Why cipro weakens tendons

Hi all,

I once promised that you guys would be among the first to know if a theory of mine worked out, and it appears that it has.  Ciprofloxacin and related antibiotics have some unexpected effects, including inhibiting the prolyl hydroxylase enzyme that crosslinks collagen.

For more details:

jbc.org/content/early/2015/07/23/jbc.M115.671222.short?rss=1

and follow the pdf file link for all the details.

Best wishes,

Doug53, now almost 60

Five years ago tonight

Five years ago tonight, I blew out my Achilles playing basketball. I thought I would stop by my old online community and say hi to mark the occasion.

I had surgery five days later, followed by a rehab I made up myself as I went that was way faster than what my doctor recommended. The main thing I did different was to start calf strengthening almost immediately, (details in my 4/29/09 note). I also wonder if using a vibrator on my calf helped, (details in my 8/6/09 note). It all worked out well. I thought about giving up basketball for a year or two, but eventually got back into it. It’s all a distant memory now.

It is good to see Norm is here, helping out new arrivals with his expertise.

I succeeded in getting a researcher to look into an idea I had about why antibiotics like ciprofloxacin make ATRs more likely. The work is going on now. If it works out, I’ll post about it here someday.

Hang in there, folks, it gets better.

Best wishes,

Doug53, now 58

Tendon healed a little long, but OK

Hello all,

I know this site is about Achilles injuries, but it was interesting how similar my finger extensor tendon tear issues were to Achilles issues. In particular, don’t rerupture and don’t heal long. Well, my autistic daughter got out of control about two weeks in and, while getting her into her safe room, my finger splint came partially off, messing up my healing tendon in the process. It is now out of the splint and functions well enough, so it’s fine.

I see there has been some discussion about faster rehabs here lately. I believe faster rehabs can be done safely. The key is being aggressive, but in a very gradual and careful way, I think. In my case, I did a lot of pushing early, then backed off, once my goal of being able to handle my daughter’s meltdowns was reached. Once I had enough range of motion to walk fairly well in my shoes at four weeks, I didn’t stretch any more for some time. I worked the strength fast enough to be able to hold up my weight with my calf at eight weeks, but didn’t work at anything “explosive” for some time after that, and then very gradually. Again, I had reached my goal, so the risk was no longer worth it. That path worked for me. We all have different lives and goals, so it makes sense that we rehab at different paces, at least when we have a chance to do so.

Best wishes everybody,

Doug

Basketball claims another tendon

Not another Achilles, though, just one of my fingers’ extensor tendons. I’m in a homemeade splint for now, and will work on getting to a hand specialist tomorrow.

On a more Achilles-related topic, I have a hypothesis about why ciprofloxacin weakens tendons, and I’ve found a biochemist willing to test part of the hypothesis in his lab. Wish me luck!

Doug

Two years postop, doing fine

Hello fellow ATR sufferers,

It dawned on me while I was out cross-country skiing this morning that today is the two year anniversary of my ATR surgery.  I failed to note the day of the rupture itself, 2/8.

I had been off the basketball court for over two years after a bicycle accident caused a fairly bad neck injury.  The impact actually fused two of the vertebrae in my neck, and probably would have killed me had I not been wearing a helmet.  So I was rusty as could be after such a long layoff, but after an hour on that first day back I was starting to get the feel of it again, until the dreaded pop happened.

I was a bad patient, rehabbing well ahead of my doctor’s plans, walking in my shoes between three and four weeks, riding my bike on the road at four weeks, and able to hold up my weight with my calf just past eight weeks postop.  So I was back to everyday stuff pretty quickly, and was soon biking as if nothing had happened.  I stayed off the basketball court for a long time, though, just getting back to that a few months ago.  The Achilles doesn’t bother me at all now, it’s my arthritic knees that get my attention while playing basketball.

Hang in there, folks, it’s a nasty injury, but you can get back in the action.

Doug53, now 55

Back on the basketball court

I’m a long way postop, over 21 months. The early part of my rehab was pretty fast, and my leg has felt nice and strong for over a year. Still, I took my sweet time going back to basketball.

