Swimming at almost week 6: is that too soon?
Almost week 6 - ortho told me to take out last 2cm wedge on Monday (week 5 exactly) but it felt too much like it was pulling on the tendon. So I’m varying it & taking last wedge out for a while each day then putting it back in.
I also went for a swim yesterday, very gingerly, but again the doc said I could (although aware he may have less clue about what’s ‘right’ than I do). But it felt great to swim! Did anyone else swim this early?
Doc also said 2 shoes at 8 weeks, but he didn’t mention any inserts. He said, ‘just wear trainers’. Any advice welcomed. Is 8 weeks too soon (non-op) for 2 shoes?
Also, if I’m comfortable in 2 shoes at 8 weeks, can I drive? We have just started renovating our house too, so driving will be even more useful than usual for lots of things! Although I still have my knee scooter: am loathe to give it up until I can walk a bit faster.
One other interesting thing my doctor said was that I only had a partial rupture, according to the ultrasound I had at 10 days post injury. While I would be happy if this were true, I don’t think it is since I failed the Thomson test the first night of the injury when I went to casualty. I also failed it a week later when the first cast came off. I suspect that the tendon had just started to knit together by day 10 and that’s why it looked like a partial tear on the scan …
Hope everyone is healing well: I have my days of feeling down, especially having to deal with renovation too & work as usual. But trying to stay positive & see light at the end of the tunnel!
November 14th, 2014 at 11:03 pm
Nice progress. Regarding driving once in two shoes, I would think that would be fine. I was pretty tentative on the brake pedal on the first day for two shoes. I continued to brake with my uninjured left foot for a day or two. I had been driving my automatic transmission left-footed since pretty early in my recovery (not recommended and may be illegal depending on your location). I was well practiced from a previous right ankle sprain.
November 15th, 2014 at 12:03 am
Once you realize that you are often the best advocate for your own recovery I think you are set. Those last degrees to neutral are not so easy, taking it gradually is definitely the right approach.
I bet it felt amazing to swim. I have no idea if 6 weeks is too early but if you are careful then it sounds logical. As for no heel lifts- I was told that I wouldn’t need them by my OS. I am at 12 weeks non-op and am still walking with lifts or small heels, my big concern is heeling long and my PT agrees that we will get the length easily when the time is right.
As for driving and getting into renovating, I don’t think that may be realistic. Everything that you do during rehab has an level of risk, once you are in two shoes it is more important than ever to pick your battles. For me, riding a spin bike for 45 min and working hard at pushing the PT are within my comfort zone. However, there is unpacked snow around my house now and if I re-ruptured walking to my car then I would be devastated so I still shamelessly wear my boot for that short journey.
The down days are a reality and we all have them - for sure they make the good days so much better and are part of the journey. All the best
November 15th, 2014 at 3:25 am
On my blog, I tell the story of my THREE UltraSound scans of my second (left) ATR. They were at 1 week intervals, all interpreted by the same fancy sports-med doctor along with the same US technician, and I got THREE different interpretations of my ATR!!! First it was simple and complete, then it was partial, then it was partial and multiple!
I have NO IDEA what it really was — my Thomson Test also said it was gone — but I’m convinced that interpreting ultrasound images of an injured AT is more art than science.
As i always say, when recovering from an ATR — especially non-op — I’d stay close to the protocols that have produced the best results, like the three at achillesblog/Cecilia/Protocols. I think they ALL got to 2 shoes — or more accurately to “wean off boot” — at 8 weeks in, so I’d do that.
I would NOT short-change the PWB and FWB time you spend re-educating your injured leg and your “new” AT to do the job they’re going to have to re-learn to do properly. That is, I’d throw away, store, hide, or sell the scooter, and stay on your feet to get around. At 5+ weeks, you should be FWB in your boot, and your AT should be starting to respond to the walking, trading in the first kind of “emergency plaster” collagen, in return for some better and stronger collagen — more like what tendons are made out of. That transition doesn’t happen while that leg is kneeling on a scooter, sorry!
People who got access to swimming pools during ATR rehab generally loved it, but more for the joy of walking normally in deep water than from swimming. Don’t bite off too much, but as long as you’re smart and careful and incremental, you can gradually introduce (and benefit from) exercises in the pool that would be crazy too-soon on dry land. Good for the leg, the rest of the body, and the soul and the attitude!
