12 month Post-Op update

12 mos and 4 days since surgery and all is well. i can jog, but still can’t really sprint due to my calf strength not being 100%. i can jump up and down without fear (jumping jacks, jump rope, etc.). cutting side to side is still not crisp, again due to calf strength. i continue to do assisted one legged heel raises, but still can’t get on my tippie toes unassisted. building strength back in the calf has been frustrating as the results are incremental. i’m returning to PT to hopefully assist in calf strength and more agility exercises in order to get me back to full functionality. for those newbies, hang in there, it gets better.

40 week, post-op update

i’ve started running some sprints after a short 2 mile jog. i’ve also started to do some plymetrics like shuffling laterally in both directions. the plymetrics are a bit more difficult as calf strength is still not the same-i just can’t float on my toes on my bad leg. until i get my calf strength back, cutting won’t be a possibility. i’ve noticed that doing heel raises allow my calf to get off the ground, but to really start getting on my tip toes, the sprints have helped. not sure why this is, but i think i’m firing the calf muscle fully when i sprint (80-90% intensity) as opposed to a less intensive heel raise or a jog. another exercise i’ve tried is grabbing a railing or support (facing it) with both hands and jump (as if i’m skipping rope) and slowly start to put more weight towards my bad leg. my AT was a bit sore after this, but my calf was also very sore which i’m hoping means it continues to strengthen.

i can probably only do 1-2 full heel raises (one legged) and although i do see progress, it’s at a snail’s pace. frustrating, but given where i was just a few months ago, i’ll try to remain humble.

For those football players out there, here are some stats post ATR:


Achilles Tears Plague the NFL - NY Times Article

I thought this was interesting. No offseason workout and there have already been the equivalent Achilles tears in preseason that take place during the regular season.

An Early Surge in an Injury the N.F.L. Wasn’t Expecting

When the N.F.L. lockout ended last month and players streamed into training camps on short notice after no supervised off-season workouts, many expected a series of nagging hamstring strains and quadriceps pulls to result, the normal early-season indicators of overexertion and uneven fitness.

But so far, the unintended winners of the lockout are orthopedic surgeons. With training camps open for less than two weeks, unofficial counts have 10 players with Achilles’ tendon tears, season-ending injuries that Monday claimed their latest victim, Mikel Leshoure, a rookie running back for Detroit.

The number is notable because nine players are thought to have torn their Achilles’ tendons in all of the 2010 preseason. According to figures compiled by Football Outsiders, a Web site that tracks every game of the season, nine players were on injured reserve with Achilles’ tendon injuries in the first week of the season last year.

Although the N.F.L. closely tracks injuries, it has not yet received injury data from trainers for training camps. On average, there are eight Achilles’ tears in a full season, said Dr. Elliott Hershman, the director of orthopedics at Lenox Hill Hospital in New York and the chairman of the N.F.L.’s Injury and Safety Committee.

Hershman said it was far too early to draw any conclusions about the spate of Achilles’ tendon injuries. He could not even confirm the number.

“Many times, we see single seasons with a particular injury that has a higher incidence for one season and then the next season it drops back down,” he said. “A few years ago, we had a lot of AC joints in the shoulder,” he said, referring to acromioclavicular joints.

When there are unusual spikes in injuries, the N.F.L. studies workout programs and weight room regimens to try to discover the reason and figure out how to modify schedules to reduce the injuries. Hershman said the N.F.L. always saw more muscle and tendon injuries in trainings camps, with hamstring injuries always the top injury in the first two weeks of the camps. But he pointed to another reason there might be more Achilles’ tendon injuries: teams are allowed to have more players — 90 — on the roster this year than in regular years because of the lockout, so more players are exposed to injury.

Coach Jim Schwartz of the Detroit Lions said he did not think the lockout was to blame for losing Leshoure, a second-round draft pick.

“We had a player a couple of years ago get one, and there was no lockout that year,” Schwartz said Monday. “He was in great shape and was one of our hardest workers. It’s just one of those things. Running backs obviously load up their ankles and things like that quite a bit.”

