy but conservative treatment is more cautious. In the long run, and we’re talking the full year of recovery, both protocols should get you to the same place, IMHO. Good luck with your recovery.
wow. thanks, Dave, I think! Now my head is really spinning! I guess there is no wrong or right, just what works for each individual. It seems more than anything, no matter what protocol you elect, patience and perseverance is key. I can’t thank you guys enough for sharing your stories, it has really helped me to stay positive, be patient and especially act as my own advocate. Be well!
Here’s yet another twist for you: I am 48, ruptured the Achilles’ while dancing, but was overweight and out of shape, never athletic, although good health otherwise. My ortho doc, near 70 himself, was very aggressive in getting me walking and out of the cast - no boot, just straight into sport shoes, taking it slow. I was shocked that I should be taking such a risk at 5 weeks post-op to be FWB, and I did take it very easy indeed, for fear of rerupture.
So there you have it: a case where the patient wanted the doctor to slow it down, but he wouldn’t! I think muscle can always come back - that’s what one of the team told me.
Remember, there’s more to life than sports, as you will find out. The life of the mind, anyone?