For driving, I think the key is what you can, and would, do if you had to make an emergency stop. Having to choose between a car crash and a rerupture is a very serious Don’t Go There. But if you can trust yourself to hit the brake with your heel, it might be safe. But don’t be a cowboy!
November 15th, 2014 at 3:32 am
A good trick for making a transition closer to neutral (in your case, the last step to neutral) is to remove the wedge at bedtime, and sleep in the boot in the new position. (If you’ve been sleeping bootless, or with just a liner, or with loose straps, revert to the full boot for one night.) That gives your ankle, calf, and AT a whole night, NWB, to get used to the stretch, before you load it up with your weight.
UWO did not prescribe heel wedges in 2 shoes, and I forget what the other two most successful protocols did. Some Docs prescribe them, some don’t. Again, I’d follow the winners.
November 15th, 2014 at 4:42 am
Hi heeling.
Good to hear that you’re progressing nicely.
I would love to go for a swim and will look into it as a matter of fact!
I’d like to share my progress with you since we’re at similar stages of non-op recovery. And I tell you this NOT because I recommend you do the same, but to emphasize the point that you are the best advocate for your recovery because you know where you are in your progress and how you feel better than anyone. There is an abundance of great information and help here at these blogs. And I felt that reading all the different recovery blogs helped me with gauging my own recovery. I don’t mean pacing myself against someone else, but a good sense of what I can and cannot do when I feel like X, Y, and Z.
In regard to driving and 2 shoes, here is my PERSONAL experience thus far. I had my 6-week check up with the OS earlier this week. He performed a visual check, examined the tissue build-up around the tendon, checked ROM (almost the same as good foot), and checked how much pressure I can exert from the ball of my foot. He seemed pretty happy with the progress and told me that I can start weening off the boot, didn’t need to sleep with the boot, and cleared me to drive. I asked whether it was okay to move a week or two ahead of protocol. He said protocols are general guidelines and a little flexibility on a case-by-case basis is acceptable. I specifically asked him what the weening off boot process entails and how long it should last. He said, start wearing 2 shoes in controlled environments as long as I’m comfortable in them and wear the boot when going to public or unfamiliar places, and that I should be completely done with the boot in 2-3 weeks. So I said GREAT! He didn’t mention anything about putting heel lifts or gel inserts in the shoes. Just 2 shoes. Okay Doc.
The truth is, a few days before my OS visit, I felt like I had enough strength in my injured leg to try to stand on both legs without the boot. So I tried and it took a little bit to get my balance, but I was able to stand with no pain. With a little more practice, I felt stable standing without the boot. The next day, I started taking baby steps in the morning without the boot and was able to walk with a limp but in a stable manner by day’s end with no issues. The day after, I put shoes on and did some more walking practice and felt fine. This was all inside my home obviously. At this point, I knew that I was able to exert a fair amount of pressure from the ball my foot through resistance training. So the day before my OS visit, I went to the car with the boot on, took it off in the car and tried driving. Other than a very slight pull on the calf when hitting the brakes initially, no real issues to speak of. Your pedal sensitivity should come back fairly quickly. So my OS visit basically confirmed what I knew I could already do which was reassuring. For the past several days, I’ve had no problems with sleeping bootless, driving daily 65 miles round-trip (avoiding heavy traffic hours) to work, and spending most of my time in 2 shoes at home and office. Even my PT told me I don’t need to bring my boot anymore.
When you get into 2 shoes without any inserts or lifts, do yourself a favor and find the most comfortable pair of trainers you can find. I found that the amount of cushion you have in your shoes will make a world of difference. I was dumb and first wore my regular work shoes to the office and my knees and hips were killing me at the end of the day. The next day with trainers was like a different world. Gait was much improved and pain was non-existent.
Hang in there. There are better days ahead. And like everyone says here, take little steps at a time…….
Steve
November 15th, 2014 at 2:58 pm
Exchange with your Doc is interesting:
“I asked whether it was okay to move a week or two ahead of protocol. He said protocols are general guidelines and a little flexibility on a case-by-case basis is acceptable.”
Of course trivial variations from any good recipe are trivial. And bigger variations can make the dish better, or worse. But we have a pretty solid understanding of the impact of an extra bit of sugar or salt in the pancakes, and we have precious little understanding of the impact of one more week, or one less, in ATR rehab. The data points from the best published studies are the only solid evidence we’ve got, including your Doc. So I’d generally follow the protocol of a successful study whose results you like.
