9 month update

9 months ago on 24 Aug 2015 my right achilles snapped. It was a terrifying experience that left me doubting whether or not my exercise life would ever be the same. Thankfully our bodies are absolutely incredible and they heal in the most amazing way. So now, 9 months later, I barely ever worry about it and there is nothing that I can’t do because of the rupture. I hope this gives hope to anybody who is just starting the road to recovery from an achilles tear.

I last posted at my 6 month mark and at that point I was already feeling the exhilaration of exercising almost normally again. Over the last 3 months my strength has grown and I have built up my plyometrics (explosive movements like jumping and running). I had great plans that focused on building calf strength but I’m afraid I have actually been pretty slack with the calf raises since my other training is so much fun. I know this is bad and that I need to make sure that my right calf gets as strong as my left, so I need to correct this over the next 3 months (bring back the discipline!).

One thing I realised as I trained back to fitness is that my glute strength on my right leg was dismal. I think this is possibly something that we don’t focus on - we can physically see our tiny calf, but we can’t see our glutes. Glute strength is extremely important, so when you guys start exercising remember your glutes!

I have been pleasantly surprised at how quickly I have been regaining strength and fitness. My cardio vascular fitness came back first and very quickly - within a month I was getting back to handling fast paced workouts without running out of gas half way through. Strength has been slower, but it’s something that we measure at the gym so it has been wonderful to view my progress graphically and as you can see below, I’m pretty much exactly back to where I was pre-injury for both front and back squats and this took just over 3 months.

I am jumping, skipping, hopping and running without any problems.  I can run comfortably for 5km at an easy pace that is only a bit slower than my easy pace pre-injury.  When I run I can still feel the scar tissue.  It sort of feels like someone put a sticky plaster inside my leg.  I feel the skin or tissue sort of bunching up and sticking.  If I do calf raises then other people can see the adhesion that I’m feeling.  I’m not sure if it will ever go away.  It doesn’t hurt at all, it’s just noticeable.  I haven’t gone to anybody for scar tissue or adhesion release or massage since 6 months, so I don’t know if that would help.  I haven’t tried going for PB run times yet so I can’t comment on whether or not I can still run at the same pace I used to, but I can’t see any reason why I wouldn’t be able to when the time comes … I will definitely update the blog with the results when I try it.

Like I said before, I haven’t been doing lots of calf raises to get the full calf strength back.  I still do 2×15 straight and 2×15 bent leg eccentric lowers over a step each morning on both legs just to make sure I’m always strengthening both tendons.  For my 9 month analysis I wanted to get an updated picture of my calf strength, so I’ve put together another side-by-side analysis.

As you can see, the right calf is still smaller than the left.  A big improvement is my bilateral calf raise where the right is almost as high as the left (previously it was 2-3cm lower).  My right side only calf raise is still about 3cm (1 inch) lower than the left side, so I definitely still need to work on it.

That’s it from me.  Good luck to everyone going through this, I wish you all the best and happy healing!

6 months post surgical ATR repair

I’m at 27 weeks, just over the 6 month mark.  When I ripped it the OS told me 6-12 months before you’re back at sports … He was right on the money.  I’ve been really lucky because nothing has gone wrong during my recovery, so I’ve managed to hit 6 months able to participate in most of my prior activities.

Here’s a progress report on the items that feel relevant to me in terms of my achilles recovery:

Scar tissue
Earlier I posted that I was trying to do the Graston Technique on myself to see how it went.  The jury is now in … you cannot do this to yourself effectively.  4 weeks ago I started seeing an Osteopath who has specifically studied adhesion release.  He does Active Release Technique and Graston on me.  These are 30min sessions of which 20min of them I spend sweating and biting my knuckles - it is really really REALLY sore!  He has no empathy, when I gasp (trying not to scream) he just chuckles!  When he does the Graston it feels like he is carving up my ankle, I feel like I’m a prime roast!  I expect to look and see blood.  There is no way I could ever inflict so much pain on myself.

The good news and the reason I’ve actually been back 6 times in 4 weeks … it works.  What used to be a massive very hard lump that felt like a large golf ball around the achilles at the join to the calf is now soft squishy normal feeling tissue.  The whole area has thinned out a bit, it’s still thick, but it looks and feels more like an ankle should.  We have also made headway with flexibility during each session.  So everyone, if you have lots of scar tissue then I highly recommend Graston.

Week by week I’m managing to eke out small increases in my flexibility.  This has definitely slowed down and is something I have to persevere at daily otherwise it starts to regress.  I am unfortunately extremely flexible.  My good ankle does a knee to wall measure of 18-19cm.  At 6 months I’m getting my injured ankle to 14cm when I’m warm.  That’s still only 78%, so although 14cm is more than most people get, it’s putting me off quite a bit in some of my movements and I find it very noticeable.  The ankle feels really stuck and in back squats I’m compensating much more than I used to leaning over which is not good for my knees or my back. 

