An Athlete’s Torn Achilles Recovery

Last night was Kobe Bryant’s first game back after rupturing his achilles 8 months ago. I’m not a big Lakers or Kobe fan. I do respect his skill, work ethic and determination though.

While watching the Warriors play the Lakers on April 12th, I saw Kobe get his body low and try to explode around a defender. He pushed off with his left foot and his face immediately showed the pain he was in. When he took a step and tried to put weight on that same left foot he went to the ground holding his achilles. In the replay you can see his left foot in a ridiculous dorsiflexion position when he pushed off. I really didn’t know anything about achilles tendon ruptures at that point, so I didn’t really feel for him as much as I do now.

This is similar to how I ruptured my achilles. I had just rounded first base and lowered my body to get in position to sprint to second base. As I pushed off to begin my sprint, my left achilles popped.

Another pro-athlete made his return from an achilles rupture recently.

Last week, San Francisco 49ers wide-receiver Michael Crabtree had his first start since rupturing his achilles May 22nd. I had to go to that game. I was 5 weeks post-op and full weight bearing in my VacoCast. Crabtree caught a 20 yard pass then ran for 40 yards with a clear path to the end zone until two defensive backs caught up to him.

Would he have scored if he wasn’t fresh off an achilles injury? I don’t know, maybe. But he had the biggest grin on his face afterwards. That was the moment he was waiting and training for over the past 6-months of rehab work.

I’m sure everyone who is coming back or who has come back from an achilles rupture has had their breakthrough moment.

What was yours?

I’m in the boring stage.

I have been just treading water until my surgically repaired tendon is fully healed at the 6-week mark. Each week I moved my VacoCast closer to 0-degrees in 5-degree increments. I’m at 20-degrees now in the Vaco. My recovering foot rests at just about the exact angle as my non-injured foot and I have almost the same plantar flexion in both feet.

I was partial weight bearing in Week 3, then transitioned to full weight bearing in Week 4. The hardest part was Week 4, when I first started full weight bearing my whole leg ached pretty bad. It was a dull ache that was rather annoying. It was the kind of ache you got when you were a little kid and would run around in the neighborhood all day and at night your legs were just dead tired when in bed.

During Week 4, I progress from 237 steps on Monday to 693 steps on Wednesday then I was up to 2,561 steps by Friday according to Move. I’ve been getting around just fine and can walk pretty fast now at Week 5. I even hung Christmas lights using a step stool this weekend.

I had just one checkup with my doctor and two physical therapy sessions over the past couple of weeks. The doctor says I’m on pace with his protocol. He and my physical therapist say I can transfer to two shoes at 7 weeks if I can get to 0-degree plantar/dorsiflexion.

My physical therapist sounds like she knows her stuff. I have had two sessions over the past two weeks with her so far. She says I’m ahead of schedule and moving along steadily so I don’t need to see her for another couple of weeks (until week 6) as long as I follow my exercise regimen. I’ve been pretty diligent with it so far.

Exercises
I have progressed from range-of-motion exercises to working with resistance. I have a routine of coming home from work, taking off the VacoCast and plopping down on the couch. I either read, surf on the iPad, play XBox or watch TV, but my feet are moving the whole time. With my legs propped up and stationary, I do ankle rolls and hold my foot for 5 seconds in up, down, left, right positions. I do these exercises off and on for 3 hours or so while I relax after work. I ice my ankle and calf afterwards.

Last week my physical therapist gave me a yellow resistance band. It’s the lightest they have. She instructed me to use it to strengthen inversion, eversion and left and right foot movements. I tie off one end on my coffee table and rotate my foot left or right or roll it inwards and outwards with varying resistance while my leg is stationary. Pretty basic stuff.

I’ve started to vary my speed and stride distance while walking to get my muscle memory back. I’m hoping not to have too many issue with my gait. I have also started riding the stationary bike to gain muscle and get my stamina back.

Two weeks from now, I get to use the gym and start water therapy exercises. I’m so excited to start to really get into the rehab process and move on from my current light exercises.

I couldn’t stand it anymore.

