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My PT starts to piss me off

February 24th, 2010 by marina

Okay, I’m getting mad. Yesterday I did pretty much same exercises, and ultrasound and ice at the end. Every time I finish an exercise, he tells me to walk for rest, without limping, but this is IMPOSSIBLE! And it’s not my mind. It’s my body. My tendon hurts me when I push myself forward with this leg, my ankles are swollen and my whole leg muscles from top to calf are aching from the exercises, since they have been inactive for 3 months now. He really pushes me to my limits to walk correctly, but I just can’t do it without a hint of a limp and I get dissapointed. I’m 2 weeks and a half on two shoes I think, how normal is that I can’t walk without limping? I try to stay focused and listen to my body and I’m anxious to see how my walk will go soon as I’m free of my muscles pain.
Yesterday, he said it would be great if I could go to a pool and walk in the water on various ways (forthwards, backwards, to the sides etc). I don’t know if I’ll do this, my daily schedule is already very stressed and tiring, actually I’m exhausted. I have now completed 19 sessions, only last 2 of them concerned strengthening, so probably I’m still on progress..(?)

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15 Responses to ' My PT starts to piss me off '

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  1. josher47 said,

    on February 24th, 2010 at 6:47 am

    I couldn’t walk without a limp for probably 4 weeks after getting into two shoes. It gradually went away, but I do have to concentrate when I walk or run. It is hard to push off with your toes without gaining some strength back. It sounds like your recovery is going like mine. I am making progress, but I have frustrating moments along the way. It is good that you have a PT that likes to push you as long as you trust him and his expectations.

  2. doug53 said,

    on February 24th, 2010 at 7:09 am

    Hi Marina,

    Your PT should understand that you cannot walk truly normally until your calf can support your body’s weight.

    If you are taking a stride of decent length, with your good foot going forward, your weak calf has to support your body’s weight as your weight rolls over that foot. (I hope that makes sense.) If that strength isn’t there yet, that injured heel is stuck on the ground until your front foot hits the ground and takes some weight. That means there is a limp, unless you walk slowly and with short steps.

    So, even if your ROM and “technique” are perfect, it is impossible walk truly normally until your calf gets stronger.

    Norm and I recently discussed a section in my long 4/29/09 note about “the frustrating plateau” that goes over this issue.

    I hope this helps,


  3. "Frouchie" or "Grouchie", or just "Chris" said,

    on February 24th, 2010 at 7:28 am

    I feel your pain, and I too have the same issues. I’m only 14 wks post-op today.
    I have a slight limp too when I walk. I force myself to take shorter steps and walk slower. After sitting at my work desk for a short time and then get up to go out on a service call…thats when i limp the most.

    Let the PT push you and do the best you can after. The PT has started adding more strength training with me and I do notice that the pain and limp are getting a little better.

    Keep up the good work. Keep us posted.

    “Slow and Steady Wins THIS Race”.

  4. Gerryr said,

    on February 24th, 2010 at 9:06 am

    I’ve been in two shoes since before Thanksgiving and still limp, sometimes only a little, sometimes a lot. I find that if I walk slowly I do not limp as much.

  5. sam66 said,

    on February 24th, 2010 at 12:34 pm

    My physio insisted I walk with crutches until I could walk without a limp to ensure correct posture/pelvic alignment etc.
    Apart from the obvious need to stretch the tendon and wake up the calf muscle, after some 11 weeks NWB my knee and glutes were also very weak.
    You’ll get there - keep at it.

  6. 2ndtimer said,

    on February 24th, 2010 at 12:58 pm

    I can understand your frustration. If your ankle is still swollen, and the tendon hurts it is maybe not very good to walk a lot. Something is not ready for it yet. Perhaps your calves are too weak. It might be a good idea to exercise them with stronger therabands, doing calf raises sitting down (and lean your elbow on your knee if it is getting too easy) etc. before walking a lot. And do try to exercise 3 times a day. Your whole weight might be a bit too much for it to carry without a limp yet. Practicing the right movement is very important so I would strongly recommend going to the pool where you could have the satisfaction of doing calf raises easily and rolling your foot properly. I found being in the water a great relief.

