Having a bad day - it had to come :-(
Visit to NHS physio this week has cast a nasty seed of doubt in my mind. She is concerned that I actually have too much dorsiflexion (she’d expect it to be tighter) and given the leg appears very weak she has questioned whether the repair is complete. Private physio this morning also felt the leg was very weak. I haven’t been religious with my exercices, but to be honest I have so little power in the bad leg there’s a limit to what I can actually do (largely I’m focussing on heel raises - which I can do when sitting, but when standing I struggle to get even a little way off the floor and the bad leg can not hold any weight in planta-flexion on its own). I feel connected and the exercises appear to work the right bits, the hope is that the repair is “long” and that I’m still very weak. If the repair isn’t complete this will be a major setback. I see the consultant on Monday so it will be interesting to hear his view - propbably slap my wrists for not still being in the boot!
The physio felt she was probably being over cautious but her comments are enough to get me worried.
How strong did you feel at just over 8 weeks? I appreciate that some wouldn’t have been out of the cast/boot at this stage!
Fingers crossed!
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Hi JG,
I’m not sure what the NHS physio means exactly by “complete.” If you can push your leg up with your calf while sitting, your tendon must be connecting your calf to your heel bone as it should. That’s exactly where I was at five weeks, nice and flexible but still quite weak.
The only bad alternative I can even imagine is if you are “cheating” and actually pulling your leg up with your hip flexor muscles, the muscles you would use to pull your foot right off the ground while sitting. If that is the case, you won’t feel added pressure on the bottom of your foot as the leg goes up.
Do you have a bathroom scale? If you still have doubts, you could put that scale under your toes to verify that you are indeed putting some weight onto your toes with your sitting calf raises.
I don’t know how reassuring I can be over the internet, but I really think you’re fine, and you just fell outside the “normal experience” of the physios you are seeing. As I said, what you’re describing is exactly how it was for me at five weeks.
Hang in there,
Doug
Thanks for the comments Doug. I don’t think I’m “cheating” as you describe, if I lift the heel on the bad leg whilst sitting I can feel it in the calf and heel. So that sounds promising! I have scales at home and have tried the “how much pressure with my bad leg test” at this stage I can manage about 55lbs pushing down with my toes and I’ve noticed this has improved over the last week or so. I’ll try the sitting calf raise with the scales in place and report back.
What’s worrying to me following the physio comments is the complete lack of strength in the bad leg and so the questions and doubts start to creep in so it is interesting to hear your comparable experiences.
Thanks again,
JG
Gotta go to work, so I’ll be brief. If you’re pushing down with 55 pounds, you’re fine. You don’t have a “lack of strength,” you’ve proven that you have 55 pounds of strength, and you will soon have more.
Doug
Hi jg,
At around 8 weeks, my ATR leg felt weak. When asked by physio to stand on one leg on my bad foot - i could only manage a few seconds at a time. I can now (9 weeks post-op and with practice) manage upto 45 seconds. At 8 weeks post-op I could not do (was not asked to by physio) any heal raises. Now (9 weeks post-op) I can do 2 foot-heal raises (although - I probably favour more weight on my good leg when I do 2-foot heal raises). A tip when doing 2-footed heal (calf) raises is to make sure that your belly-button is central and does not sway towards your good leg-side when doing the raises. I was also told to take approx. 3 seconds on way up and 3 seconds on way down whilst doing the calf raises and to use support if necessary. At the moment, I find it difficult to do 10 x what I describe as good 2-footed heel (calf) raises - but I do find that things get easier with time & practice.
At this stage I can not do one-foot heal raise on bad leg - it’s too weak.
Hi Guys,
Just a question for you re-habbing folks. When you say that you are “weak”, what is the limiting factor? Are you pushing as hard as you can with your weak muscle, or is it pain in the tendon which limits your strength?
PeterH, in answer to your question about weakness, my answer would be YES. Yes to both parts. Remember your muscle(s) are weak or unable to do the work being asked of them no matter the effort. There is also pain weakness due to tendon stiffness, soreness, fear of reinjury. Pain helps us guage if we are going to hard or too soon. So my answer would be yes. I can always tell when I’m pushing myself and try to vary my routine of excercise as well to not overwork or underwork any one area. Hope this helps.