A damp cast after showering with a garbage bag over my leg. The itching. Not being able to rest my foot on the ground. Not being able to carry anything with my hands. Uncomfortable, sleepless nights. Asking people to do things for me. The smell. Standing on my good leg, all. damn. day.

I took a Dremel with a 426 Fiberglass Wheel and started sawing down the inside of my leg. There are two layers of fiberglass in my cast–an outer layer and middle layer. The layer of the cast that is closest to your skin is a soft bandage, but right between that and another layer of soft bandage is a middle layer of hardened fiberglass.

My visiting mother and wife were pissed.

The outer layer was easy to cut through, but the middle layer was hard to see. It was also kind of scary to get the blade that close to your skin. I felt the heat of the blade and the soft bandage on my leg a couple of times. I went slow and steady while resting my leg. The cut went from the top of the cast to the toes.

My cousin was also visiting from New Orleans and helped me cut the outside of the cast, the same way.

After the fiberglass was cut, I used scissors to cut through the last layer of bandage. My cousin came over and helped me tear the two pieces apart.

I immediately put my foot into the VACOcast in a fixed, 30-degree position. A few hours later I washed my leg and foot in soap and water and replaced the suture bandage with a new sterile bandage. I also wrapped my foot in an elastic ankle wrap afterwards.

I didn’t put any weight on my foot but to gently rest it while standing or sitting. This was my doctor’s protocol–no weight for the first two weeks.

I saw the doctor two days later at my normally scheduled two-week appointment. The nurse I checked in with mentioned that I needed to have my cast removed and I let her it wasn’t necessary. She looked at my wife, rolled her eyes and commented, “Guys always want to remove it themselves.”

Dr. Neufeld didn’t make any comments about me cutting off the cast. His body language was either, “It’s no big deal,” or, “This guy is an idiot and there’s nothing I can do about it now.” I couldn’t quite tell. He had me lay on my stomach as he removed the elastic bandage and checked out the sutures. He snipped the ends off and said that the wound looks great.

He loved the VACOcast. He hadn’t seen one in person and was asking all kinds of questions about it. He said that cast seemed way more functional and comfortable than the boot their hospital provides.

Then he told me it’s time to gradually start putting weight on my recovering foot. My eyes grew twice their size.

I’m back on my feet. Just a man and his will to survive.

I must have told the achilles rupture story 40 times already.

I went back to work 2 days after surgery. My coworkers offered help a lot, but I don’t really like getting help for things I can do myself. I thanked them many times as they watched me hobble around to get to my cube, grab our catered lunches, crutch to meetings and make bathroom visits.

I took the back off of a chair, put a pillow on top and rolled it under my desk to keep my leg up. We also have lounge chairs near my desk so I laid on those with my laptop on my lap. Both helped with swelling, but I still left work a little early each day.

Driving to and from work is about a 30 minute drive. My fiberglass cast wasn’t padded or tight enough on my leg to rest it on the floor of my car comfortably so I wedged a pillow between the seat and my upper leg to give my foot enough leverage that it gently rested on the floor with less weight.

My leg keeps shrinking. I saw it for the first time since surgery after I couldn’t stand my cast any longer and cut it off myself last weekend with a Dremel saw.

I’ve updated my measurements below.

I’ll post more about how I cut my cast off soon. I’m editing the video now.

I want to return to regain my previous muscle, flexibility and speed. I thought I might need a baseline to compare my rehabilitation progress against so I collected some data. I’m not sure if this will be helpful or not yet. I’ll try to update this chart and post it once a week.

The first data I collected were the obvious weight and height. I then measured the circumference of my thigh and calf of my injured leg, both un-flexed.

The following measurements were taken by sitting with my leg stationary and perpendicular to the ground at as close to a 90-degree angle as I could. I placed a perpendicular notebook behind my heel (or to the side of my foot, depending on what I was measuring) perpendicular to the ground where I traced the bottom of my foot for each angle below. The line I traced was straightened out the best I could and measured with a protractor. It’s not exact, but it’s the best I could do with what I have.

