John’s AchillesBlog

I know how you feel I am 19 weeks too. Just starting to do the calf raises with two feet. Very scary, I can do it, but not for very long. I wonder sometimes if fear is holding me back.

Hey kb60. I wonder the same thing - I’m seeing my surgeon tomorrow and am going to ask him what risks there are at this point to re-injuring the achilles doing these calf raises.

John,
I’m almost at 16 weeks and my therapist has me doing calf raises on a machine. At this point I am doing the single leg calf raise equivalent of 50 lbs, 25 reps and 3 sets. In your case, it sounds like your therapist wants you to put your full weight on a single calf raise. That might be pushing it too hard. According to my therapist, it’s alright to feel the burn in my muscles but not any pain in the tendon. A simple alternative to doing calf raises with less than your body weight is to sit on a chair and balance a dumbbell on your leg near your knee. You can use this method to start off with a very light weight and work your way up.

I’d be especially concerned about the box jump drill. Several people on this site initially ruptured their AT using that exercise.

Starship, what week did you start light calf raises?

Kimjax,
I started the calf raises at about week 10 with very little weight applied to it.

Talked to the surgeon today, and he agreed that the go slow and steady approach for my rehab is advisable. He said that up to 1 year after our ATR injuries, the tendon is still “remodeling” itself and even small re-injuries may cause the collagen rebuilding to be impacted negatively - he described the optimal “remodel” to be equivalent to a cord. So if it hurts a lot during rehab, take a few days off.

Wow, johnsfbay, that it is interesting that it takes up to 1 year for the Achilles to completely “remodel” after an ATR! I wonder how that was determined? Either way, sounds like good advice to take time off from rehab if you feel any pain at all in the Achilles.

BTW, thanks for the interesting info regarding the heel raises! I am also very nervous about trying a single heel raise as I recall the story on this blog of a guy who, at 6.5 weeks post-op, was told by his doctor to do a single heel raise…and it re-ruptured!! I do plan to try a single heel raise within the next week (at 11-12 weeks post-op) and will let you know how it goes….

Sounds like most people on this blog are not trying any single legged heel raises until around at least 15 weeks post-op?

Hi Brian,

Definitely let us know how your rehab progress goes -start slow though on the heel raises.

I’m pretty sure that was Norm’s post, and those way too early heel raises set him back 1 month in his rehab - I remember his post as well.

It would be interesting to see at what point in our recoveries that most therapists introduce heel raises.

My achilles is not ready for single leg heel raises with full body weight, so I’m going to ask my gym trainer to work with me today doing heel raises on the leg press machine, where I can control the weight, as starshep suggests.

Good luck with your rehab!

John

I remember that story that Brian remembers, too, and it wasn’t mine. Brian’s recollection of it is similar to mine, too.

I did have a re-injury during rehab for my first (”op”) ATR, back in spring of 2002. Slow post-op rehab, 3 casts then a hinged boot. Around maybe week 22-ish, still mostly wearing the hinged boot, I discovered that I could walk normally in bare feet. YAY! I had a PT appointment that afternoon. The PTist paraded me up and down the U. of Toronto Sports Medicine Clinic in my bare feet, showing me off to everybody. Then we settled down to work. Toward the end, she told me to do some 1-leg heel raises. I told her I wasn’t ready, because no way could I do 8 (or more) “reps” yet. She said “Just do as many as you can.”

During your rehab, if anybody EVER tells you to do as many of ANY calf exercise as you can, I say run — OK, walk — for the door and don’t go back. Dumb, dumb, dumb! I was dumb, too, because I DID do as many as I could (maybe 3 or 4). No pain at the time, but quite soon afterwards, the back of my heel, where the AT attaches to the “calcaneus” heel bone, it started hurting like the devil. And it kept hurting for a MONTH, while I stayed in the hinged boot until the pain completely went away.

I don’t think it caused any lasting damage, other than setting back my rehab a month and scaring the $%^& out of me — but who knows? ANd who knows how close I was to doing worse?

Instead of doing as many whatevers as you can, do a few more than you did the last time, assuming you felt fine after the last time. Progressive, even aggressive, but also incremental.

If you click on “Rerupturing your Achilles” link on the left side of the achillesblog home page, you will see a list of personal blogs on the new page. Read the personal blog of “Jacobp” who re-ruptured when his PTist asked him to do a single legged heel raise. There is also a “gary hibbert” on the rerupture page who went non-op and reruptured while doing a single legged heel raise at 6 *months* post-treatment.

Yesterday, my PTist had my do standing 2-legged heel raises in between the “dorsiflexion board stretches” (not sure what it is officially called). They also had me to do them on the leg press machine. Recall the plantarflexion on my bad foot is still 8 degrees less than my good foot and I can notice some (ankle?) resistance during the heel raises and calf presses when I get on my tip toes. I am determined to get the plantarflexion equal within the next week so that I can maximize benefit from the calf strengthening exercises. Up to this point, I primarily only worked on the dorsi and lateral ROM exercises(both feet are the same now), not the plantar. I expect the plantarflexion will come back quickly now that I am working on it daily.

I’d expect that too, Brian. There shouldn’t be much there that would limit your DF ROM long-term.

Thanks Brian, I will read those re-rupture blogs you mentioned. I had no idea you could re-rupture the same achilles 6 months after surgery doing single leg heel raises!!

John- people have ruptured at 6 months; but it’s pretty uncommon. My suspicion is that those late re-ruptures are due to a poor re-attachment (surgical or non-surgical). Under normal circumstances, the tenon itself is fairly strong at 6 months, especially compared to the wimpy, atrophied calf now attached to it.

I tried to be careful until 12 weeks. Weeks 12-16 were spent figuring out what strength exercises I could do; carefully testing and practicing. Starting at 16 weeks, I started hitting it pretty hard; doing my best to overcome/ignore fear and a lack of confidence.

It’s good to be careful… but too careful will yield a sub-optimal result. It’s a balance. At some point, you’ve just got to have faith in the science/data; and trust that your tendon is strong.