Re-Rupture….have UWO protocol questions
Hi all. Came across this site and have enjoyed reading everyone’s trials with an ATR. The info I found so far has been valuable. A little background - intial rupture playing in a competitive basketball league, subsequent surgery and was almost 13 weeks post-op and doing well until phys therapist added light plyometrics (part of their protocol) and complete re-rupture occurred. It’s been a rough ride (moslty mentally/emotionally) since. Went to a specialist this round and opted for another surgery. FHL transplant was used for extra re-inforcement - haven’t read anywhere that it is the magic bullet, if anyone has had this done would like an account of the pros/cons experienced.
Right now I in the 2 week period waiting for the 1st follow up appt. which is in 3 days.
So this go around I going to be much more pro-active in the rehab protocol. I have become very focused on everything that was done intially and trying to eval if it was right/wrong and whether to repeat. Another re-rupture is not an option. Initial rehab was NWB for 6 weeks then more or less going right to aggressive ROM, 2-shoes, and strenghting/resistance. After reviewing multiple protocols found through this site, this protocol was crazy.
The logical approach of the UWO makes sense, but the devils in the details as I’m learning with this injury. So questions:
In the 2-4 week period:
PWB - what body wt% is typ?
Any advice on swelling treatment? First time used elevation/ice/compression socks….never did use heat. Was that a mistake?
What type of incision mobilization is done? Seems like it would need to be very gentle to not disturb repair and this stage. I had adhesion issues the first time, so interested in what others have done.
In the 6-8 week period:
Details of the graduated resistance exercises (mainly therabands?).
Other than the resistance exercises above, no other strengthening done?
Gait retraining with the boot on? Proprioceptive with boot on?
Fitness/cardio to include WBAT - with boot on?
Does treadmill walking not begin until fully out of the boot?
Sorry, this post wasn’t well organized (my boys provide quite the distraction!).
Thanks,
Jeremy
August 21st, 2011 at 2:54 pm
Good luck, Jeremy. I like your approach (this time), FWIW. Some subjective answers from a UWO fan non-pro patient:
“In the 2-4 week period: PWB - what body wt% is typ?”
Some people give % numbers, but then patients can’t figure out what they mean and get more confused than without numbers. I think that period is kind of “Gentle and progressive partial (or “protected”) WB on crutches”. The %, for me, started at “virtually 0″ (just resting the boot on the floor as I crutch-walked over it) and progressed seamlessly through the 4-wk milestone into “FWB As Tolerated”.
One day, you realize you can stand balanced on both feet (=50%), and on one later day, you realize you can stand on your boot, or walk on it without crutches or cane (=100%). Everything in-between is in-between, and I’m not convinced it’s usually helpful to dictate the speed. Most people have no AT problems with WB; the problems are mostly from sole and (esp.) heel tenderness, which can usually be resolved with foam or gel footbeds, etc.
The only late-boot-period strength training I did — besides walking FWB, faster and faster — involved therabands and a towel or strap (against hand-held resistance). And at ~7 weeks this time (non-op), I dug out my old hinged boot, and set it to hinge from neutral down (and walked even faster!). That’s NOT part of the UWO protocol, but AirCast sponsored the study (and God bless them for doing so!) and they don’t make a hinged boot, so maybe. . . (I only got into trouble when I briefly switched from fast walking to BACKWARDS fast walking, which is/was an inappropriate and much more strenuous test for a healing AT. I stopped immediately and was fine, apart from my life flashing past my eyes!)
And Yes, the exercises pre-week 8 are with boot on, AFAIK.
Last Q: I don’t see why treadmill walking couldn’t start very soon after normal FWB walking, as long as the pitch (level or close?) and pace and duration were appropriate.
August 21st, 2011 at 3:31 pm
Hi Norm - thanks for the guidance, makes sense.
I was hoping you would respond as your other posts sound as if you are the UWO champ and resident expert!
So I go into the boot next week and am trying to plan whether to sleep in it or switch to the splint for comfort. The boot will have heel lifts and the splint is angled toe down (approx 20 deg) - so should it matter?