I also measured the dorsiflexion and plantar flexion range of my non-injured foot. What are those? Dorsiflexion is when you keep your leg stationary and point your toes up and plantar flexion is when you keep your leg stationary and point your foot down.

Finally, I measured my non-injured foot’s inversion and eversion. Inversion is measured by keeping your leg stationary and foot flat on the ground at a 90-degree angle to your leg then rolling up the inside of your foot as high as it can go while keeping the outside of your foot on the ground. Eversion is the opposite where you keep your leg stationary, foot flat at 90-degrees to your leg then rolling the outside of your foot up while keeping the inside of your foot on the ground.

The other data I noted isn’t really quantifiable. I made a mental notes of my balance and flexibility by doing simple hamstring, calf and other single leg stretches and squats/raises to test my strength.

After this week’s measurement. I was surprised at how much my calf has shrunk already. I figured there would be some swelling or something that would keep the circumference closer to it was a week ago. The other thing I was surprised at was my body weight.

I am genetically top-heavy, slightly overweight for my age and height (32, 5′9″) but I did not expect to drop 11lbs.

I am lucky enough to have my employer cover a majority of my healthcare. My wife and I are on a Kaiser HMO plan where about $100 or so comes out of my paycheck a month to cover the both of us.

My achilles surgery cost me $250.

My surgeon had scheduled my surgery for Monday, 3 days after the injury. After paying and checking in at Kaiser I waited in the hospital surgery room for a while before being called in to change into the surgery gown. I was then put on a gurney and hung out with the nurse, who was doing her routine checks, in a curtained area. A young dude came over and told me he was the resident surgeon on duty. He had to be about 25 years old or so. He walked me through what was going to happen after I was rolled into the operating room.

Then the operating podiatrist came over and introduced himself, Jason Neufeld, DPM. He is in his mid 30’s. I had lots of questions for him and he answered quickly and confidently. It really made me feel comfortable. Below are a few questions I paraphrased from our conversation.

How many achilles tendon ruptures have you repaired?
I have repaired 100’s of achilles ruptures over the past few years.

How many re-ruptures have occurred out of those you have performed surgery on?
None, that I am aware of. I follow and keep in contact with all of my patients until they have fully recovered from the injury.

[After giving Dr. Neufeld a brief background about who I am, what I do and what my active life is like] What is your recommended recovery and rehabilitation timeline?
With surgery, we keep the patient in a cast for 2-3 weeks and when the cast is removed the patient is given a walking boot. The stitches are removed when the cast is removed. The walking boot is in a fixed position with your toes pointed down similar to the cast. Patients will still need to use crutches for the first month or so after surgery and shouldn’t put any weight on their recovering leg. After that we slowly ease patients into allowing weight on their recovering leg in the boot with the toes still pointed downward. Depending on how that goes, we adjust the boot a few times until the foot is moved towards a position where it’s flat on the ground. Patients are in the boot in a fixed position for about 6 weeks total. Afterwards we keep the boot on, but allow patients to move their foot and increase their range of motion until we feel they are ready to remove the boot.

Each patient is different so this timetable is not in stone and will be adjusted depending on physical therapy and feedback from our appointments.

Do you have experience with the VACOcast boot? Do you recommend it?
I have had a few patients use the VACOcast. They all showed great results from using it, but a majority of our patients don’t use it. The reason they don’t use it is because it is quite expensive and not covered by Kaiser. The bottom line is you should recover just fine regardless of the type of boot you use. Recovery results depend on how well you follow our rehabilitation process.

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I asked more questions about the procedure itself including how long it took, what are the anesthesia options, how long it takes to wake up from the anesthesia, etc. I also asked about rehab and physical therapy which I’ll cover in another post.

What I was most satisfied with was the doctor’s overview of his recommended recovery path. That was the rehab plan that I had been reading about. It was exactly what I want to do.

I decided to take local anesthesia instead of general anesthesia. I just wanted to be out, then wake up when it was over. Both do that, but local anesthesia allows you to breathe on your own. General anesthesia requires a tube down your throat to help you breathe which can get complicated with this type of surgery since you are laying on your stomach.

