Posted by: johnsfbay | June 9, 2012

Grinding it out at 19 weeks

Hi all,

Hard to believe that it’s been 19 weeks since ATR surgery, and I just had only my 3rd (of 4) PT sessions that were provided by my medical insurance :( No massage, cool machines, or even weekly PT sessions - just thirty minutes every 2 weeks to show me how to do several rehab exercises on my own at home!  I guess the only bright side is that it hasn’t cost me much money out of pocket.

The hardest part of my rehab is getting myself to do these exercises every day at home - it is a real grind - and certainly not as fun as going to the gym or doing aqua aerobics!  I know the rehab exercises are critical to getting back to full strength, though, so keep pushing myself to try to do at least one set a day.

In my latest PT session, I was happy to find out that my ROM is back to normal in all directions - Woo Hoo!

Then came my first attempt at single leg calf raises - yikes!

Single leg calf raises are the scariest part of my rehab program now.

My therapist had me try a series (see below), and it made my achilles sore for two days. Now I’m nervous to try them again, so I think I’m going to just go slow and concentrate on the easiest of the calf raise series until my tendon seems ready to move onto the next. Maybe I’m being too cautious - not sure…

I’ve really appreciated  others on this site sharing their PT exercises (thanks starshep, ryan, et al), so in that spirit wanted to provide my latest “homework assignments”:

Bosu balance drill - Double and single leg balancing, progressing to include a ball toss/catch against a wall

Calf raise series:
=> first 2-footed (up with both feet, shift weight, lower on bad leg),
=> second up/down with bad leg with my good foot constantly on my toes,
=> third up/down with bad leg with my good foot constantly on my toes up on a step,
=> last up/down with only the bad leg, my good foot off the ground.

Star exercise - Standing on single leg, place and pickup cones (or plastic cups) in various positions to your left/right/front,

Ladder Step drill - kind of like a football drill where you alternate stepping on the outside of a “ladder”, then stepping into the middle of the “ladder” for about 10 feet (not using a real ladder of course but tape in that shape on the floor),

Side Step drill - shuffle sideways with both feet then touch the ground with your hand at the end of each right/left/forward/backward direction (similar to a soccer drill I used to do pre-ATR),

Box Jump drill (two footed progressing to single leg) - hop into each quadrant of a 4-square box in clockwise, counter-clockwise, and diagonal directions with increasing speed.

My therapist said that once I can do the box jump drill without pain, then I’m ready to start running again.

Given how tough all of these drills are for me, I’m definitely not planning to run any time soon!

To those of you in the early stages of your recovery - take heart - it won’t be too long before life does get back to near normal.

I wish a safe recovery and fast healing to all of you!!

Responses

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.

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