I feel like life as I knew it is within reach. Overall, I am progressing each week because I have been moving forward with fitness. After my ski trip at Week 18, I was ready to return to my classes (Thanks to the encouragement along the way by HereWeGoAgain and Norm). I have been back for five weeks at my regular weekly classes in Kickboxing, Step/HIIT, and Boot Camp. I’m not running hard or jumping onto high platforms yet. In the short-term, I switched some plyometrics with alternatives. I am working on incremental build-up in my classes.
I was concerned that the Achilles repair at the heel meant I could not do exercises that involved planking. But over the last few weeks, I worked my way to burpees, mountain climbers, push-ups, and single/double/side leg planks. I am currently refocusing energy back on ankle/calf strengthening because running faster and getting more power in jumps can only come from getting that last bit of strength back into my injured leg. Some examples of what I am working on in my classes:
- Doing Now at Shorter Duration and Range — Running, jump rope, jump squats, jumping jacks, broad jump, jump onto low platform
- Modify for Now — Alternating lunges instead of dynamic jump switch leg lunges, jogging instead of high knees
- What’s Next — Building strength in injured leg for more power, running at faster pace, endurance
My Achilles/heel injury discomfort is gone on some days and returns on others. My therapist thinks that the heel reattachment is tight after surgery. When I feel the heel discomfort, a few minutes of walking with long strides, Pro-Stretch, or squatted heel raises loosens it. It took some trial and error to find something that worked. For some reason the squatted heel raises work the quickest for relieving the tightness and I came across it on Tom’s Blog. (It’s in the “tomtom” exercise sheet and I’ve adapted his excel sheet to track my PT exercises and workouts.) I asked my therapist and she said it stretches the soleus. Stretching takes time and on the days when I am racing to the gym after work, trying to get stretching done can be rushed. But investing time for stretching beforehand pays off before I engage in an activity. Prior to this set of injuries, I only stretched after a workout, never before.
My calf is still thinner and not 100%. I have tightness at the ankle late at night or in the morning when I get up. The thickness in my Achilles is slimming down and I am starting to see a return to what my therapist calls the “hourglass” shape. The surgical site is becoming less sensitive. I don’t have incidences of swelling. Things have calmed down at the injury areas.
For a summary of my ATR post-op recovery timeline, check out my first blog post for Weeks 1 to 12.
My Physical Therapy:
I wanted to capture my thoughts about my Physical Therapy experience. My PT started at Week 12 at the end of my two-shoes period and is wrapping up in the next few weeks. Because of the Achilles tear at the heel requiring titanium reattachment, the doctor kept me at NWB for a longer time (5 weeks). I accumulated a lot of PT visits (at three times/week) because I had to address my troublesome injury #1 AT/calcaneus issues. Injury #1 gave me a very tough time. I call this injury #1 because my accident sequence was partial AT tear at insertion to the heel first, followed by injury #2 which was the Achilles tear to the calf muscle. The MRI noted that I had a third injury, a sprain to one of the ankle ligaments.
My doctor has told me that my ATR injuries are “unusual” because I had two Achilles injuries in the accident. During two-shoes, the two injury sites were behaving independently, with swelling alternating between the ankle or heel (sometimes on both) depending upon the activity. Of the two, #1 gave me the most issues. Walking or biking for very short durations at 12+ weeks caused hot swelling and stiffness. The injury #2 repair, where the Achilles severed from calf, resolved itself fairly quickly within three weeks of PT while the heel injury took longer.
I have to give a lot of credit on my recovery progress to my therapist and to the modalities which helped move me further along in recovery. The treatments helped accelerate pain reduction and swelling. Without them, I would have struggled for months with pain and swelling. When I look back over the weeks of PT, I see fast progress. The treatments helped speed the healing process, especially for injury #1 at the heel.
At 5 weeks post-op, I realized that other than routine follow-ups, my doctor’s job is pretty much done and I will be in the hands of a physical therapist. My doctor will write the PT scripts when I request them and receive progress reports from the therapist.
This is not my first trip through Physical Therapy (e.g., broken tibia from skiing, torn calf muscle, sports-related injuries, but never for surgery). I started by checking local therapists. Questions that come to mind are: Do I go with a large medical-affiliated institution or do I go with a small independently owned one? I’ve had good experiences with hospital-based ones where you are assigned to a dedicated physical therapist. With some of the smaller offices, the PT decides treatment and then leave you with a PT Aide or PT Assistant. I decided to go with a small practice after interviewing therapists and office staff. Another consideration was whether I should get a therapist who is into sports. In the end, I decided that if I needed to, I can look for a sport medicine professional or a personal trainer with rehabilitative experience.