They rolled me in to the operating room and asked what kind of music I wanted to have playing. I told them I’d rather have the surgeon have his favorite music playing–he’s the one who I want comfortable.

My drugs were kicking in and I was getting drowsy. I remember was Dr. Neufeld doing what they called a, “Timeout.” They went around and each person in the operating room took a turn, giving a status update. After the last person gave their status, I asked if I could give mine. I wished them good luck and asked them to bring their, “A-game.”

Then I asked if they had seen Rookie of the Year. “I want to come out of this surgery with a laser left footed (soccer) shot. Hook me up, boss!” That’s the last thing I remember.

It was obvious my achilles left achilles was torn.

I arrived at the emergency room late in the evening and was put in a wheel chair and wheeled in to a curtained ER room. I hopped up on the gurney with my good leg. After the normal nurse duties of questioning my medical history, getting my weight and taking my blood pressure, the ER doctor came in.

The doctor immediately had me lay on my stomach and began the Thompson Test. He squeezed my right leg’s calf which constricted my achilles and moved my foot. He then tried the test on my left leg. My foot didn’t move at all and faced straight down towards the floor. My left foot was at a 90-degree angle from my leg when laying on my stomach with my feet hanging off the end of the stretcher while my other foot had a normal rest of about 120-degrees.

The doctor went over my options and sent me home with a splint. The splint held my left torn achilles at the same rest angle as my right foot. He instructed me that the podiatrist would give me a call the next day.

The podiatrist called and went over my options. By the time she called, I had already spend hours online researching which types of treatments were available. I immediately told them that I wanted surgery with a 2-week non-weight bearing cast, then I wanted to begin rehab with a walking boot.

Here’s why I knew what I wanted

I used to be really into music from independent music labels. I would follow all the new releases and new artists to try and find the next big thing. Diamonds in the rough. This was very time consuming, expensive and didn’t produce results all the time. It got worse when the internet made accessibility to music easier. I decided to optimize my search for new music by letting the experts do it for me. Instead of scouring for new artists, I found a handful of DJs that shared similar tastes as me. I basically trust them, as experts, to greatly influence my decision. I mainly listen to DJ mixes now, but still follow a few of my favorite artists.

I took this theory and applied it to my injury. NFL linebacker Terrell Suggs, NFL wide receiver Michael Crabtree and NBA superstar Kobe Bryant have all torn their achilles within the past couple of years. Kobe being the most recent. These guys consult like 10 expert doctors from around the world before deciding on how to treat their injury. It’s not just an injury, it’s a team protecting a multi-million dollar investment. It’s an athlete who has reached the pinnacle of their careers, wanting to go even farther. They require the best, most successful treatment available. I’m sure these doctors have treated hundreds of these type of injuries have read thousands of studies or completed some of their own. Do I trust a doctor on the phone completing their residency who has never met me in person or do I trust how a group of top docs treat athletes?

None of these professional athletes took the non-surgical path. Because of this, I barely researched non-surgical treatment at all.

Each of these players took very similar paths and each one has almost outdone the other in terms of rehab time. Terrell Suggs returned to the NFL 5 months after surgery and hasn’t shown any signs of slowing down. Michael Crabtree is on pace to return in November, 5 months after surgery. Kobe was walking normal after 3 months of rehab and is on pace to play professionally after 7 months.

Suggs, Crabtree and Kobe are professional athletes. They’re arguably some of the best at what they do. They’re beasts. I am very aware that I am none of those things, but I am athletic, in shape, young and full of optimism. I’ve played competitive sports in the past and want to play them again. From their choice of surgery to their modern rehabilitation techniques, I am going to try and follow the steps these guys have taken as closely as possible and come back stronger from this injury. I’m going to use their results as motivation.

My point in all this is that I feel surgery is what is right for me in my situation and my goal is to fully recover and get back to playing soccer in 5 months.