It feels like something that I just have to work on daily and it will slowly improve.  Part of the problem is extremely tight toes, so my physio has me using yogatoes to try stretch them out and I use them when I do stretching, balancing and squating at home.  I also roll out the bottom of my foot and concentrate hard on rolling my ankle in, lengthening the toes and trying to flatten my arch to the floor when I stretch and squat.

Calf Strength
This is a slow process just like flexibility, but I think that it’s going well.  I can do the 180 eccentric lowers with 8kg in the backpack now.  I’m doing the "burns" routine I posted about earlier but only 2xboth legs and 1xinjured leg per week so far.  It BURNS!!! 

My injured calf is 1cm smaller which currently equates to 97% - so it’s really almost there.  It is actually 0.5cm bigger than what I measured the good side to be 9 weeks post ATR - poor thing can’t catch up because with all the calf exercises I’m doing my other calf just keeps expanding!

Diameter / size isn’t really a good measure because different parts of the calf muscles do different things.  So my biggest deficit in strength is still at the very top section of a raise.  The only way for me to measure this it to try take equal level photos of single straight leg raises on each foot and measure the height difference.  The last time I did this I was getting 12cm on the injured side and 18cm on the good side.  So that’s 67% difference.  Not great but it’s getting there.  I can do sets of 20+ single heel raises but the height deteriorates as I go.  Endurance should be another section to my post, but there’s no way for me to measure that, so let me just say that the injured side’s endurance needs work!

The most terrifying of all the exercises I do! :)

I can now hop 30+ times in a row and I have been jumping onto my bosu ball which is about 9" high with a nice soft landing.  I (stupidly?) entered the crossfit games open last week and when the first workout was announced I went into a cold sweat … 20 minutes of 25 foot lunges holding 65lbs (30kg) overhead (knee must touch the floor and feet must alternate), bar-facing burpees (that require you to jump over the bar with two feet and land on two feet) and chest to bar pull-ups.  At first my fear was mostly for jumping over the bar, but then when I started warming up and lunged with my injured foot behind me carrying my weight + 30kg right through the toe and with the heel off the ground … I almost bailed!  It felt really scary - I don’t want to go through this ATR again. 

That’s the problem with this injury.  I’m pretty sure I could be running full pace already, but I’m terrified … and I feel rightly so - who wants this to happen again just because you wanted to do some exercise?  But living in fear is a bad thing!  So … I went ahead with the workout and although that injured leg was weak and I struggled to stand up when it was at the back, I managed a total of 225 feet of those lunges and 32 of those jumps over the bar.

This has given me quite a lot of confidence which is good since I know that with 4 more workouts to come we are bound to get box jumps and/or skipping and I need to get comfortable with jumping a bit more.  So yesterday I did some broad jumps along the pavement, and today I stacked some plates on the floor and did some (very scary) 15" jumps.  The box is 20" … so I’ll build it up slowly but I think I’ll be doing box jumps by next week!  Woohoo!

This is probably the easiest of the exercises at the moment.  I’m sticking to a max time of 30min and I still jog-walk just to make sure I’m not overloading anything.  We are going away mid-March and I plan to jog every day and start to keep them continuous (no walking) and then add a bit of pace.

My squats as measured for about 3-6 reps are at about 65-70% of what they were prior to injury.  Front squat is the easiest.  Back squat is actually the hardest.  This is because of the flexibility issue - when the bar is in front the weight forces my foot down but when it’s behind my ankle is stiff and if I hold good form then I fall backwards.  Overhead squats are mid-way between the two.  To be honest I’m not pushing the weight with the squats yet, I just want to do them at a decent weight to build strength and improve flexibility.

That’s it for the 6 month summary.  I’m hoping to keep moving forward with the strength and flexibility during this next month and to lose some of my plyometric fear!

Happy healing everyone!

Research on strengthening the achilles tendon and calves

I’ve been doing quite a bit of research on how to strengthen the achilles tendon and the calves.  Since I’ve had an ATR I know I’m always going to have a question in the back of my mind as to whether it will happen again.  Although I’m pretty sure my injury was caused because I seriously overloaded the tendon to its breaking point, I can’t be sure of this.  Most ruptures I see people are doing what they’ve been doing in sports for years and it suddenly just snaps.  So is there anything we can do to help make our tendons stronger so that we have a better chance of this not happening again?

It appears that there is.  It also appears that strengthening the achilles and strengthening the calf are not the same thing.  At the bottom of the post I’ll copy in some of the URLs to the studies that gave me the info I’m summarising.

