Day 1 - 27/1/20
What happened
I’m 58 but reasonably fit. Most days I’m either running, boot camping, or spinning and occasionally all three in the same day. On this particular morning I’d booked in for a cardio tennis session at the local indoor tennis centre. This was something new for me and I didn’t know what to expect. As it turns out I never found out as I managed to completely rupture my Achilles tendon while doing the warm up. We’d already done some jogging around the courts and some jumping jacks and had moved on to what I know as spotty dogs. I think you have to be British and to have watched The Woodentops in the 60s to know what that is. The best way I can describe it is it’s a bit like jumping jacks, but your feet alternate backwards and forwards in a scissor motion instead of going side to side. My tendon snapped as I my behind leg landed with my foot in a fully dorsiflexed position. It was the usual scenario. I felt like I’d been kicked in the back of my leg and assumed that my exercise partner had got too close. I looked accusingly behind and saw that she was nowhere near. It was then that I realised what must have happened and I collapsed to the ground. It was an instant sharp pain and it took my breath away. However it wasn’t long before it turned into a manageable dull ache. I was offered pain relief by the staff but I didn’t feel the need.
Why did it happen?
After all these years of 5Ks, 10Ks, boot camp and spinning I’ve found myself dwelling on the reasons why this should have happened right now and during a warm up of all things. The following are all the reasons I could think of:
· Stretching . OK I admit it, I’ve never been a big one for stretching. I’ll always do the stretches at the end of an organised session, but never beforehand and I never do any stretches when I’ve been out running by myself. I now believe that on this day my calves were tight and a little stretching before we got going could have been just enough to reduce the risk.
· Overdoing it . The previous weekend I’d been on a 10K woodland run. I often do 5K Parkruns, but this was my first long run in nearly six months. In addition to that it was on rough, variable and muddy terrain. As usual I did no stretching at either end and the backs of my legs felt really stiff for a number of days afterwards. It’s possible that this was still contributing to tightness in the muscles.
· Poor form . In researching what ‘spotty dogs’ is actually called (I never did find out) I came across a video where the instructor pointed out that your heels shouldn’t touch the ground. I’d never been told that before, but it’s clear now that if you stay on your toes the landing will be much more cushioned and there will be nowhere near as much energy going through your Achilles.
· Cushioning . I usually run in fairly well cushioned running shoes - Hokas or Altras. On this day I’d arrived at the centre in my old tennis shoes because they’re non marking. However they’re fairly flat and have next to no cushioning. This would have caused even more energy to slam into the tendon.
· Surface of the court . The court surface was immensely grippy. This would have meant that as my foot was landing, yet at the same time still going backwards, it would have been brought to an almost immediate halt in the dorsiflexed position, causing even more of a jolt up the tendon.
· Trying too hard . Another admission here. I’d never met anyone at the session before and I didn’t want to lose face by being behind the curve on the warm ups. That meant that I was putting an awful lot of effort into doing it and generally going at it too hard. This was simply unnecessary, it’s a warm up after all.
· Over pronating feet . I noticed in my research that there’s a school of thought that flat feet can cause uneven forces to act on the Achilles tendon, particularly when landing. It seems that one side of the tendon takes a lot more force than the other side. This unevenness would make a rupture much more likely.
· Wear and tear . Scans done during my first day at the hospital showed that there was a certain amount of degradation to my tendons. I was told this was normal wear and tear due to the level of exercising I was doing.
· Running style . For Christmas I received a fitness band which came apart so the main unit could be attached to your shoe to make an analysis of your running style. I’ve always thought that I should be a lot quicker for the amount of effort I put in. So, having received a critique of my style from the app, I’d started trying to run as a toe striker rather than the heel striker that I actually am. I had only been doing it on the occasional sort run and certainly not on the longer Parkruns, or the 10K. Could this have been a contributing factor?
· Plant pot foot. At least that’s what the wife calls it. Plantar fasciitis to be more precise. I’d been suffering towards the back end of last year. I’d more or less eliminated it by rolling a tennis ball under my foor every night, but you never know.
· Age. Finally good old father time. Figures show that people most at risk are men between the ages of 30 and 40. My guess is that the figures tail off after age 40 due to people being less active as they get older and not because their tendons start getting more resistant. If anything I would imagine that the tendons continue deteriorating with age and making this sort of injury even more likely for an active 50, or 60 year old.
So, there you have it. A perfect storm of factors possibly working together to make the rupture inevitable. Some of them avoidable, some of them not. And what are the takeaways from this? For me, assuming I can get the leg back to normal, it’s going to be all about preparation. Doing the stretches, warming up slowly and wearing the right footwear. It’s also about being mindful of the exercises and the risks involved. I have to start asking myself if I really need to do that exercise, or is there something less risky but equally effective that I could be doing? My first thought is that boot camp may have to go on the backburner. After ten years I’d be gutted about that, but hard decisions are going to have to be made.
Hospital
The tennis centre phoned for an ambulance straight away, but they phoned back to say they would likely be a very long time and asked if alternative arrangements could be made. Luckily my daughter’s boyfriend happens to work there and was on duty that morning. He drove me up and dropped me off.
My luck continued because after the initial x-ray and assessment I booked into the fracture clinic on the very same morning. Further tests and an ultrasound scan confirmed that it was a total rupture. I was disappointed because the lack of any real pain had convinced me it was more likely to be a slight tear than anything major.
The specialist then told me about the two different treatments for this kind of injury. It was either going to be surgery, or non-surgery. In the former, your leg is cut open and the tendon is sewn back together again. In the latter it somehow magically heals all by itself. We discussed the pros and cons and he told me that both treatments had advocates in the medical world. His own view was that either was okay and he preferred to let the patient decide rather than impose a decision upon them. I opted for the non-surgery route. I’m writing this three and a half weeks on and I’m currently glad that I did. That may yet change, but the factors against surgery seemed to outweigh the factors against non-surgery. In fact the main factor against non-surgery appears to be in dispute. Originally research showed that there was more risk of a re-rupture when taking the non-surgical route. However, more recent research has shown the risk to be similar in both treatments when using the latest techniques. Only time will tell if I’ve made the right decision.
I was then referred to the DVT unit where I was given a ten day supply of anti-coagulant injections which I would need to self-administer for the next six to eight weeks. I asked what happened after the initial supply ran out and was told I should speak to my GP. (More on this in a later chapter).
Finally it was back to the Fracture Clinic for a cast, or more specifically an equinus back slab cast. To do this your leg and foot have to be dangling down off a chair or tall bed. Your foot and lower leg are then cast in this position. Then, once the cast has set, they cut the front of it away and wrap bandages tightly round it to hold it all in place. I believe the idea of the back slab is to allow for possible swelling. This would be a risk in a full cast. In my case the note which went through to the casting team did not mention back slab. The nurse was about to do a full cast when the assisting nurse said she thought it should be a back slab. The main nurse was reluctant to investigate due to being about to go off duty. Fortunately the assisting nurse twisted her arm to allow her to go and make enquiries. When she came back I got the correct cast.
Having spent most of the day in hospital I eventually got home at teatime. It was then that I was able to let the full enormity of my situation sink in. I could see that this wasn’t simply going to be a four week broken bone style recovery, but more likely a six, nine or twelve month slog to get back to where I was before the injury. I could also see that there was a real chance I may never be the same again. There’s nothing quite like having to enter your own house on your hands and knees, while your wife is watching on and your daughter is taking a video, to bring it all home to you.
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