Week 9, Finally PT, 1 month till Running?

Now at 2 plus months out from my partial ATR, I think the most consistent information I contantly get is from this blog, as it seems every time I go from one professional to another, a different opinion surfaces.  In my last post, I went on and on and on about being told to wait on PT after week 7, when so many of you in your recoveries were well on their way in the PT process.  Fortunately, those issues got solved, albeit a week or so later than I would of liked, as I started PT yesterday.  Over the past 2 weeks, I generally have stopped wearing the boot unless I am in large crowds or for a couple hours in the office if I am sore.  I am starting to pick up the pace of walking, really focusing on getting a full heel to toe stride, and have stopped limping for the most part, unless I do a bit much, and I feel some sharp pains the next day.  This past Sunday, I took a 2 mile walk in sneakers, did 3 X 20 calf raises and some other resistance stretching, and with some bad drivers out there causing many break slams, I was fairly sore yesterday, which is why I am glad at PT we mostly talked, did measurements, and he showed me a couple new stretches.

The only thing with my PT is he is definitely not up to date on modern protocols.  He was very surprised as an avid long distance runner I did not elect for surgery as he compared my achilles to a rope that has 50% of its fibers sheared off, and when I run long distance I am taking a gamble every time of a complete rupture.  I assumed whatever percentage tears, whether its 10% or 50% knits back together.  He even went as far as suggesting if its not too late, to get a surgical repair now as to not risk a future complete rupture during training or races.  I was really taken aback by this and told him I would discuss with my doc today.  The PT came highly recommended and I feel confident he could get my strength and range of motion to improve, but I think he is off base when it comes to the non-surgical vs. surgical approach.  He also stated I could ride a stationary bike with a decent amount of resistance w/o risk.

Today I discussed this all with my doctor, and he did not approve of the PTs advice to say the least.  As at previous appts, he assured me, with the placement of my partial rupture, he has full confidence with proper rehab that I will get back to my pre-ATR self.  If I was a good candidate for surgery, he would of recommended it.  It gets tiresome to constantly get differing opinions from professionals, but I think it is a bit crazy to suggest surgery 9 weeks in!  I’ll listen to my doc on this one.

One last note:  The doctor said I could begin an elliptical in 2 weeks, but to still take it easy on the bike for now.  I have not done more than 30 min with the highest resistance being 8 for the past 2 weeks.  Unfortunately, while it gets my legs moving, I am not working a sweat or getting much of a cardio workout.  Anyone in my timeline post-ATR have success working on the bike/elliptical at at least a moderate level?  The highlight of my appt was the doctor saying at my next appt, after week 12, he may clear me for light running.  If that happens, I would be quite happy to say the least.  Lots of rehab and strengthening to go until then.

13 Responses to “Week 9, Finally PT, 1 month till Running?”

  1. Good update! For me, I rode with heavy resistance while in the boot at 80-85 rpm and got some good cardio in. Since being out of the boot, I’m still able to work up a sweat at medium resistance and continued high rpm’s for 35-40 min. Surprisingly, I did the elliptical at PT last week, and was cleared to use mine at home as well, but no good cardio coming from that in the immediate future!

  2. Thanks Sporti! I did 30 min of the bike today with the last min being at resistance 8-9 and between 80-90rpms. Between that and calf raises I am much sorer tonight than I hoped. Perhaps alternating days between bike and extended walks would be best for now.

  3. I wouldn’t aim for “sore” at 9 or 10 (or 11 or 12) weeks.

    I wonder where your PT got his (mis-)info? Long-delayed reruptures are vanishingly rare, op and non-op, both in the literature and around here, so it’s hardly something one of your health professionals should be warning you about. Of course, a successful non-op cure sounds like magic compared to a surgical repair (so it’s easy for “normal people” to doubt), but the evidence is quite strong that it works very well. . .

  4. Agreed Norm, I have no idea where he would have gotten that information, but Im going to of course stick with my doc’s non op plan at this point.