So, starting with the tendon …

Published studies indicate that a lack of eccentric strength is what causes both micro-tears in the tendon (which cause tendinitis and eventually tendinosis) and acute ruptures.  One article I read showed that in a group of runners, all the runners who had tendinitis had less eccentric strength than the runners who didn’t.  There is a lot of evidence that achilles tendinitis and tendinosis can be cured by following a 12 week eccentric strengthening program.  This means that eccentric strengthening heals the tendon and improves strength so that future micro-tears are prevented.

I have read other studies which showed that the way a tendon works, the more elastic the tendon the more ability it has to store energy.  The more energy it can store, the stronger it is and the less likely to fail (i.e. rupture).  Static stretching does not improve tendon elasticity but eccentric strengthening and ballistic stretching do.

So by doing eccentric exercises every day, we are healing micro-tears, improving eccentric strength and improving tendon elasticity.  All very good things that should leave us with healthier and stronger tendons that hopefully will not rupture again so easily.

The downside it that eccentric strengthening is dead boring and a LOT of reps are required.  The 12 week program is 3×15 straight & 3×15 bent eccentric lowers done twice a day and adding load as tolerated.  And since the key is to slowly lower from the very top to the very bottom, there’s no way to get them done quickly.  Still, I’d rather be bored and knock these out than be back in the ER!

Now we get to the calf …

Unfortunately, just knocking out 180 eccentrics a day isn’t going to build us back our calf strength.  It will help but since our calf atrophied while our tendon was knitting back together, it’s going to need a lot more work to get its strength back.  Where better to find out how to build up calves than in the world of body building?!

What I’ve found out is something we are all experiencing - the calf is a very difficult muscle to build.  Apparently Arnold Schwarzenegger (aka Mr Olympia) said that it takes 500 hours to build good calves - that’s 3 years of 4 45min sessions per week!  Thank goodness we don’t need calves like Arnie’s!

The consensus seems to be that calves cannot be built in the same way as other muscle groups.  Usually for strength training a muscle group performs best if it’s worked with heavy weights at low reps and then given 2 days to rest before repeating, meaning that you usually only work a muscle group twice a week.  Calves however don’t respond to this.  Instead, calves need to be worked about 4-5 times a week and they need high reps and not too much load (since you have to do high reps).

Additionally (although this applies to all muscle groups) a full range of motion is very important.  Quite a few tips I’ve read recommend that you hold for two seconds right at the top really squeezing and again right at the bottom for a full stretch.

I’ve found one 8 week training program that is supposed to really work the calves which I’m thinking of starting in a couple of weeks.  You do 15 slow calf raises on a step or block really stretching the bottom and squeezing at the top, then you shake your calves out for 5 seconds each twice, then 8 slow raises and shake and then another 8.  Immediately you start doing fast bouncy mid-range calf raises not trying to go all the way down or up but just going fast and trying to explode upward.  You do these until you can’t take the burning pain in your calves anymore.  As soon as you stop the fast calf raises you do eccentrics, going up on both then down very slowly on one, then up on both and down slowly on the other.  You aim to do 10-20 eccentrics on each leg.  Then you rest for 3-5min and walk and stretch (apparently this will burn but stretching is important).  Then you repeat the whole thing!  They say after 2-3 weeks you should add another set of the fast raises and eccentrics.  The idea is to absolutely burn out your calves, they should be on fire.

So I think I’m going to give the above a try and will report back on progress.  I’m a bit wary as I don’t want to hurt the achilles.  Obviously if I start and it does hurt the tendon I will stop and wait until the tendon is ready for calf prime time.  I’ve been lucky in that my Physio gave me eccentrics to the floor at 12 weeks and then over a step from 16 weeks, so I have been tendon strengthening for a while now which is great.  I’m also pretty happy with my calf strength, it is definitely returning and I’m even starting to see the soleus muscle again which has been missing since the op.  But I’d like to get it strong as quickly as possible because I don’t want to run hard until that calf is able to absorb some of the heavy impact of running.  My OS told me that while the calf was weak the achilles would pick up the force instead.  I really don’t want to strain the achilles, so that means I need my calf back … let the hard work begin :)

Here is a list of some of the URLs:

  • http://revdesportiva.pt/files/form_cont/Eccentric_Training_for_the_Treatment_of_tendinopathies.pdf
  • http://www.ncbi.nlm.nih.gov/pubmed/12942235
  • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658965/
  • http://runnersconnect.net/running-injury-prevention/achilles-tendonitis-and-insertional-achilles-tendinopathy-in-runners/
  • http://www.fitnessunderoath.com/a-painful-way-to-put-1-5-inches-on-your-calves-in-8-weeks/
  • http://primehealthsolutions.org/how-to-get-big-calves-fast-arnolds-top-tips/

5 month update for surgically repaired ATR

It’s really hard to think about your achilles when every other muscle in your body is screaming.  I keep wondering each morning how I’ve managed to miss all the buses that have obviously been running me over! :)

I’m not joking, it is that bad, but at the same time it’s really good to be back in action and getting fit.

