8 months: Running’s a pain in the rear

February 25th, 2014

<img src=”"Not being a competitive athlete like some of you impressive people here, my "good-enough" goal for these middle months has been to resume normal activity (2-mile walks with some hills 4-5x/week; spin bike; walking up the 6 flights of stairs to my office at least once a day). It was encouraging how smoothly this all came back between months 5 and 7, with the soreness gradually going away (though I can still feel those stairs by the time I’m near the top). Flexion is normal in every direction, the healed tendon is no longer bumpy and lumpy, and I can do a few sets of 4-5 single-heel raises. Hoorah!

Come the new year, I decided it was time to start giving this process some more active head space again. So I started tracking what I was doing a little more carefully (hate counting reps!), and dusted off my kids’ old Wii Fit Plus with the balance board–don’t laugh–it’s actually been very helpful in giving a more precise picture of how, exactly, my strength and balance on the healing leg match up to the other. So Mama now spends time most evenings with her virtual Wii trainer, who’s too dumb to know he’s dealing with an ATR recovery case. He first compliments me on my excellent balance on the right leg, then says "Your leg is a little shaky!" in the same tsk-tsky digital voice every time my balance tracks out of the circle in, say, a one-legged pendulum exercise. I’ve come to kinda like the guy despite his limited vocabulary and one-track mind (plus, I’m already married).

And then I tried picking up the pace from brisk walk to a slow jog–first for a few yards, then 50, then 100. I’ve been alternating these little jogging bursts with walking, thinking that gradual is the way to go. I feel it only mildly in my calves. But what I feel much more strongly is a strain in the back of my upper thigh and, literally, in the rear. At first I ignored it, but after three weeks of trying to take it slow and stop when it hurts, the low-grade pain here is persisting. (But my tendon and calf feel fine!) A little google searching suggests maybe high hamstring tendonitis. Has anyone else experienced this when returning to running–or have any other advice?

Week 16: The mid-marathon doldrums

October 14th, 2013

Hello everyone–I’ve lurked a few times but haven’t posted since I went back to work with a vengeance (as opposed to part-time at home).

The first, happy thing to report is that I met one of the goals I’d set at the outset of this process, which was to make the 22-hour transatlantic trip to Germany for a conference, and do some sightseeing in Berlin–this was at my 12-week mark, so it seemed a little iffy. The flight was fine (go, compression socks!); I will report that those twist-and-shake instant ice packs don’t work after having been in a pressurized cabin. Luckily, my scanty German extends to the word “Eis,” which also means ice cream but did make sense in context. Once there I walked a ton, out of both desire and necessity (a comical evening spent wandering across the endless expanse of the Alexanderplatz looking for an ATM machine that would accept my card), and suffered no ill effects even after a 5-mile day.

I’m back to my 2-mile woods walk with my dog (who does notice I’m slower than I used to be), and that’s a total joy. I’ve used up my 10 PT appointments, though when I’m ready to start training to run again (surgeon said wait till SIX TO TEN months!), they’ll re-authorize for that. I’m wondering what “pre-running” PT would be, if not “just keep walking faster until you find you’re running”?

Without the PT to be accountable to, however, I have not been so good keeping up with the regular exercises, much less actually counting them. I know I should be; I’m just admitting my fallibility and general difficulty in keeping up with a very busy life, now back to “normal” but not really normal. Everyone assumes this is the case–”hey, look at you walking without a limp!”–and I act as if it were, but the truth is I feel it constantly: the little twinge, the big twinge, the dull ache, the tightness temporarily relieved by ankle circles. I think I’m going to be doing ankle circles in the grave, it’s such a reflex.

What I do manage: lots of walking, stairs whenever possible, and some (not enough) time on the stationary bike. Calf raises/stretches when I’m at the computer. Whenever possible I stand for as long as I can balancing on The Sad Leg (my physical therapist said not to call it “the bad leg”). I can’t come close to a solo raise. On the whole, though, attitude of gratitude.