Dr. Jonathan Glashow, an orthopedic surgeon and a co-director of sports medicine at Mount Sinai Medical Center in New York, said the injury frequently happened to weekend tennis players who had not been on the court in months and then tried to play at full speed. He says he suspects the frequency will taper off as the football season continues and players work themselves into better shape. The injury is season ending, but it is not usually career threatening, Glashow said.

“It usually happens to muscles that are out of shape or when the limb has other ailments like a knee injury,” said Glashow, who treats professional athletes. “Having had that lockout, maybe some guys didn’t work out. I think they’re more vulnerable.

“My intuitive sense is this injury usually happens in people who are not ready to function yet. It usually happens to people at the beginning of the season, due to a lack of muscle memory or preparation, or at the end of the season, due to fatigue.”


9 month post ATR surgery/embolism update

I haven’t posted here much, but have gotten so much helpful information (especially norm) and support from everyone, I thought it was about time I posted my full experience here and where I am in my recovery 9 months later. For those that are in the early recovery stages, I hope this helps in terms of  light at the end of the tunnel and also not to be afraid to be a bit more aggressive with your rehab protocol. For those that just experienced an ATR and haven’t seen a doctor yet, some warning signs and advice to follow.

My ATR started on 11/6/10 playing flag football. I was backpedalling, tried to break forward to defend a pass and everyone knows what happened next. It was a Saturday and I pretty much knew I had an ATR so didn’t bother going to the ER. I already had an ortho doc who scoped my shoulder a couple of years ago and emailed him for an ATR surgeon recommendation. I propped my leg up on my ottoman and proceeded to watch football all weekend long. The bottom of my leg was still in considerable amount of pain, but so was my calf.

I saw the ortho first thing Monday morning and he confirmed what I had suspected, but he also found it strange that my calf was swollen and hurt more than my AT. Turns out the swelling from my ATR had blocked a vein in my calf and clots had formed in only a very short period of time. I was immediately rushed to the vascular department where I went through a series of ultrasounds and was told to start giving myself blood thinner shots 2x a day. 2 days later, a clot had moved through my leg and into my lung and I experienced a pulmonary embolism. I was hospitalized for 2 days and under observation. I was told the only way I could have ATR surgery was if I had a filter inserted through my jugular vein to catch any subsequent clots so that I could be taken off the blood thinners temporarily to have ATR surgery. Given I had didn’t have any alternatives, that’s what I decided to do. Now when I first got injured, I tried to adhere to the RICE principle: Rest, Ice, Compression, Elevation. I skipped the Ice part and was told that could have been key in preventing a clotting scenario. So, for those newbies out there who haven’t seen your doctor yet, if your AT is swollen: ICE IT! And, if your calf is in a lot of pain, insist on an ultrasound to make sure you don’t have a clot.

After having the filter installed, I was able to undergo ATR surgery on 11/22/10 and was back on blood thinners a few days later. I was told that standard protocol is be on the blood thinners for 6 months. Some of your doctors may prescribe blood thinners post surgery anyway since you will be inactive for 4-6 weeks post op.  My ortho’s usual protocol was 4 weeks NWB and then into the boot and directly to FWB. But, my incision had not completely healed and he feared that if I was FWB I would put stress on the incision and it would not close. So, I was NWB for another 4 weeks, while in the boot. By the time I was allowed to be FWB (8 weeks later) my calf was tiny.

Once I got over the initial pins and needles of FWB, everyday I started to walk a little further and start taking wedges out of my boot every week until I had no wedges 4 weeks later. Another week went by and I was told by my ortho that I was ready for 2 shoes and PT. Once I was in 2 shoes (I had a 1/4 inch heel lift on my bad side) I started walking as far as I could until my gait would fall apart from fatigue. Within a couple of weeks, I was able to walk 3-4 miles but would have to elevate and ice in order to manage the swelling. Most of my PT with exception of ROM and stability exercises didn’t help because my calf had atrophied so much I spent the bulk of my time doing calf presses. I left PT and decided I would return when my calf was strong enough so that I could work on more plymetrics that would help me get back to explosive sports. I would continue to walk 4-5x per week for 3-4 miles with a compression sock which reduced the swelling considerably as well as icing when I got home.