It’s 5 months since surgery today, so I wanted to post, but I don’t really have much to add - things are going really well!

  • My jogs are up to 12min intervals during a walk.  I walk-jogged 5km the other day and it felt good and comfortable.  I’m going to keep taking this very slowly and not rush it or push too fast or far.
  • My knee-to-wall measure is now at 11cm, that means I have about 6cm to go until it’s the same as my uninjured side.
  • I’m still doing 6kg in the eccentrics.  The bent leg ones are managing 6kg fine, but by the third set of the straight leg ones I really struggle to slow my descent, so I’m not ready to move to 8kg yet.
  • The big lump of scar tissue feels like it’s getting softer and smaller but there is still a lot of it.  The achilles is also getting pliable - I can grab it with two fingers and wiggle it a little bit left and right.  I’m not sure if the scar tissue is getting better because of my self inflicted and unprofessional Graston scraping technique using a spoon handle or the increase in activity or both.
  • Single calf raises are still the same.  I have fairly good strength to lift about 2-3cm, but I still have no strength to get to full height.  As everyone comments, the calf seems to be really stubborn and difficult to strengthen especially in that top range.  So there’s lots of work left to be done on that front.

At this point I consider myself to be recovered in terms of getting back to normal.  The only things I’m holding back on are jumping, running fast and other plyometric activities.  Those will come with time, as will better strength. I’m no longer concerned that they will never return, but I don’t want to push too much because I know the tendon isn’t strong yet.  Biology says it hardens for up to a year, so I don’t want to push my baby tendon too much at this point.

I still have questions that can only be answered much later in this recovery:

  • Will I be able to run at the same pace as I did pre-injury?
  • Will I regain the mobility and flexibility that I have in the uninjured ankle, i.e. will I be able to get the same dorsiflexion measure on both sides?
  • Will I be able to rebuild my calf strength so that I can achieve the same height and endurance in single calf raises?
  • How much of the scar tissue will return to normal as the months progress?

None of these are important for living well.  I know that, and I’m completely happy with being at the point I am at now.  I don’t feel injured anymore. Still the athlete inside me wants to know how much this injury will affect my overall performance in the years to come.  So I plan to log in from time to time to update my progress with regards to the above questions.  There’s very little blogging that I could find where people tell you how their performance compares to pre-ATR and since I searched for this information and struggled to find it, I would like to provide it for any future ATR’s who may want to know when it happens to them.

I know they will never see this, but I would like to thank my two physios - Nick Torrance and Melita Moriss from Balance In Motion.  They have been absolutely fantastic with assisting me through the rehab and I am so grateful!

I also want to thank the whole achillesblog fraternity.  At first I only appreciated the site for the wealth of information.  But as I became involved I realised just how awesome it is to have people alongside you who are always supportive and understanding.  The encouragement has made this whole recovery so much easier.  You guys all rock, thank you so much!

All the best everyone, and as always … happy healing!

21 weeks - jogging

The happy streak that started last week has continued!  I think I turned a big corner in my recovery 2 weeks ago and I have a feeling that a lot of it had to do with regaining enough dorsiflexion to let me participate comfortably in almost everything again.

Although I wasn’t cleared yet by the physio, I started adding short 15-30sec jogs into my walks last week.  I am slowly increasing the amount of total time jogging in the walks.  I started at 1.5min, then 3min, etc.  When I tried hopping and jogging a bit at 18 weeks it put me out of action with stiffness and swelling for 2 days.  But now the ankle has no reaction to jogging or any of the other activities I’m doing, so there’s no forced downtime.  I still stick it in an ice bath at night because it gets warm, but by the next morning it’s fine again.  At first the jogging felt a bit flat footed, but I started to focus on trying to really activate the foot and use it to push off and this has helped.  I took my tracker along on the last walk-jog and found that I’m jogging at about 6:30min/km which is faster than I thought I’d be going or would have allowed myself on a treadmill, but I’m happier that I didn’t use a treadmill because I think it’s probably better to let my body work out what feels natural and comfortable right now.