Your stories help push me to try to do better. I’m sure that if I were working at it more systematically and with more vigor I’d be further along. But the same could also be said of my parenting, my career, my caretaking of my own parents and spouse, and all the other things that divide my attention. There’s a concept in psychology called the Good-Enough-Mother. Maybe there’s a Good-Enough-Achilles-Recovery.

Week 9.5: Learning to fly

August 27th, 2013

Nothing earth-shaking here, just some observations on my first week of FWB. As others have reported, I’ve found that once things start to click, they really move fast! Every day I feel less dependent on the cane, and I mostly get around the house in shoes without it. Here’s a full frontal selfie of my calves–kind of a weird perspective shot. At least I can feel a little muscle movement on the left now when I flex my foot, even if it’s not visible to the world yet:
<img src=”calves
I even ventured out into the world bootless this morning, hoping to impress my physical therapist. Instead she corrected my gait and posture, forcefully and repeatedly! I guess those years of slouching have taken their toll after all. I can’t do a step up yet. I did a few heel raises underwater over the weekend, but it hurt a bit, so I laid off. Haven’t tried that one in actual air yet.

As promised, I went to the local running store and had an actual fitting for good solid trainers. They’re half a size larger than what I always thought was my proper size, FWIW. I also tapped Zappos for a pair of Fit Flops with a back strap around the ankle, as recommended by kellygirl, and I like those too.

Limpers can’t be choosers with shoes. The Asics are mint green and fuchsia–not my favorite colors. The FFs are flamingo reddish-pink–that’s all that was left in my size after summer. (This is maybe my payback for rejecting frilly pink dresses as a girl…)

Others have described having very sensitive feet in the early walking days. I always interpreted that to mean something like “ticklish,” but now I think I get it: every surface my foot touches feels harder than it normally would–as if I’d been hiking in the same boots for several hours, rather than shuffling back and forth to the kitchen. It’s very “Princess and the Pea.”

Final observation: I haven’t been so exhausted at the end of a day since the first weeks after the surgery. It hardly seems like what I’ve done all day merits being so tired, but I am.

Death to old running shoes!

August 23rd, 2013

Just returned from my first physical therapy visit after moving to FWB last Monday. In addition to all the new tasks (balance board, step-ups, and the least dignified move in the world: walking with a band tied between the ankles to keep the hips wide), my trusted therapist played detective with my shoes. I’ve been wearing my ’second-string’ running shoes around the house, with an extra half-wedge under the heel. Actually, the right shoe of this old favorite pair has been my mainstay for many weeks now.

Bad idea.

Examining my shoes, she demonstrated to me how the apparently generous cushioning of the sole was worn out. Worse, because I habitually underpronate, the outside, back parts of the shoe were the squishiest, offering almost no support to the ankle and–hello!–to the Achilles. Then she compared the left and right shoe and pointed out that the left was even more worn in this way than the right. Because I’ve been wearing the right shoe longer, it should look better, correct? But no. The left shoe was demonstrably more beaten down. Meaning that for some time now, I’ve been pushing off harder on the left leg, in a way that stressed the Achilles tendon.

Which also means that if I had taken the trouble to have my stride properly analyzed, and to buy the right running shoes instead of whatever was on sale and fit me (true confession time), jamming my toe in a rabbit hole wouldn’t necessarily have been The End.

I took out the “better” pair of shoes I’d been wearing during the accident. Equally bad. Throwing them both away. I know charities send running shoes to developing companies, but I don’t want to be responsible for someone else’s tendinitis (or worse!).

Another silver lining to count now is that I’m determined to come out of this experience with better, more mindful, stronger physical alignment all around. I’m turning 49 in a week, and I want this body to last another 49!

Flipping the status bar

August 20th, 2013

strikeoutsJust changed my status on the widget to FWB! Those of you baseball fans will get the visual analogy above.

Experimenting with different dance steps: The one-crutch. The cane. The minor assist from a hand on my 8-year-old’s shoulder. It all feels good. It feels great, in fact! If I could, I’d jump for joy.

Bad girl or informed patient?

