Brock’s AchillesBlog

Hey Brock,

How are things now? I just reruptured and am going the non surgical rout. Hope all is well!

Thanks for the support Scott, hope your concerns are put to rest soon.

Brock, wow you are the first similar retear to me. I did mine in June at 13 weeks post op. I’m 5.5 mo now into recovery and seem to be doing OK. w\o surgery the second time. I thought I was the only one to do OP then Non-OP back to back. Mine to was a 2 cm gap on MRI, I did 8 wks in the boot w\lifts. I never did physo the second time, my OS just didn’t think I needed it. I did follow the protocal from UWO though. My biggest concern is the stitches that didn’t hold, I wonder what that are doing now? Is it like extra support in the tendon or is it an irritant to haunt me later? Time will tell. Thanks for the blog,I hope you get back to the Rugby in the spring.

Norm,

That is correct, my timeline starts after my re-rupture. If I were to include the first injury, it would probably be around 24 weeks.

I’ve certainly gotten further than I did the first time which is a big milestone for me. Rehab is going well, I am walking faster everyday, gaining strength back in my leg, and increasing ROM.

Sounds like you’re getting toward the light at the end of a long tunnel, Brock. You deserve a break, after what you’ve been through!

The “13 wks 3 days Post-OP” I’m reading on your ATR Timeline today is the time since your SECOND immobilization, after your re-rupture, right?

I hope the rest of your rehab goes smoothly, without too much of the “frustrating plateau” that so many of us experience!

Good luck, Brock!

Some of our US friends may not know that Canada celebrates Thanksgiving this coming Monday.

thanks for the info!

There are many suggestions here for good ways to wiggle! The UWO Protocol I’ve posted at bit.ly/UWOProtocol has some basic (though techy) notes. Others have suggested spelling the alphabet in the air with your big toe. Staying below a neutral angle, at least at first, is common to all of them. And staying “active” rather than “passive”, at least at first — i.e., just using your foot and leg muscles to wiggle your foot, rather than pushing or pulling it around with Therabands or towels, etc. All those other things will come, but not at first.

So I talked to my doctor and he said it would be fine for me to take my foot out of my boot and move it around. Obviously I will not be putting any weight on the leg without the boot . 3 more weeks and my heel lifts come out and therapy starts once again.

I can’t remember how big my heellifts were but I have a feeling that the original one was larger than 2cm (may have been 3cm?). I’ve been walking around with the boot and with a running shoe on my good foot to keep my body relatively level. You do make a good point about having more movement before 10 weeks and I’ll definitely shoot my doctor an e-mail to see what he thinks. I’m not entirely sure about walking around my house in crocs/barefoot though.

I don’t know how big your wedges are, but I wouldn’t rush to go below 2cm heel lift before 6 wks (= UWO). But do something to straighten your body, by lifting up your “good” foot when you walk. I don’t think you have to equalize the heel-left angles, just the overall elevation so your body is straight and balanced.

Especially if your boot is a fixed non-hinging AirCast-type, I’d start walking around the house in Crocs or barefoot sooner than 10 weeks, again like UWO. Nobody knows what’s best for reruptures, but the old assumption that slower is safer seems to be Just Plain Wrong in general, and especially for non-op patients like us.

I often think (and sometimes write) that the MAIN reason why the older studies showed high re-rupture rates for non-op was non-random, biased, streaming of patients — “jocks” got surgery and “crocks” got casted. But many of the studies that were summarized in the 2005 meta-study WERE randomized, so the difference between those bad non-op results and the excellent non-op results from the 4 post-2007 studies is NOT (mostly) in the non-random streaming of patients. So it must have been the different

You might be right, GR, but the statements made were commonly held beliefs, most of which were believed by virtually all the experts just a few years ago — e.g., when I tore my first ATR. So I didn’t mind summarizing the case for the evidence one more time, whether it’s for wowreally or for anybody else who has heard those same opinions expressed with similar conviction.

Norm,
I’m surprised you didn’t recognize wowreally for what it is, just an internet troll with nothing better to do than troll around trying to insult people.

Wowreally, there’s a huge difference between the old “conservative casting” that produced rerupture rates in the 15% range (especially with non-randomized patient selection, when “jocks” got surgery and “crocks” got casted for way too long), and the new-fangled non-op protocols with early mobility, weight-bearing, and PT.

The latter non-op protocols have now (since 2007) been tested in four randomized prospective trials, each using the same protocol on both surgical and non-op patients (all complete AT ruptures). In all four studies, only ONE measurement of strength, ROM, or re-rupture rate showed a statistically significant difference between surgery and non-op, and it was in favor of the non-op. Of course, the rate of complications WAS statistically different, as we all knew all along.

Check them out, either on my studies page, or follow the links at references #4-7 on the Wikipedia article on ATR.

Me, I’m “clinging” to the latest and best evidence on the subject; what are you clinging to?