JIM
peterh,
I can only speak for myself, but my answer to your question was different at different times. Up to eight weeks postop, (when I could first hold my weight up on my bad calf), I tended to chicken out before giving my all. My tendon didn’t hurt, I just didn’t feel confident yet going all the way on effort. (As hard as I’ve pushed my rehab, I’m nervous about rerupture, too.) Since then, though, I’ve pushed as hard as I can and as long as I can.
Maybe what you are getting at is a fundamental question, is your calf ever strong enough to pull the tendon in half all by itself? I don’t know the answer to that.
Doug
Interesting. I’m at 5 weeks right now, and can push with 60lbs before I feel slight pain in my tendon. I could definitely push harder if I wanted. I guess my calf will keep getting weaker and my tendon will keep getting stronger until my calf is the limiting factor. I’m not supposed to be doing any rehab at all (according to my surgeon). How early did everyone else start calf strengthening?
This issue of the strength of the tendon versus the strength of the calf was much on my mind early in my rehab. Wouldn’t it be nice if our tendons had little meters that told us how much force they could handle without damage, so we could exercise to near that point but not go past it? Of course, they don’t, so we are left with guessing. The uncertainty is unnerving, because rerupture is a steep price to pay for overestimating.
Going by what I’ve seen in this blog community, the common approach is to do nothing for weeks, while the tendon gets stronger. This strikes me as excessively cautious. The tendon has some strength, maybe not much but some, soon after surgery, so why not take advantage of that and do at least some calf strengthening to lessen the eventual atrophy? My surgeon is somewhat aggressive, and said I could stretch my tendon, using my own leg muscles (tibialis anterior) only, starting at five days postop. I used that as my safe limit, and slowly worked up to calf strengthening with that amount of force, (pushing against my other leg’s tibialis anterior, by pushing against the top of my other foot), as I detailed in my long blog post on 4/29. It wasn’t until five weeks postop that I started exceeding that limit, figuring that the tendon must be considerably stronger by then. I’m sure some people think I was taking great risks, but I really think I was being quite cautious. If I had to do this over again, I think I would get to that point of pushing against the other foot’s full strength sooner than four weeks postop. My calf workouts were very tame by normal calf standards, but they were enough to prevent the withered calf that so many in this blog community have described.
I don’t remember where, but I remember reading somewhere that someone had been told by a health professional (of some sort) that for every week of inactivity, it takes a month to recover. I have no idea if that’s true, but severe atrophy surely adds a lot to the recovery time, and limiting that atrophy seems worthwhile. But exactly how hard and how quickly can we safely push it? I surely don’t know the answer, but I do know the answer is more than the weeks of complete calf inactivity many doctors insist on.
Doug53: I have had it both ways. My first surgery was done with an extended immobilization period. My second and third were done with (different doctor from the first) immediate motion and rehab. Trying to recover from the first surgery was torture compared to the others. I can only support your theory. My second and third surgeries, I was required to pull my leg out of the boot with in 24 hours post-op (never casted) and start rotating my ankle, bloody bandages and all. My recovery was MUCH quicker and MUCH less painful. My third surgery which was done on a different leg than my other two surgeries, the doctor had to take the lower 2 inches of my tendon sheath completely out. This made it mandatory that I kept my leg in motion because scar tissue could attach and ruin all my mobility. On all 3 surgeries my Achilles was either blown apart or cut apart (to make longer) so I was still dealing with healing the tendon (among other things). Because of the job I use to have, I was able to talk with a well known sports orthopedist who works on a lot of professional athletes. He happens to also be in the ATR club. He told me that he feels that immobilization and non-use for a long period is almost death for tendons and ligaments. He was up and back doing surgeries within a week of his ATR surgery. I wonder if ATR surgery is starting to change like they have changed ACL surgery. Twenty-five years ago my husband sat in a full leg cast for 8 weeks after his ACL/MCL surgery. Now they have people on those motion machines before they even wake up from surgery.
-Smish
Hi Smish,
That’s interesting, as my surgeon is a knee specialist. I wonder if his experience with knee ligament rehab influenced his approach with ATRs.
Your experience with your different surgeries does reinforce my belief that many ATR victims are being unnecessarily tormented with weeks of immobilization.
But doctors, like the rest of us, are often creatures of habit, and change comes slowly. I hope that change is coming.