I saw the physio yesterday and she was happy with my progress these last two weeks and did not bite my head off for having started jogging already.  Some of the ankle joints are still not moving quite right when I squat and she spent most of the time loosening those.  She also did a lot of work on the bottom of my foot again and can you believe it - the golf ball has worked!  Although there were still painful spots my whole body stayed relaxed as she dug into them - compared to last time where she almost needed to strap me down and I’m pretty sure I tried to kick her a few times! :)

There’s one movement I’ve been struggling with, it’s a stationary forward lung where you lunge forward and then lower until your back knee touches the ground and then stand back up onto the back foot.  I am able to do forward lunging walks and backward lunges where you stand back up onto the front leg.  I showed her and explained that I just feel too nervous to put so much weight onto the back toes while the tendon is so stretched.  She said she understood my fear but that I am ready and I must (and should) go ahead and do these lunges.  So I did 20 reps yesterday, still nervous but no problems.  I can feel the achilles while I do them, I guess that’s why I feel scared, but it was fine, so yay!

The plan from physio now is to keep doing what I’m doing.  I can keep increasing the jogging.  She said that if the jogging makes the bottom of my foot sore or the achilles tight then I should back-off, and also reminded me to concentrate on letting the ankle move and making sure the injured side feels and moves like the uninjured side.  I keep up with the eccentric lowers and adding 2kg per week - I’m currently at 6kg doing 4-6 sets of 15 straight and 4-6 sets of 15 bent every day.  Keep stretching.  And do all the other training as much as I want :)

I’ve started adding a bit of weight to my squats.  I think that by next week I’ll be comfortably squatting with the 15kg bar.

That’s all the news, I can’t believe next week it will be 5 months!  Although it’s taken forever, it’s also gone pretty fast.  On day one I imagined that I’d be completely out of action for 6 months but it hasn’t been anything like that.  So I hope this can give some encouragement to people starting out on their achilles rehab adventure.

Happy healing to you all, I wish you all the best with your recoveries!

20 weeks - training again

20 weeks post surgery - 4.5 months!

I’ve had a great week … I’ve started training again!  It feels amazing :)

So my big milestone of the week is that I have returned to the scene of the crime!  Exactly 20 weeks after the day of the injury I went back to my crossfit box and joined a class.  I was pretty nervous about a whole bunch of things but once I was there it was just like old times and I can’t even begin to explain how happy it made me feel to train side by side with all my friends and feel capable again - injury? what injury?!

Crossfit forms the strength and high intensity section of my training, but triathlons are my thing.  So I’ve also started a sprint distance triathlon training program but I am walking instead of running.

In terms of rehab:

  • I am up to 4kg in a backpack while doing the eccentric lowers.
  • My knee-to-wall measure is 10cm most days and I can hold it for 30 seconds but if I’m stiff I only get 9cm.
  • I’m still walking around on my toes, doing strange lunge walks, walking backwards, walking in a crouch and generally trying as much as possible to engage my calf whenever I’m on my feet.
  • The bosu ball at home is just awesome and I am getting better and better at doing balancing and single leg mini squats on this.  I have also found that a great exercise is to turn it onto the dome side and then stand in the middle on the injured leg and try to push it forward so that the front edge touches the floor and then back so that the back edge touches.  It works my calf like crazy on the push forward and then gives a nice stretch as I go back.
  • Squats are improving.  Although I still fall backward a lot of the time, I am managing to do some overhead squats with a broomstick.  Overhead squats require flexibility and stability in ankles, hips and shoulders so I’m pretty happy that I’m managing to get a few done, but I admit that they aren’t pretty and when I record myself I can see how my uninjured leg is compensating which puts my alignment out, so I have a lot to work on in the squats.
  • I’m rolling my foot out on a golf ball and I’d say the discomfort has moved from pure teeth pulling torture to that of a waxing session (sorry boys, some of you won’t get this but I can’t think of a better analogy).
  • I did some research on removing the deep scar tissue.  One method that pops up quite a bit is the Graston Technique.  I’ve tried to find scientific articles with experiment based research results but I haven’t had any success.  However it gets favourable responses from lots of people with surgical scar tissue.  The reason I locked onto it is that although it uses expensive tools and you’re supposed to be trained in the technique, there are quite a few "self help" videos and articles on it where people do it to themselves with spoons or blunt butter knives.  This also led me to Gua Sha which uses a similar technique with ceramic Chinese soup spoons.  I couldn’t find any reason how I could hurt myself if I tried it as long as I stay off the actual tendon.  So I’ve been giving that a go with a stainless steel teaspoon edge and handle.  I’ve been doing it for 5 days now, only on the sections between my achilles and shin on either side.  I lubricate heavily and then do just 10 up and 10 down rubs on each side.  The first day I did it I couldn’t believe the sounds and feeling I got from the inside (medial) section!  It sounded and felt like driving over gravel.  Today it still sounded gravelly in sections but nothing near as bad, and I was able to push pretty hard.  What happens is a lot of blood floods to the area in those few scrapes and it goes red, so I figure a lot of blood in the area can’t be bad.  I’m not hurting myself at all, there’s no pain while I do it.  My plan is to try and do this myself for a month.  I don’t really have the time or want to spend the cash to go to another therapist, especially if this is something I can do myself.  And I also think that doing it once a day must surely outperform once or twice a week?  I do it before the eccentrics in the morning because I read that there’s more benefit if you disturb the tissue and then give it direction using stretch and strength - no idea if this is true, but it made some sense. So the jury is still out on this one … I will keep you posted :) I am also massaging the whole area quite vigorously with my hands twice a day and it seems to be getting more supple generally but first thing in the morning its still hard as a rock.