Once the swelling was under control, at week 24 I tried a jog for the first time. Given my ROM wasn’t back to normal and my calf was still a bit weak, it was more like a shuffle, but what I realized is that my calf was extremely sore and had been worked out thoroughly for the first time in months. I only jogged once a week initially and then slowly started 2x per week. The more I jogged, the more my calf was sore and I started noticing the difference in my calf strength. Also after the gym, I would do a set of assisted calf raises 3-4 days per week. I also ended up getting a trial membership at a gym that had a pool (pool access in manhattan costs an arm and a leg) for 2 weeks. I nearly went everyday to do heel raises in the pool at different depths to exhaust my calf.

I’m now 9 months post op and can run (not jog) for about 2-3 miles at a decent pace. My lungs and heart are probably more of a contraint than my AT. According to my ortho, my AT is fully healed and as long as I don’t do anything stupid, I should be good to go. I have been hiking for 3-4 miles every other week now which works my calf a bit and leaves it moderately sore. I can do 1 very weak one legged calf raise and that has been the most frustrating part of the recovery. I work my calves incessantly and still seem to not be able to gain strength fast enough. That said, I am progressing, just at a slower pace. The extra 4 weeks of NWB while my incision healed really set me back. I feel that had I pushed my rehab protocol more aggressively, I would be further along. Regardless, I feel that i’m close to a full recovery and it’s just a matter of time before my calf gains all of its strength back. Then I’ll plan on returning to PT to start working on more intense exercises to hopefully get my AT back in shape for more rigorous activity.  I also was allowed to get off blood thinners as the doctors felt it wasn’t a blood disorder, rather a sports injury that caused the clotting.

Thanks again for all the good information, feedback, and advice everyone has shared. There were times when I felt extremely discouraged and frustrated with my progress, but tracking other’s recoveries kept me going. I feel the recovery process sometimes can be frustrating where you spin your tires for a while and then all of a sudden you get traction and breakthrough another barrier. I plan to keep on truckin’ and hopefully will be back with a 12 month update where multiple one legged calf raises isn’t just a dream. In the meantime, good luck to all of you whatever stage of recovery you happen to be in.

What activity is the riskiest for a healed ATR?

I’ve seen some rehab protocols that say jumping down (off a fence or platform) is the riskiest for a re-rupture. What about jumping up, sprinting, cutting, etc?

My injury was from backpedaling and then trying to shoot forward. I’m now 7.5 months and feel pretty good. Once my calf strength returns and I’ll be able to start playing sports again, I just want to be wary of what activities I should be mindful of?

Scar Tissue below actual surgical repair??

hope everyone is healing well. i visited my surgeon a month ago (i’m now 7 mos post-op) and he was a bit puzzled at why i would have scar tissue below where the actual rupture occurred.  i went for a 2.5 mile jog yesterday and feel fine.  in fact, i passed up a few really slow people which made me feel great. i don’t have much soreness now as my muscles, joints, tendons, etc. are getting used to a bit of physical activity. anyway, did anyone have the same experience? is this normal? like i said, i feel fine and have been progressing great (the OLCR isn’t there yet), but i’m a bit scared after he found that.

24 weeks post-op, should i jog?

I have a follow up with my surgeon tomorrow and obviously will ask him if it’s ok for me to start jogging, but wanted to hear others experiences? I can barely do a one legged heel raise, meaning that my calf has a long way to go, but as far as walking long distances and even scurrying across the street to avoid traffic seems fine. Just wondering if I’m at more risk of hurting my AT since my calf isn’t full strength if i try a light jog?

heel raises, just curious how long after you started PT did you start heel raises? i’m at week 14 post op.