    By “sore” do you mean whatever activity is causing that (i.e. the bike workout mentioned above) is too much for now? Im having a hard time distinguishing between whether to stop a workout if i feel discomfort or to continue expecting to feel some as I work on the atrophied calf. Between the commute to work, to the gym, back home from the gym, I generally have some discomfort in the evening. Trying to explain it to the doc is hard w/o him experiencing the discomfort. What I am doing now is as bare minimum exercise as it is, I would hate to cut back more, but would if I am putting myself in a jeapoardizing situation.

  5. Sporti, you should work out enough to get your gastroc and soleus to fatigue, which will probably cause some soreness. That’s probably where you’re feeling the soreness anyways. You’re not going to build back any muscle without that sore feeling. Keep that up unless you feel any acute pain in the achilles. But try to avoid any large amount of delayed onset muscle soreness at this stage. Keep in mind, the sore feeling is probably in muscles that weren’t injured, the AT doesn’t have muscle fibers that get sore in the same way, its just there to connect your calves to your heel.

    Your PT is definitely speaking quackery about the physiology of the injury, but still probably has a good strengthening program to follow. Tell him to treat you as if you had surgery.

    Also, since about week 9, my experience with the bike has just been to use it for 5 minutes with little to no resistance to warm up my AT ROM before I do a real workout. But remember, cardio isn’t going to help build any muscle unless you’re getting into an anaerobic state.

  6. thanks Roark, what do you include in your routine as part of your real workout after the 5 min bike warmup?

  7. I’ve pretty much been able to do anything in p90×3 in the boot, since about week 4. So it rotates depending on the day and there are some really great things I could do out of the boot too like yoga, pilates, dynamics and isometrics. Anything but agility stuff. I can even do some plyometrics minus the jumping around. You can look up the movements online but it really comes down to a lot of pushups, pullups, different type of core stuff, full body stretching, squats and lunges. Mostly stationary, but I could use a chair for support and modify for anything I couldn’t do on both legs. Any time I’m worried about something being too much I just put the boot on and just proceed incrementally.

  8. Funny, I’ve been doing some P90X3 as well, but more focusing on P90X2 because it is all about strength and core training through balance, which is fabulous rehab for this injury.

  9. I’m going to look into incorporating P90, yoga, isometrics going forward. Im concerned about the sharp pains Im having after the bike ride yesterday in the ATR area. Thanks guys

  10. Yeah, I’d actually prefer X2 because its better for sport performance but I was able to get my wife to do X3 because the workouts are shorter and easier to modify for beginners. I was amazed how good some of the training has been for rehab. When I ruptured initially I thought I was going to be sitting out the rest of the program, but once I realized I would be fine as long as I wore the boot it became a great way to maintain fitness.

    gocanes, I would definitely say take it easy until any sharp pains die down. Maybe put the boot back on just to do a workout so you don’t have to worry about it.

  11. right, i think if i wear the boot for the duration of my upper body workout tonight I should be ok

  12. Roark, your comment of June 4th, 2014 at 10:54 am is addressed to Sporti, but seems to be intended for gocanes? I agree that strengthening the Gastroc and soleus need levels thatmcause muscle fatigue and soreness, but I think 9 weeks is too soon to work on muscle strength, because those muscles are still attached to an impaired AT. At least until the risk of rerupture and other serious AT setbacks has passed, I think all lower leg exercise on that side must be tailored to the needs of the AT, though it leaves those calf muscles atrophied a while longer. The rest of your body can be sore after a workout, including your other lower leg, but I think this one should wait for muscle fatigue. Muscles are good at signaling when they’ve been overstressed (though sometimes slow), but vulnerable ATs are pretty mute until they’re injured.

  13. yeah, I messed that up, I meant that for gocanes. It is definitely a high risk period. Personally, I started strengthening with standing calf raises with an isometric hold around week 10. Now around week 12 I’m getting close to 50% of my weight on it so its going well. But I agree, my main point is that the calf muscles are probably going to feel sore before any indication from the AT. How far you want to push that is always a big question.

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