BTW, ROM is closely related to healed tendon length. So the fact that measured ROM with the non-op protocols is indistinguishable

so, you cling to the thought that non-op management is best for ATR??? in a blog of 5 people, 2 are talking RERUPTURE. in this day and age, why would any active person attempt non-op management??? the tendon ends do not get back together without putting them back together. historic re-rupture rates approach 20%! that is why you have it fixed. you shouldn’t be congratulated on opting for non-correction a second time… you should be mocked. glad your non-doctor family member recommends this choice. my herbalist gives me financial advice.

I have talked to my PT since norm and the jist of what he said was that the re-rupture was likely going to happen anyways (meaning he didn’t think it healed properly) and that it was better it happened in a controlled environment versus once I’m back on the rugby pitch where I could suffer potentially more severe injuries as a result.

Now as much as the latter part of his explanation made sense to me, it still sounded like bs as if he was saying I didn’t do anything wrong. Anyways I simply told him I thought he was a little aggressive in his rehab approach and should take that into consideration for future clients. Whether he listens is another story but I know I will be looking for a new PT when the time comes.

2ndtimer, that is correct. When I re-ruptured I was wearing my boot when I went outside of the house but in the house I would practice walking normally without it.

Thanks for all the support guys and best of luck to you as well gqsmoove7.

I understand where you are coming from 2ndtimer as I was strongly considering opting for surgery. I guess having a family member who is becoming an OS describe the surgery process and suggest I stick with the non-op gave me that confidence.

I admire your courage to stick with the non-surgical treatment again. I guess I never had confidence in it so the 2nd time around I wanted surgery. I am amazed your doctor gives you all these options. Mine insisted on keeping me in the boot after the re-rupture for 11 weeks even though I told him I am feeling great!

I am sorry to read about your re-rupture…. I find it surprising how different the protocols are. Do I get it right that after 7 weeks of cast you were wearing the boot and still in the boot when started leg raises? You re-ruptured 3 weeks after getting out of the cast?

There’s another ATR web-site online that I think is linked on the main page here — something with “family” in its name — that quizzed all their re-rupture bloggers on HOW they re-ruptured. They had a sample of maybe 2-3 dozen, IIRC. The leading cause was tripping and falling, then maybe getting your foot stuck under something. But a sizable minority just said “Physio”!!

Heck, the whole rehab thing is a lot like walking a tight-rope: go too slowly, and you’re not just wasting time, you’re potentially making the final healed leg weaker and MORE vulnerable! Go too fast, and POP!

I had a similar experience, though much less serious. I was much farther along in recovery from my first ATR — around 17 weeks post-op, and JUST FINALLY able to walk normally in bare feet. My PT literally paraded me up and down the length of the U. of Toronto Sports Medicine Clinic in my bare feet, showing off my great recovery. I was 58, no spring chicken, and I was walking properly much sooner than the few undergrads I’d met who’d ATR’d at about the same time, so we were both proud.

Then we went back to her PT station, and she did her things, and

hey brock

good luck with it all, hope your decision for non-op is the right one, i’m counting on it too!

happy healing…

Nice work, Brock. Your approach sounds very sensible to me, and should give you the best possible chance of a good recovery.

Unfortunately, even surgeons who specialize in legs don’t spend much time and effort on ATRs. And the more the evidence from good studies shows that surgery doesn’t add any value, the less time they’ll spend on it!

My Dad used to say “Go to a carpenter, he’ll tell you to make it out of wood.” Kind of like Mark Twain’s(?) “If your only tool is a hammer, all your problems look like nails.” Surgeons repair things surgically. If they didn’t want to do that all along, they wouldn’t have become surgeons in the first place! Then they trained in surgery, surrounded themselves with other surgeons, and kept seeing the near-magical results from their surgery. It’s not reasonable to expect them to be neutral on this subject!

So it’s remarkable and kind of heart-warming that you’ve had a few suggesting non-op treatment of your ATR — even just a few miles up the road from UWO! Now if we can just get more adherence (from the OS’s AND the PTs!) to rehab protocols that actually seem to work well. . .

I went to Sunnybrook since its near where I live. It really seems like a lottery to me on which doctor you get. If you read my new post in my blog I explain the differences between my new and old doctor.

Definitely agree with the whole not deferring to the experts thing now but at the same time you have use your judgement of the situation. Obviously tough to do if your not experienced.

Seems some doctors make an effort to update themselves on new studies while some don’t. I guess they just get into patterns. Actually read an article about this recently in a Reader’s Digest while I was waiting to get my wisdom teeth removed.

Your “conservative” treatment was quite old-fashioned slow in the length of your casting/immobilization, in the delay before PT, and the length of NWB. But it was quite aggressive — I’d say TOO aggressive — in changing your foot angle!

I’m also in Toronto, so I’m curious WHICH hospital follows this odd-ball protocol, and what (if anything) it’s based on.

If there’s one thing that emerges from following the stories here, it’s simply that “deferring to the experts” for ATR treatment is NOT a great idea! Unless by “experts” you mean the authors of the best and latest studies, of course! (But nobody ever means that, alas!)