Unstitched
Posted by cgdh13 on October 29, 2012
I made it to the doctor’s office and got my stitches removed. Now he said I’ll be back in two weeks. He also said yo be more aggressive with my stretching. At home hunkering down before the storm.
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- cgdh13 has completed the grueling 26.2 ATR miles to full recovery!
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October 30th, 2012 at 1:32 am
As discussed elsewhere here, several of us (including ryanb and me) partly ignored our health-pros urging to get aggressive with AT stretching early on, and would do so again. You do need to regain ROM in both directions, of course, and the AT heals better (faster and stronger) when it’s mobilized progressively starting early on. But SOMETHING causes too many ATR patients to “heal long”, and too-early and/or too-aggressive stretching (in the dorsiflex direction) seems like the most logical candidate. Healing short, with limited DF ROM, is not a totally “free lunch” either (see my latest blog page on that), but it’s still probably not as bad as healing long.
October 30th, 2012 at 1:47 pm
How and at what point, can you tell if you’ve healed long? I did the same thing and didn’t start actively stretching until week 12. I’m at week 16 now, and I’m pretty happy with my DF at this point and am still working on it.
Also, I wonder if healing a little long can be good for some people. I was looking at some pictures around here, and it seems like I may have short achilles tendons to begin just judging by my good leg. I never noticed it before, but it seems like some people have better DF on their injured leg after recovery than I do on my good one. Is it possible that if my ATR heals a little long, it’ll be even better than before? Geez, I’ve never thought so much about body mechanics, and I’m getting addicted to this website!
October 30th, 2012 at 3:15 pm
The tell-tale sign of healing long seems to be an inability to rebuild the calf muscle - both size and strength; plus (sometimes) an inability to fully plantar-flex. Even with a “too long” achilles, I think most people can fully plantar flex with very low resistance; using the other muscles around the ankle. I was able to get to very near full plantar flexion a day before my surgery, with zero achilles- but I had no strength. Getting too much early dorsi-flexion flexibility is also (I think) a warning sign.
The blog by “tomtom” is very insightful. He took pictures of his calves through the his recovery process. Everything seemed to be going fine… but as time went on, he just couldn’t get his strength back- the healing long diagnosis came very late; over 1 year into recovery.
From experience, I know that flexibility (like strength) is somehting that can be improved with dedicated hard work. Gymnasts and contortionists aren’t just born that flexible, they work hard at it. So, my theory was: even if I heal a bit too short - with work - I could stretch my calf muscle to re-establish lost dorsi-flexion that I might need.
On the other hand, if you heal long, there really does not seem to be any recourse other than shortening surgery, and starting the process all over again. In many cases, it’s as bad as a re-rupture… maybe worse, because the diagnosis and treatment often comes much later into the (1st) recovery process.
So, I chose to err in the too short direction: happily accepting a (slighly) too short recovery if it happened, so as to minimize the risk of a “too long” result. So, like I mentioned on Sheena’s blog- I was a big wimp at dorsi-flexion during the early phases of my recovery. I very deliberately limited my range of motion, and minimized any early passive stretching.
I still am not 100% sure how it turned out. I am pretty confident that I didn’t heal long. When I do seated hamstring stretches, I *am* a little more flexible on my right (injured) side; but I think that’s just because I spend a lot more time stretching it ;-). I have good strength through my plantar flexion range of motion, and my calf muscle is (slowly) coming back nicely. I do have dorsi-flexion limitations when my knees are bent (Soleus)… so aggregating all of that data; I’d guess I’m like Goldi-locks, not too long, not too short; just about right
October 30th, 2012 at 3:37 pm
I’ll also add: with a healthy tendon, when you are stretching, you are really stretching the muscle. The tendon is a fixed length structure - just think of it like a fixed length cable connecting the muscle to the bone. So, when you’re stretching your calf, you are simply putting a tension load into the tendon.
You don’t have to stretch to put a load into the tendon. Any flex of the calf muscle can - in theory - put an identical load through it; you don’t have to be stretching. The position of the (fixed length) tendon shouldn’t really matter… a load is a load.
So, in additon to being a wimp at dorsi-flexion, I tried to be very careful to minimize the load on the tendon. So, I did lots of high-repetition, low load exercises (think cycling, elliptical trainer, etc.) during my rehab. I think that’s just as important as avoiding too much dorsi-flexion: minimize and avoid peak loads through the tendon. No jumping, for instance. Logic tells me that explosive efforts are probably more dangerous to the tendon than stretching… it’s hard to imagine how I’d be dumb enough to impart a higher load on the tendon stretching, than - say - doing a box-jump.
That said, during recovery, the tendon is not healthy. There may be elevated risk factors from stretching exercises that make it especially bad. I don’t have much of a guess at what they’d be… but why take the risk. It’s not much of a sacrifice to hold off on passive dorsi-flexion stretching for a few months; so I did. But I honestly think avoiding peak loads through it is *more* important.
Just my inflation adjusted $0.03 worth-
October 30th, 2012 at 6:09 pm
Thanks for the advise. I have just been doing a little active stretches as I don’t want the soreness.
October 31st, 2012 at 1:49 am
I thought I’d add a bit to what Ryanb has already said about explosive movements. Its not only things like box jumps to watch out for. I’ve been doing calf raises and I have to be conscious about keeping the movements slow, especially on the downward phase. A bounce at the bottom really puts a lot of strain on the tendon.
And as far as the speed the calf recovers, you have to be patient. It is astounding how fast my calf atrophied and how long it is taking to build back up. At 60 years old, I’m not producing much human growth hormone anymore so that doesn’t help either. Yet I try to add 1 more rep at every visit to the gym or 5 more lbs. to the weight stack. It’s getting there but I sure have a long way to go.
November 2nd, 2012 at 6:08 pm
Yah, what THEY said!
Another indication that I’ve healed long with the connection between my gastroc and my AT-and-heel (ATR #2) is that my gastroc muscle on that leg (that’s the calf muscle on the medial=inside side, AFAIK) looks higher than my other one, at any given ankle flexion. My soleus looks about the same as on my other leg. That corresponds with my experience: my 1-leg heel raise is wimpy, but my athletic speed — a lot of which comes from ankle extension with a BENT knee — isn’t so bad (in fact, not even noticeably impaired from pre-ATR).
This is an easy comparison to make with a tall mirror and a 2-legged heel raise — just don’t rush into a 2-legged heel raise before your leg is ready for it!