kiwiclaire’s AchillesBlog

New Zealand weblog

Rehab exercise for a non gym “bunnie”!

I hate gyms!! To keep fit I have a 9.5 km loop with some big hills that I walk twice a week; I swim once a week (should be twice!) and I horse trek, usually on steep terrain so there is a lot of shifting your weight to help the horse and often walking down hills to give them a rest. I hoped to do my rehab without going to a gym.

I am a neuro physio and this background meant I have a slightly different approach as I have always thought the feel of how we move is equally as important as just getting the muslces working and strong; you need to practise the movement you want to improve because then you also train the sensory feeback loops needed for coordiantion of movement and balance. For example there is no point having a strong calf muscle if it doesn’t contract and push at the right time during walking, or can’t quickly react if you go off balance. However at week 12 I got some really good advice from two sports physios, so I guess I don’t know it all!!

So here goes - and sorry there may be a bit of overlap from my Rehab protocol page.

At 10 days with my protocol I came out of the cast and into a boot which I took off every hour or so and did movement below 90 degrees with the foot hanging so that there was no active plantoflexion (see Twaddle protocol). This meant that I had no ankle stiffness when the foot was below 90 degrees.

At 6 weeks the boot was flat and I was allowed to fully weightbear. At the 6 week check my orthopaedic surgeon asked me to actively dorsiflex when lying on my front but nothing happened!! Although he didn’t say, I think nothing happened when he did the squeeze (Thompson) test either. I panicked a bit - maybe the tendon hadn’t healed, but hoped that it was just that I hadn’t contracted the muscle for 6 weeks so had forgotten how. I practised on my front, with my feet over the end of the bed or the couch, doing both feet to get the crossover from the good leg - it took about 4 days for there to be a convincing movement of the foot when I contracted the muscle.

I kept going with this and also in sitting with my foot flat on the floor trying to lift my heel up; over the weeks I worked on this, gradually leaning forward to put more weight on it and eventually lifting it with the good leg crossed over on it i.e. lifing the weight of both legs.

At 7 weeks I stood in my two shoes (which had a 2 cm heel wedge) just practising weight shift between the two feet and some standing on the left leg - all holding on.

At 8 weeks I was walking in my shoes; over the next 3 weeks I built up my walking on the flat, first using my crutches recipricolly and then onto trekking poles - (see other page). I was doing 30-35 minutes twice a day. I worked hard at not limping, so if my calf muscle couldn’t push off my whole weight then I used the crutches or the poles to give the push to help keep an even rhythm. A physio friend at the Australian Institute of Sport told me that the hardest thing in this rehab is to get a co-ordinated push off back into your walking - I always kept thinking about that.

I also worked hard towards trying to get a single leg raise; the Twaddle protocol says you can’t start stretching until you can. I continued working on balancing on one leg.

At 11 weeks I felt I’d reached a plateau; the range of dorsiflexion was still very tight so I started doing some static stretches (still couldnt do a single leg lift but orthopeadic guy agreed with me that I could go for it). I weaned myself off the heel raises.

Static stretches were doing no good and after reading a few gym “bunny” posts I decided I needed to see a “real” physio. He made me do the heels over the edge of the step which I had been too nervous to do, I’d been using a wedge instead; he said forget the stretches and just concentrate on eccentric contractions i.e. slowly lowering yourself down over the edge of the step so that the muscle is working as it is lengthening. Building up to 3 sets of 15, 3 x a day and gradually taking more weight onto the left leg from the good one (this is what I don’t like in that you can’t be specific about the weight you are taking). I have to admit I wasn’t that good at sticking to this, just did when I remembered.

Swimming - I had always thought that I would swim from early on , especially having seen the Youtube video of someone swimming in their vacocast, but in the end I didn’t until 11.5 weeks, mainly because of the fear of slipping, and even then I was pretty careful. As well as my usual swimming routine I started doing some single leg raises with water up to my chest, I could not do it with water at waist height then. I gradually increased and at 13 weeks was hopping in water at chest height 20 times at a go. I also worked hard at getting the pushoff when walking in the pool and did activities like walking forwards, backwards and sideways on my toes.

By 13 weeks I was walking on flat rough ground in my hiking boots as well as all the exercises and adding in some backwards walking on the flat in my trainers.

At 15 weeks things progressed steadily; pool twice a week with lots of hopping (water at chest height), single leg raise (water at hip height), walking forwards and backwards concentrating on lifting and pushing using the achilles. Started to walk my old circuit using the trekking poles but still only doing the short hills and gradually building up the distance. Was riding the horse for up to 2 hours with no problem but getting on from something high and very cautious getting off - lowering myself down slowly.

I’m finally getting round to posting this at 6 months; life is pretty much back to normal, still lack some strength and also some range of movement with the knee bent i.e. in the soleus muscle, but with the knee straight it is the same as the other i.e. gastrocnemius is the same. I still should be doing more single leg raises, walking around on tip toe etc but I don’t - just hoping that with the walking, swimming and riding it will gradually build up on it’s own.

I’m so glad I went the non-op route with early mobilisation, I’m sure keeping the ankle moving from day 10 meant I had few problems with stiffness. Although my progress may not have been as fast as some people’s I also didn’t push myself as hard as some people so probably evened out.

Although I wish it hadn’t happened, I have learnt so much from it that often I’m glad it happened and I’m so lucky that it is an injury that gets better in a relatively short space of time.
And of course I learnt to Blog!