August 14th, 2013

Forgive me, Doctor, for I have sinned: I took out a wedge out of my Bledsoe today without permission.* You put me in a boot with 2 wedges at the 4-week mark, told me to start PWB at 6 weeks, and waved me away until the 8-week checkup (that’ll be next Monday). It just occurred to me today that after 10 days of increasingly confidentĀ  shifting of my weight to the legs, and off the arms–as well as visible progress with my flexion–I might as well try it with one less wedge.

So I did. And it was fine.

Reading about other people’s experiences on the Achilles Blog emboldened me to push forward just a teeny bit faster. No, I’m not going to mess up your beautiful knife job (though I compliment you on the way you tailed the bottom of the incision away to the side, so the scar won’t hit right on the back of my ankle). No, I won’t take medical advice from the internet. Yes, "abundance of caution" will continue to be my watchwords.

I will also listen to my body. Sorry, not very Catholic of me.


*(You were on vacation anyway.)

Weeks 6-7: PT & a non-adjustable bike

August 11th, 2013

I work with young people in their early 20s. For them, the burning question underlying all the feelings they can’t articulate is: "Am I special?" For us (mostly more, ahem, mature) folks in the throes of ATR, the question seems to be just the opposite: "Am I normal?"

But since there are so many treatment protocols, it’s very hard to know what "normal" might be. I’ve gathered, from looking around at the variety of experiences that all of you have described on this site, that the protocol I’ve been given is on the conservative side of the spectrum. I was NWB for 6 full weeks post-op (the last 2 of these in the Bledsoe boot), and am to remain 30-50% PWB until my 8-week check-up. I’m so ready to ditch these #(*$@ crutches and scooter! If I could do it again, I’d almost say that the big fight isn’t between surgical vs. non-surgical, but between a treatment plan either way that starts you on early PWB/WBAT rather than consigning you to these long, long weeks on crutches…maybe it hurts more that way (my pain has been minimal), but criminy, this feels like forever.

On the bright side: my surgical group/insurance providers have been pretty generous with the physical therapy authorizations twice a week. Looking around at other blogs, it seems that others haven’t been given quite as much, and that’s a shame; both of the PTs I’ve been working with have been really helpful and encouraging. This is what they’ve done with me so far:

  • 4 weeks (while NWB): ROM ball exercises, toe stretches, picking up towel
  • 5 weeks: add yellow theraband 4-way stretches (anterior, eversion, calf forward, inversion)
  • 6 weeks (at PWB): add seated adductor squeeze, seated straight leg raise, clams
  • 7 weeks: add hip extensions on stomach, straight-leg raises, hip adduction and abduction (working now on building hip/thigh strength)

On the last visit they hooked up a biofeedback machine to test the strength of the vastus medialis (if I remember right!), which is part of the quad muscle group. Where "100" is the value for a moderately athletic person (and the value on my good leg), I got a 10-20. Yikes! Of course I look at the shrunken chicken leg and understand that it’s atrophied, but I hadn’t grasped what shape the rest of the leg is in as well.

I’ve only now gotten the OK to do the stationary bike as well. We have a 12-year-old Nordic Track bike that I’ve used pretty consistently 1-2x/week as an alternative to running (my usual regular exercise, in addition to the 6 flights of stairs to my office which I always try to do!). I discovered that the resistance no longer adjusts properly (there’s a button); it stays at the medium resistance level I’m accustomed to using it at. I checked the owner’s manual and did a Google search about this model–some shade-tree mechanics suggest taking off the cover and trying to free up the big magnets that control the resistance and are probably stuck–but honestly, I don’t think my mechanical skills are up to this; I’d take it apart and not be able to get it back together.

Well, I got on anyway (in the boot, of course) and lasted for all of 3 minutes. I felt a little twinge in the bad leg and stopped. I was careful to push off with my good leg, to pedal downward with the ball of my bad foot, and avoid putting any stress on the heel, but I was worried. So what do you think–is it OK to use a bike that isn’t actually "spinning," that can’t be set to zero resistance?

Travel tips post-ATR

August 5th, 2013  Tagged , , ,

I’ve noticed a lot of helpful tips about traveling post-ATR that are appearing down in people’s comments pages (now that there’s only a month left of summer, especially!) I thought it would make it easier for future readers to have a separate entry with keywords.