Even though I was still sore, I was determined to play in our championship softball game. It was our company team and the first year we organized to play together. I was one of the only players from our company’s engineering division, so I really wanted to represent for them. I wanted our company to win and knew I could help them do that with my speed.

I helped a little with organization and offered opinions on lineups and such, but I am not a big softball guy at all. I really only play when my friends are short players and give me a call in desperation. My wife played NCAA softball on a scholarship so my interest in softball and playing with this coed team was a combination of having fun with coworkers and playing along side my wife. I’m fairly new at this company and was excited to show off my wife’s amazing softball skills and my speed. Thirty or so other employees came to watch.

I warmed up like I normally do–jogging and stretching. I picked up my speed a little, but my achilles were still sore so I slowed back down to a jog and did more stretching. I went back to the dugout before the game and asked a coworker for 800mg of ibuprofen.

My wife hit a single and I follow with a double that I turned into a triple. She scored and our team was up five runs by the end of the first inning (softball is pretty high scoring in a D+ level league). The employees who came to watch were drinking, cheering and having a good time. I was up again in the third inning. My wife had hit a triple and was standing on third base when I hit a deep single to left field and ran hard to first base. I rounded first and saw the left fielder playing casually so I decided to turn it up and push for a double.

CRACK!

I felt a huge pop in my left foot. I looked back behind me. I thought, ‘Did the first baseman just kick my boot?’ He was standing five yards away and had his mouth wide open. I glanced over to our team’s first base coach and he had his mouth open too. I took another step and realized immediately that my achilles tore.

I’ve always wondered what it sounded like when someone says ‘they heard a pop’ when describing an injury. I hear that all the time. I wasn’t sure if it was a pop that you feel or if you can really hear it. Was it loud or quiet? How do I know when it happens to me? Let me tell you, when it happens you know. There is no doubt that you’ll know when you hear a muscle or tendon pop. It was so loud that all the players around me heard. Even a few people in our dugout on the other side of the diamond heard the noise. It was jarring, but didn’t hurt at all.

I started hopping until my momentum slowed down. The 2nd baseman walked over and gently tagged me out. I stood there and looked over to my wife, who just scored, and smiled. We both knew what had just happened. She returned a sad smile and a long blink. The first base coach asked if I was OK and if I had kicked myself. “No,” I replied, “I just tore my achilles.”

The umpire and my wife helped me hobble from second base to the dugout. The crowd was silent. I tossed my keys to a coworker and asked him if he’d drop off my car at work and asked my wife to go get her car.

We needed to go to the emergency room, meanwhile our team won the championship.

Two weeks before tearing my achilles running from first to second base in a softball game, I worked the flexion of my tendon pretty hard during a group circuit workout session.

One of the stations was to do Goblet Squats. Goblet Squats are where you hold a kettle bell of weight, 20lbs in my case, up to your chest and squat down as far as you can with your feet shoulder width apart and keeping your heels on the ground. My trainer had me take off my shoes for this exercise to help work on the flexibility of my achilles as my Nike Air Shox had a lift in the heel kept my feet from being flat on the ground.

The weight held at the chest in this exercise helps you get much lower to the ground than if you weren’t holding weight. In my case, doing a Goblet Squat without weight and keeping my feet flat, I was only able to get low enough for my butt to be about 12 inches from the ground. With the weight, I can get as low as 5 inches off the ground.

I have done this exercise many times in the past and have not had any issues. After the workout I drank a protein shake, took a multi-vitamin and that night  I took my normal does of ZMA (Zinc Magnesium Aspartate). The next day my achilles were quite sore as most of my other muscles are after workouts.

I iced them and took it easy the next day, but two days after the workout I had a playoff softball game with the company I work for. I warmed up and did a little stretching before the game but my achilles were still a little sore. I still played. We won.

The next day I was not able to flex my achilles without pain. I had trouble walking, especially with the soreness in my left achilles. The week after the Thursday softball game I took it easy, did not work out and iced my achilles regularly. I did this mostly because I wanted to be able to play in the championship softball game the following Thursday.

Prior to Thursday’s championship game, I had already made up my mind that I was going to play no matter what.