Week 19: In the Red Zone
Life is pretty good at this stage, but I feel like a football (American) team in the red zone where progress becomes much more difficult. I walk without a limp and my push-off strength is good. I can cycle reasonably long distances (I did another 30 mile bike ride this week) at nearly full strength. I’m up to 25 single heel raises, but my height is lacking–still only about 2/3 of my good leg, and that’s probably only the first 10. At PT I continue to focus on single heel raises, balance, stretching, and slightly more aggressive and light-impact movement: shuttle jumping, light (real) jumping, skipping, and side-shuffles. My main physical challenge now remains improving my dorsiflexion ROM, particularly with knee bent–this is still quite tight. My main mental challenge is to stay motivated to continue to work on my PT at home. At about 85% (my subjective measure) of my pre-ATR condition, the payback from PT seems a little less compelling and I’ve been letting it slide. On the positive side, my PT took some measurements today on my range of motion and I’ve added 5 degrees over the past 3 weeks: I now have 8 degrees (up from 6) of dorsiflexion and 52 degrees (up from 49) of plantarflexion–for a total of 60 degrees (up from 55). Next week I have my 20 week follow-up with my OS; I’m hoping for clearance to step things up a bit and get back on the tennis court at least for some hitting. I think I’m ready.
Filed under: Uncategorized and
Good stuff David! At 14 weeks I too am having trouble focusing on AT-specific exercises. The biggest change for me is bike riding. I am now up to 30-mile rides and am finding it is really helping both my strength and ROM (and general mental health…….). Cannot wait for your first report from the tennis court!
I also drifted away from PT and home exercises as time and fitness advanced. I’m sure that 30-mile bike rides will reap benefits, and the scenery should be way better than in the gym, too!
BTW, I’d be surprised if your PF ROM (or the sum of your two ROM measurements) has much relevance for you from here on. 52 degrees PF seems like plenty, and if it goes up or down a few degrees, I don’t think it will change anything you care about. But my podiatrist says that around 15 degrees of DF ROM is needed to walk “perfectly” without opening up one of the smaller joints in the foot that can (but shouldn’t) let our knee push forward when we walk. (He’s told me that I’m abusing one of those joints on my post-op ATR#1 right-hand side.) And I think it also follows that my <15-degree DF ROM on that side is a good measure of the calf-and-AT stiffness that eventually gave me a “trick” knee that constantly went out of alignment until I started stretching my right quad and calf muscles once or twice every day.
You make an interesting distinction — new to me, but sensible-sounding — between straight-kneed and bent-kneed DF ROM. I don’t think anybody ever measured mine bent-kneed, though I think we all do that when we see how far from a wall we can plant our foot and still touch the wall with our knee… Interesting.
Norm, my PT agrees with you. He says my PF ROM is very good now (and was 3 weeks ago), but he definitely wants to get my DF ROM to more than 10, preferably 12+, before releasing me. Although it seems small, I was very pleased to have gained 2 degrees over the past 3 weeks. I find it easiest to stretch for this while seated, with my heel on the ground behind my knee. However, I also have some balancing exercises done with knee bent that also stretch my DF ROM with weight bearing. I hope I can keep improving it, and I’m interested to see what my OS thinks of my condition when I see him next week. -David
Its always important to measure dorsiflexion with knee straight and knee bent. It gives the therapist a good idea of where the limitation is coming from. The calf is made up of 2 muscles: soleus and the gastrocnemius. The gastroc is a 2 joint muscle (meaning it crosses your ankle and your knee). So if your knee is straight, the whole muscle needs to lengthen to allow dorsiflexion. If someone is tight with leg straight but not with knee bent, it is most likely muscle or soft tissue restrictions in the way.
If someone if tight with both bent and straight knee, the ankle joint itself is limited. Usually the culprit is a tight talocrural joint. That can be mobilized by your therapist to help restore normal joint mechanics.
A quick way to do a self test is to squat and see where you feel tightness in your ankle. If you get tightness/stretch in the back of your leg/calf, it is most likely your calf. If you more feel a pinch in the front of your ankle, your joint is tight.
Anyway, hope that helps!
(p.s. if you really like this biomechanics/nerdy stuff, be sure your therapist is measuring you in what we call “subtalar joint neutral”. That way you know you truly have enough motion versus compensating through another part of your foot).
Thanks, Greg! I really appreciate your sharing your expertise. -David
Ya, good stuff! We should have a clippings library for these nuggets.
Great advice and good to hear the progress David! I, too, am a culprit of not doing my PT at home as religiously as I used to now that I am able to do more “normal” exercising. I try to remind myself to at least get my calf raises in with some stretching at least once a day. Running and biking help, but its important to continue to strengthen the calf as we move back towards our sport.