At 3-4 weeks post-op, while NWB in cast, I did a 660-mile drive (as a passenger), toured there with kids and a dog, and then flew back as the solo parent. Since my ATR is in the left leg and I have an automatic car, I’ve been driving pretty comfortably since the beginning, with splint. Although I’m now PWB 30% and 5 days into PT with the lightest theraband and ball–still on crutches, and shoes seem very far off–I’m optimistically planning to stick with plans to attend a conference in Germany in mid-September, at my 12-week mark. Crossing fingers!

Please add your favorite travel tricks and tips in the comments.

-When driving, I use a rectangular travel pillow that’s been slightly deflated to rest my left (ATR) leg on. It’s about 9×12, much easier to fit into car than a cloth pillow.

-In general, inflatable travel pillows are incredibly handy, because if you don’t have a helper handy you can deflate it and tuck it in your bag to carry. Get a bunch of sizes-my local discount store carried them.

-Driving as passenger: I was surprised that I didn’t need to recline the seat way back on the long drive. Setting the casted leg up on the dashboard was surprisingly OK.

-Padded cycling gloves make crutching for any length of time so much easier on your hands (especially before they’ve developed crutch callus).

-I also dug out my roomy fanny pack from the days when I was a bike commuter (pre-kids). The very words “fanny pack” conjure hilarity, but they’re easy to access with one hand and the weight is properly distributed.

-Lodging: so glad I asked ahead for handicapped room on the first floor. It makes such a difference to have a pull-up handle by the toilet, not to mention a detachable shower wand and folding seat in tub/shower combo.

-I wish I had thought to ask the surgeon to sign off my Dept. of Motor Vehicles form to get a handicapped parking pass *before* surgery. I lost precious time and still haven’t seen that thing in the mail!

-Restaurants: take aisle seats or booths, request an extra chair for leg, avoid little cafes where because of regulations they can’t add that extra chair for you.

-Airport: I decided to skip the wheelchair treatment (which they were happy to give me), and went through x-ray by hopping with a cane. Cast was chemically scanned (! gotta love TSA paranoia). Was supposed to gate-check the crutches after sitting down, but the flight attendant surprisingly fit them into the overhead. The last person to board the plane had a hissy fit–”Oh, please, CRUTCHES? Will someone get these out of here so I can get my bag in?” I hope she gets a big karmic payback for that one.

New cast and a step forward!

July 4th, 2013

Got my new, apple-green cast today. The wound looked great–no swelling and no sign of infection. I waved hello to the poor, flabby calf before it went back into hiding.

I have to give my surgeon props here: not only did he come in on the Fourth of July holiday to compensate for the office being so busy, but he was the only person in the office aside from the receptionist. Without the PA there, he did the bandaging myself and then spent a ton of time with me answering questions about fixed vs. hinged boots and about our future protocol. Our consultations had been so brief before. I heard a little more about his background in sports medicine–it turns out he actually started as a physical therapist (and made some helpful adjustments to my crutches and crutching style).

I asked about Vaco vs Bledsoe. He said that he was the first in his practice to try the vacuum boots and did so while his partners were still using the other kind. After a couple of years, they reconnoitered and felt that it didn’t make any difference in recovery time. There may be some difference in patient comfort, which is an individual thing. FWIW.

He also said my injury/recovery was very "best-case scenario" for a full rupture so far, so that made me feel good. And the cast went on at much closer to a 90-degree angle than the brace had been–he worked with me to find a comfortable but "ambitious" point–so I feel like I’m moving ahead! Now for the 600-mile drive!

Differences between boot types?

July 1st, 2013

Hoping for some good advice from you longer-term veterans out there. What are the pros and cons of different boot styles? I haven’t moved from splint to cast yet, and my ortho’s office has only spoken in general terms about what’s ahead. They probably have a standard boot protocol that they follow, but I want to go in well informed if there are better options. What’s the difference between the Bledsoe and the Vaco? Is there one I should push for? Thanks in advance!