Here’s a pic of my calf raises with 2 legs, good leg, bad leg side-by-side.  Even when I raise on both legs my injured leg is not reaching the same height as the uninjured side yet, but it’s close.  The single raise on the bad side is very weak in comparison so there’s a way to go still with strengthening that side.  If you look closely you can probably see the lump as well.

Here’s a pic of the broomstick overhead squat, barefoot which made it extra tough, it took me a few tries to get it.

19 week update

This last week I’ve backed off a bit because I’ve been on holiday.  I’ve still been doing the eccentrics and making sure I do at least 45 straight and 45 bent a day.  I’ve also made sure to stretch every day and keep measuring my knee-to-wall.  Other than that, I’ve done some cycling outside and some fast walks and lots of swimming in the sea.  After pushing with hopping on land last week the achilles area has been more tender and those lumps got quite big, so I think maybe a week off wasn’t such a bad idea.

I saw the physio yesterday - same practice which specialises in feet and ankles, but different person.  She had a feel of my large bumps, she’s not really concerned about the small one at the bottom, but she felt all around the big one at the top.  She said that there’s not much to do about it except keep stretching and exercising and rub it out the way I have been.  She said your body responds to a major event like surgery by laying down collagen, even if it’s not useful.  So it seems like there’s nothing I can really do about it, just keep trying to manage it the way I have been?  I keep wondering if I’ve made it worse by pushing and exercising so hard.  Hopefully not, I thought that the general idea was that the more you exercise, the more the body will lay down and align tissue in the right directions.

We spent quite a bit of time checking how my foot joints are moving when I perform the 3 major movements - balance, heel lifts and squats.  She said I’d made some progress, but my squat which was the biggest issue last time is still not right.  The problem is I’m not lengthening and splaying my foot and this apparently prevents the subtalar joint from moving correctly.  So if I squat like I am right now, then I’m crushing the bones and the joint to get the dorsiflexion - doesn’t sound good does it!  When you run or hop or jump - anytime you bend your knee with your foot planted - then that joint needs to move freely, so until I can get this right I won’t be able to start jogging.  She was not happy at all that I’d hopped a bit on land already!

She then tortured the bottom of my foot again and re-assessed afterwards and my movement was much better.  So I have three things to work on:

  1. I have to start torturing myself now!  Aaaarg!  Yes, introducing the little golf ball from hell.  I have to roll out the bottom of both feet at least once a day and definitely before I do any walking or squatting or exercising.  She says it’s not normal for feet to be so sensitive and sore and that most people can roll this ball around with no pain.  I don’t believe her yet.  So for the last two days I’ve put myself through the torture and tried not to wimp out of pushing onto those sore tender spots.
  2. I have to really concentrate on lengthening and flattening my feet when I squat.
  3. When I hop in the pool, I have to focus on splaying as I land and then making a tent or shortening my foot as I lift off the ground.
  4. Eccentrics continue as before adding 2kg each week if possible.

I came home from physio quite baffled because I’m obviously not getting this lengthening of the foot while squatting concept.  Enter Google!  I had a good look around for foot mechanics while squatting and walking, how the subtalar joint is supposed to move, etc.  And I found one article which explained it well in a way that I understood -


If I follow the advice in this article and evert my ankle (roll it in), then my whole foot immediately splays and lengthens.  I can also feel the torque which engages my glutes and I know this is a good thing for squatting.  So instead of queuing myself to lengthen my foot, I now queue to evert my ankles.  Hopefully at the next session I’ll have picked up the right info and corrected my bad movement pattern as well as loosened up my tight foot muscles / fascia.  If so, she says I’ll be ready to start hopping and jogging on land.

Here’s a pic of my air squat since I read the article

It’s feeling much easier to go low now, I don’t feel stuck.  And I used the same technique when I did the knee-to-wall measure this morning and got an easy 9cm.  So hopefully I’ve understood it now.  I will only find out in 2 weeks time.  In the meantime … a squat like the above opens up a world of training! :)  I have a feeling that the next two weeks are going to be all about getting strength back in the squat - this will be good for when I return to running too.