At each visit, I asked questions. I wanted to understand the muscular-skeletal mechanics of movements as related to my injury. I want to know whether my shrunken foot will go back to normal, why we need inversion/eversion, why does eversion get restored quickly, where does the AT start and end, etc. With some terminology and knowledge, I can research, learn, and be self-aware of the muscles, tendons, and ligaments in the foot, ankle, and calf.
In addition to the therabands, foot drills, heel raises, and progression exercises which you can do on your own, my PT treatments included modalities which took about 30 minutes at each visit. (Caveat: My terminology may not be 100% accurate, but you can look them up on the Internet).
For Both Injury #1 and Injury #2
(1) Joint Mobilization – My therapist flexed and held my ankle/foot in several directions to increase ROM. She flexed my foot DF by applying a lot of pressure. I was nervous about the DF mobilization at the beginning because my therapist pulls on my ankle to increase the joint gap, and then flexes the entire foot upwards by applying a lot of pressure to the foot and ankle. I worried about whether it can cause damage. However, because of flexing, I was able to get my DF restored almost 100% within 2 weeks (measurements and comparison with my uninjured ankle). With my DF restored, I could focus on walking with better gait.
(2) Massage Therapy – Vigorous massage of the Achilles from foot, heel, ankle, Achilles, and up through the calf. Besides restoring blood circulation, this also helped with dispersing the dark discoloration around my ankle. I had no feeling in my calf when I stretched it in the early weeks, but with the circulation and nerves back, I feel the calf muscle during a stretch.
(3) Biodex – Because of Achilles/heel pain, I could not do double heel raises in the early weeks. I used a Biodex that was set up for eccentric calf exercises. The machine applies torque and I have to push with my foot which then targets the calf muscle. A Biodex machine assists in a lot of other PT isokinetic/eccentric functions, but my sole use was for the injured calf. A picture of a Biodex was posted by someone in an earlier AT Blog.
For Injury #1/Achilles Insertion to Heel
(1) Neuro-Electric Stimulation with Cold Wrap (switchover to hot wrap as treatment progressed) – The therapist attached four electrodes for two channels (Red/Black) with cross-over, 1 pair R/B to outer ankle/heel and 1 pair to inner ankle/heel. The electricity level is adjusted to your tolerance. The purpose is to stimulate the nerves and blood flow circulation in the injured area and help reduce swelling. Another reason is to address the pain and discomfort with my Achilles insertion at the heel. I had dark discolorations on both sides of my foot from the heel up the ankle to the base of my calf. This is blood that pooled there from the day of the accident. The discoloration started to disperse after a few weeks. The skin tone on my ankle is almost back to normal. This treatment also helped reduce the occurrences of swelling and stiffness. After 3 weeks, I had no more swelling and most of the stiffness was gone by 5 weeks.
(2) Cold Laser – My therapist used a hand-held flashlight-like device on my heel and calcaneus bone. Cold laser was used instead of ultrasound because of the titanium metal at my heel bone. This addressed my heel pain. After 3 weeks, my heel pain was much improved and gone on most days.
My Physical Therapist
My therapist is a bright, quick-thinking, and creative 78 year old woman (not a typo and she looks younger) and she is the owner. I was not sure about her when I met her (e.g., “I need someone who is into sports. How is she going to help me with my recovery?”). I have since learned that she has a lot of experience and in treatment of ATR. She takes the time to massage the small muscles in the foot, Achilles, and calf. Because of work schedules, I did switch appointments and see a couple of other therapists on my visits, but none of them can do DF mobilization with as much strength (Lesson: Never underestimate an individual’s strength and technique). Or provide a similar massage (it seemed the younger therapists were tentative about applying too much pressure). My therapist likes applying some older techniques which rely on massage and joint mobilization. She mentioned that in the “old days” there were no therabands, balls, or equipment that are available in PT nowadays. I was a little amazed at this.
My therapist was an ATR patient when she was younger. She was crossing a ditch being dug up for a water pipe and her foot did not make it fully across. Her foot slipped into the ditch and ended up at an extreme angle and she ended up with an ATR.
She probably doesn’t have a lot of patients like me who ask a lot of questions about the tendons, muscles, alternative exercises, and return to daily living. After a few visits, I learned to trust my therapist and her judgment. She had a lot of information to share and I was not shy about asking for help with my heel problems, exercises at the gym, future things to look out for, and post-PT self-maintenance. She made adjustments to my treatment when I told her about issues or pain. She also offered alternatives when I could not effectively perform an exercise. When I had swelling from an exercise in the early weeks, she helped me see that I am not ready for that activity yet and to try it again in another week. Because of my therapist, I am well along the way towards recovery.