There’s also an implication that a Doc can analyze an individual patient, leg, ATR, or repair, and use that
November 15th, 2014 at 3:11 pm
… individual info to customize a protocol that’s better than some study’s “one size fits all” protocol. It sounds logical, but the evidence here shows that the variation almost always tells us more about the Doc and his preferences, than about the individual patient, leg, etc. And with very few exceptions - and you’re one, Stevenk - the variations are usually in the slow direction. A hangover from the pre-2007 state of the evidence, when everybody still thought that slower was safer.
I’ve only seen one study that went fast enough to get bad results. It’s linked on one of my pages, and discussed in comments from RyanB and me. Its worth a look if you’re going faster than the most successful studies, just to make sure you’re not going THAT fast.
BTW, Wallace found a way to personalize ATR care in a brilliant and successful way. But I can’t think of another case where the individual variations got better results than the recipe.
My $0.02, from “some guy on the Internet”, same as always…
November 15th, 2014 at 3:14 pm
Absolutely agree. And it is the very reason why I stated at the onset that my personal progress is not a recommendation to follow, but to use more as a reference point to somethings that heeling can expect in the coming weeks. I still have a long way to go. So I have and will continue to exercise extreme caution while trying to make progress. I’ve read a lot of your insight and they’ve been very helpful in deed. Thanks.
Steve
November 15th, 2014 at 5:09 pm
I haven’t read the study, but I wonder how much skill / experience is required from the doc to approximate the ends of the tendon and get the angle exactly right (as I understand what was done in Wallace)? Could the reluctance for this partly have to do with the docs feeling uncertain with this, and worried about getting it wrong? This not so much on the timing/speed of protocals, but rather the surgical / non-op preference… Also Norm, I’ll try to look for the study with “too fast” progress, interested in seeing how that could look and what the issues were.
November 16th, 2014 at 5:04 am
Gravity, remember that the non-customized non-op studies (like UWO) also produced very good results, although only Wallace treated a bunch of reruptures non-op. Also, I think it’s pretty easy Doctoring to approximate the tendon ends. Many of us noticed a visible “divot” from our torn AT, and we could also see when it closed up. Visible and palpable, both.
I think any new medical procedure is a hard sell with busy docs and hospitals, and there are no fancy Big pharma sales reps marketing this one to OSs, because there’s no big sales to be made.
November 16th, 2014 at 5:07 am
As I recall, the too fast study just went too fast - like FWB immediately, and 2 shoes pretty quickly. The post-op patients did badly, and the non-op ones did worse. The link should be there…
November 16th, 2014 at 4:08 pm
Thanks everyone
Had another swim today, which was fine. I think I will stick with the regular fast protocol - I only have 2 weeks to go until I can try ‘2 shoes’! I’ve lasted this long so I can do another fortnight. I won’t try to drive until I’m back in 2 shoes either. The other thing I have been doing since week 4 is a Pilates class - teacher was very understanding. Obviously, you only do what you can with the boot on - also, I did a lot of Pilates before. I don’t think now is the time to take it up but if you know what you are doing its great for core strength & upper body aches & pains from crutches & sitting too long.
November 26th, 2014 at 8:39 am
I’ve been thinking of swimming and I’m at 7 weeks post op and 7 weeks 1 day post injury
Back in 2 shoes two days ago and itching to try swimming or pool exercises to get back in basketball shape sooner rather than later and help it recover. I am glad you are doing well, keep it up!
I am going to start Yoga as soon as I am able to, I might try it and just explain I ruptured my achilles and had surgery! Maybe!
Best of luck!
November 26th, 2014 at 8:45 am
I didn’t have surgery - so not sure about swimming with regard to infection risk etc - perhaps ask your doctor if you can. If the scar is well healed I would think it would be ok, but best to check; you don’t want to set yourself back after all you’ve been through. I have found pilates great - have not attempted yoga yet: too many standing poses, I think. Most pilates is done lying down and that which isn’t can be adapted!
I’m at 7 weeks and 2 days post injury so about the same time frame as you 13 JumpmanRugs - still in my boot but taking it off next week. I do take it off and walk around in shoes at home a bit, which feels ok. I sent my knee scooter back today, which is a huge deal for me, so will have to walk around now! I’ve also driven a couple of times - it’s fine for the most part, but difficult if I have to make a sudden move from the accelerator to brake as it’s my right achilles. Am going to limit the driving to only when I absolutely have to, for now…. need to do those dorsiflexion stretches gently with my theraband (big elastic band I got from physio).
Good luck!