One final thing, I have a bosu ball at home now.  I’m doing balancing, lunges, squats, etc on this.  It’s so much fun and so good finding that perfect balance where you don’t wobble at all.  My calf aches from working out on this thing and it just takes a few minutes at night.

Happy healing everybody!

Happy Hopping! - 18 weeks

18 weeks and things are still moving along, sometimes well and sometimes not so well.  I’m extremely happy with my progress on the good days.  I get a bit down and worried on the bad days.  I think that my ratio of good to bad is about 1 to 2 right now, i.e. I have 1 excellent day followed by 2 not so great days.

I hate writing anything negative, I don’t really like to even think negative.  But the blog won’t be helpful unless I express that this rehab is not a walk in the park.  It probably doesn’t help that on those good days I tend to try and push as much as possible which inevitably leads to the bad days where I get worried that I’ve done too much and hurt my fresh new baby tendon in my exuberance.

Up to week 16 my good:bad ratio was 1:1.  I would work hard then rest the next day.  So it’s a bit worse now at 1:2 but I think it’s because of how much more I can do on the good days.  Nothing ever hurts while I do it, but afterwards I struggle with sensitivity to touch, heat, swelling, reduced ROM, tightness, general uncomfort and awareness that it’s not 100%.

So now that I’ve laid out that it’s not a bed of roses, let me go into detail about the good days :)

I’m trying to stick to the eccentric program up to my personal point of failure each day.  No matter how bad I feel, I do at least 30 straight and 30 bent eccentric lowers over a step in some form every day, i.e. 3×10 or 2×15 or 6×5.  I usually do more, aiming to hit 90 of each every day.  I have just started to add weight as well - boy does that wear me out quickly.  Just 2kg and even my good leg starts shaking at the end of the sets.

On Christmas day (last Friday - 17 weeks), I did an 8km (5 mile) coastal walk which was wonderful and surprisingly ok.  It was a long walk, so I rested on Saturday.

On Sunday, I did a 2km walk in hiking boots in order to get used to having the feeling of a boot pressing on my achilles.  Then I hit the gym intending to work hard.  I did a 20min treadmill walk cranking it up to 6km/h (3.7 miles/hr) and pushing the gradient up to 5%.  This is pretty fast walking and it made me want to jog.  Although my physio said no 1.5 weeks ago, I decided just to try two short jogs of 15 seconds each at 6km/h (very slow for a jog).  Although transitioning to a jogging style was scary, it didn’t hurt at all.  I then did 5×15 rack toe presses building the weight.  Then 5×10 single calf raises but with body weight supported by the tricep cable pull down machine.  Then split squats.  Then 1km row - with both legs for the first time!  After 4 months of rowing with one leg, I can’t explain how weird two legs felt.  Then in the pool I did hopping, squat jumps, single calf raises and finally a length of running focusing on pushing off and extending backwards like a proper run.  It was a big day and I loved it, leaving the gym with both legs wobbling.  I have certainly paid for this afterwards.

Monday and Tuesday were spend babying my injured leg with as much elevation and rest as possible and a few ice water baths as well.  Strangely my ROM increased significantly and I could suddenly do a knee-to-wall measure of 8cm holding for 30sec with barely any pain.  I have really been struggling with a tight muscle just under my shin on the inside of my leg that prevented me from deep dorsiflexion.  But that seems to have disappeared now which has encouraged my hope that the "big calf day" was actually a good thing.

Today at almost 18 weeks, i pushed it again (I must be stupid!).  I added 2kg to my eccentrics.  I tried proper lunges which I haven’t been able to do with the bad foot’s toe bent and taking weight - but I managed so I did a bunch of back and forward lunges.  Then I tried a squat aiming for hip crease below knee crease and I got it!  So I did a bunch of those.  Then I did some side-stepping exercises and a quick few jogs.  And then I decided it was time to try out hopping on land - and I got this too!  Unfortunately, as I type I am once again paying for it and wondering why I don’t just hold back and try one new thing instead of 10 on the good days?!?!  Hopefully what I’m doing is not setting me back.

Finally, I have 2 big lumps of hard (scar?) tissue inwards from my scar towards the shin / ankle and they are not getting any smaller no matter how much I massage them.  The whole area used to be hard but now it’s getting more supple and these big bumps are emerging.  I think they’re getting bigger, but it’s hard to measure.  Robyn posted me some great information on massaging scar tissue which I’m now trying to apply - thanks so much Robyn!

Happy New Year everybody!  I hope 2016 holds a year full of mobility for us all!