Yesterday, I had an appointment with a doctor who specializes in ultrasound exams of healing ligaments and tendons. The appointment started in a funny way. He asked me to stand on my toes, both feet, no problem. Then he wanted me to stand on the toes of my once-injured foot. Heck with this, I thought, I’ll cut to the chase and show him what I can do. I hopped a few times as high as I could on my good foot, then the other, same height. He got the point, and that was the end of his assessment of my rehab. He said the ultrasound looked great on both sides, no evident areas of weakness at all.

So, to celebrate, I played some basketball today. It certainly wasn’t as competitive a game as I used to play in, and I took it pretty easy, but it was great fun, nevertheless. I didn’t think about my tendon once the whole time. As my body and brain shake off their rust, I hope I can can get back to my old, more competitive game.

Keep healing, everybody,

Doug

Nine months postop

Hi all,

Friday the 13th in February was the day of my surgery. Things are going very well now. There is still that trace of stiffness for the first few steps upon awakening in the morning. When I jump up and down on my injured foot, keeping the heel off the ground, it gets a little achy after about five jumps.  So, I exercise by alternating feet, jumping off one foot, then the other, sort of a bouncy running in place, and there is no ache that way.

My other, more stubborn injury is getting better, too, although much more slowly. The arthitis in my neck was made much worse by a bicycle accident three years ago. My neck extension is pretty limited since then.  I can’t look straight up when standing without bending my waist backwards a little. The past few months, I have been able to do some stretching of my neck without pinching the nerves, but I have made only a tiny amount of progress in my flexibility. I can go for days now without taking Aleve and stay comfortable.  That ’s a nice improvement.  I can take Aleve and Tylenol and ride my bike for about 60 miles before my neck gets too sore, a big improvement over about 30 miles earlier this year. Maybe someday I can get my neck healthy again, too.

Hang in there everybody, it gets better,

Doug

First dunk since the rupture!

Well, okay, on a 9 1/2 foot basket; but cut me some slack, I’m 54 years old. Still a nice milestone, though, as I haven’t dunked on a real ten foot basket in ten years. It felt great. I have been doing lots of bouncing on my toes lately, so I guess that paid off.

Feeling just a little younger,

Doug

Six months on, calf at full strength!

Hello all,

It has been six months since that ATRocious day I popped my tendon playing basketball, with surgery five days later. I can honestly say the calf is back to full strength, with just one exception. The strength is all there for the single leg calf raises. I measured each calf lifting around 460 pounds, with just a few pounds difference between the two. When I jump, though, that sudden burst (such as it is at 53 years old) still isn’t all there yet, so there is still a little more work to be done.

I posted a couple of days ago about the possibility that using a vibrating massager might limit muscle atrophy in the early postop period, as there is a rat study that strongly suggests it could help, and I did use a vibrating massager on my calf starting the day after surgery. That may well have been an unintentional but nevertheless important part of my rehab. The bad news is that so many are stuck in those (*censored*) casts during that period, and that removes vibration as an option. I think using vibration massage starting very soon postop may be worth a clinical trial. I’m going to check with my ortho and PT and see what they think. If it does indeed help, it’s a very simple way to make the recovery easier. If you’re about to have surgery and won’t be stuck in a cast, I would consider getting a good, vigorous vibrating massager. Other than paying for the massager, there isn’t a down side to using it that I can think of, and it feels good, too.

Best wishes,

Doug

Vibration to lessen muscle atrophy?

Hi all,

I just ran across something really interesting. There is a rat model of muscle atrophy where the back legs are kept off the ground. It is primarily used to study the effects of weightlessness in space. Like after Achilles surgery, the calf muscles atrophy a lot after 14 days of no use in this rat model. In a study of these rats, vibration was applied to the Achilles tendon, while it was being stretched, for just 3-4 minutes a day, and the muscle atrophy was a great deal less.

http://jap.physiology.org/cgi/content/abstract/87/1/3
(The Journal of Applied Physiology is an excellent journal, by the way; no crackpot science there.)

This is especially interesting to me because I used a vibrating massager on my calf rather often during my first few weeks postop. I don’t recall if I was ever stretching as I did it, but I’m sure I averaged well over 3-4 minutes a day of vibration applied. I wasn’t looking for any effect on atrophy, it just felt good, but I wonder if it was an unintentional but important piece of my rather fast recovery.

Doug