16 weeks - eccentric strength program begins

My physio has given me the clear to start the eccentric strength training phase of his protocol. Up to now I’ve been doing the eccentric lowers to the floor. I now have to build up to doing 3×15 straight and 3×15 bent leg eccentric lowers over a step twice a day, the idea being to go as far down into dorsi-flexion as possible while lowering on one leg. Once I have managed all 6 sets twice a day for a week, then I progress by adding 2kg to a backpack each week until I get to 14kg. I started this yesterday and I have to admit it hurt quite a bit in the tendon as it stretched down, so I just did 1 set each over the step and then another set to the floor. The physio said to expect this and just build it slowly as pain permits. This morning is much better and I’ve done 2 sets each, so I’m hoping to get up to the 3 sets each and then twice a day by next week.

I have discovered that I can do a single leg calf raise too. It’s not to full extension but I think I am getting 2-3cm which is great. I took a video and grabbed a snapshot - this is what it looks like:

Here’s a link to the video too for anyone who wants to see how I’ve slowly built up my morning toe rolls into doing a lift like this:

We discussed introducing jogging but the Physio wants me to wait and has two very good reasons for this:

  1. My dorsi-flexion is still pretty bad (6cm) and jogging requires quite a bit of flexion, so he doesn’t want a jogging step to force a stretch that I’m not ready for.
  2. Up to now I’ve been building strength in the plantar range, in other words from neutral / 90 degrees to pointed toes.  Jogging requires strength in the dorsi-flexion range that I don’t have yet, so he wants me to have done a few weeks of the eccentric strength program in order to build strength in this range before I start jogging.

It all makes sense and I wasn’t expecting to hear that I could start jogging, although I can’t say I wasn’t hoping.  By the sounds of it, I could be introducing jogging during the first or second week of January which will be 19-20 weeks for me and that sounds fantastic!  Very exciting.

I had hoped to start doing some plyometrics on a mini-tramp but the gym doesn’t have one and I don’t really want to buy one, so instead I will be doing them in the pool.  I am currently able to hop in the pool at chest deep water and the physio said I should continue doing this every 2-3 days and progress to shallower water.  I can also start doing squat jumps and stationary jogging in the pool.

So that’s my work load for the next few weeks.  I probably won’t check in again until the new year as there won’t be much more to report until I get new exercises or start introducing jogging.  Happy holidays everyone and I wish you all the best and happy healing!

15 weeks

This last week has been a good one in terms of milestones.

- I completed a 4km coastal walk which includes a lot of stairs and slopes.
- I have cycled outside a few times on my mtb but only for commute and with pedals not cleats.
- Cycling outside requires me to carry my bike up and down flights of stairs and I manage! I thought I’d be resorting to the boot for this but it worked out ok - apparently all the upper body exercises have helped! Heh :)
- My knee-to-wall measure is +5cm now. I seem to be improving at roughly 2cm per week. To match my good leg I have another 11-13cm to go, so if I can keep up the pace I’ll get there in 6 weeks or so.
- I’ve removed the heel lifts from my trainers
- I don’t limp when I walk unless I’m stiff or tired
- I get through my sets of single leg eccentric lowers using a wall for balance but not a table for body weight support. These sets are really tough and I sweat like crazy trying to do them. I also break them down so instead of doing 15 in a row on one leg I do 3 sets of 5 alternating between legs. I can’t do all 4 sets twice a day yet though, I still use table support at night because my leg gets too tired.

I’ve been struggling walking downhill and down stairs. I’ve read a few blogs where people start walking down stairs by putting their heel on the stair and then letting their toe roll over the edge as they bring the good foot down. When I read these blogs I thought ‘no way I’ll do that, it’s far too risky!’ Well, I’m eating my thoughts! I tried this technique out yesterday because I’m sick of going down sideways and it works like a charm and is not nearly as scary as I imagined. I still hold on to the rail though, just in case.

My exercises are still the same. I saw my Physio for the first time in 2 weeks and we went through how my foot is moving when I balance, squat and roll onto my toes. Apparently it’s normal for the first two, but on the toe roll I’m moving my ankle outward and putting pressure on my middle toe joints instead of the big toe. So now I have to sit in front of a mirror between each eccentric set and do 20 heel lifts making sure I keep the ankle straight and get the weight onto the big toe ball of the foot. Rehab exercise time just increased by 10min. Oh well, moving properly is the key! And I am actually walking downhill better since I started doing this, so kudos to the Physio yet again!

All in all things are pretty good. I have no plyometrics. I can’t run or jump. I can’t dash up the stairs or across the road. I can’t participate in the sports I used to. That will all take time and I can’t wait to get there and will keep working hard to hit those milestones. But in the meantime - it’s summer, it’s the festive season, and I can now cycle to and then walk and swim at the beach! Happy days!!