  7. marina said,

    on February 24th, 2010 at 1:35 pm

    I just got home from a busy day (@work, physio, visiting parents). I thought I’d share, I am thrilled on the progress today! I talked to my physio and let him understand that my whole foot cannot do much at the time and that this is the cause of my limping.
    So today, after laser etc, I ran 2kms on stationary bike on a pretty medium level and in general, I did same exercises as yesterday, with an addition. I popped up on the trampoline and did heel raises, but more like I was jumping with my toes not leaving the surface though, only heels. After some of these, I did normal heel raises on the ground with both feet and I then realized for the first time ever, that my tendon wasn’t aching anymore! I can’t tell you how badly I wanted to finish this set of raises and see how I can walk! I took a deep breath and made my first steps. Yes, tendon is not aching. Like it was stuck somewhere all this time and it’s now been released.
    Of course, I still limp a bit, since my muscles are weak, but now I’m pain-free, I can work harder and improve my moves.
    Josher47, I wish you best of luck to your 3-miles running next week, keep us posted.
    Doug & Chris, thanks, and yes, your post does make sense, I did speak with my PT and came up with good results. My ROM is perfect, but he said that calf and tendon is ONE thing, so I must exercise it as one. I’ll certainly read that discussion.
    Gerryr, I walk so slow, that my friends call me a turtle :-D Sam66, I really admire your patience, I don’t think I could stand been on crutches until today..
    Thanks a lot you guys, I’ll keep you posted on my progress through my blog. I think I’ll sleep with a huge smile on my face tonight :-)

  8. normofthenorth said,

    on February 24th, 2010 at 7:13 pm

    Glad you had a much better day, and straightened things out with your Physio.

    “What Doug and most of the others said!”

    I’m also still stuck on the “frustrating plateau” that Doug and I have discussed elsewhere on achillesblog. I’m doing slow and careful “deep double-heel raises” with the front half of my foot on a stairway step and my heels hanging over. (And at least one hand holding onto a banister or something else that’s secure!)

    Between your physio and sam66’s, we can see that there’s a huge range of approaches, eh?

    I’m on my second ATR. Eight yrs ago, I was in a series of casts for maybe 8 weeks, then a hinged walking boot for another 7 or 8. Then one day I could walk properly barefoot! (Then later that day, my physio bullied me into doing too much too soon — a bunch of 1-legged heel raises! — and I spent another MONTH in the boot, until I could walk properly barefoot again!)

    This time, I’ve been cast-free the whole time, doing way more ROM and strength exercises much sooner, and PWB and FWB much sooner, and leaving the boot for 2 shoes much sooner. And I’m WAY more conscious of the “frustrating plateau” — of ALMOST being able to walk without a limp, but not quite — than I was last time. I’m sure exercise and motion and massage and Physio gizmos can speed things up some (and Doug was walking straight at maybe 7 weeks post-op!), but for most of us, TIME seems to be an important variable in some of this recovery, too.

    And my bad experience last time (doing too much too soon and “losing” a month) makes me cautious about trying to be a hero and “exercise through the pain” to try to save a few days.

    Also, as 2ndtimer said, I bet walking around in a swimming pool would cheer you up (and maybe me, too!). By moving from deeper to shallower water, you could adjust the amount of weight your calf-and-AT have to push off to make a perfect gait. Sounds like fun to me!

  9. marina said,

    on February 25th, 2010 at 7:42 am

    Today I woke up and realized that after I did a couple of steps, my walking is a lot better!
    Well, I can’t say he’s giving me too many exercises, he just pushes me to do them flawlessly.
    I don’t think I’ll try the pool, even though there is one, one block away from my home, but I already feel exhausted from my daily routine, it will be too much to add another activity. Unless if I don’t go to the physio every day. I find exercises in my environment, for example at work I use the stairs very often (up and down). I tried to hang my heel as you did, but that seems too hard for now for me and I don’t want to throw away all good work been done up to now, based on your ‘bad experience’.
    On Saturday I’m off to the gym, and on Sunday I’ll get new photos to compare!

  10. mari said,

    on March 1st, 2010 at 9:32 pm

    I only get physio twice a week and he told me to expect to walk without a limp by the end of February for most of the time.
    When I ‘m tired I limp, when I just get up I limp.
    And today was the first day I was allowed to do toe raises on the floor.

  11. normofthenorth said,

    on March 2nd, 2010 at 12:11 am

    Marina, if the stairway step is too scary — and I can see how it could be — there are a few less cary variations that I’ve also been using to exercise the “push off”.

    For example, if you plant your “bad” foot just behind you, flat on the floor (e.g., as far back as is comfy), maybe in a doorway where you can hang onto something, then starting with most of your weight on your “good” foot, you can “push off” from dorsiflexed all the way to plantarflexed, without much resistance. By gradually shifting more weight onto the “bad” foot while you do that push, you can make it more and more difficult. I often find myself doing a normal 1-legged heel raise with my “good” foot at the same time.

    Another variation is to do the stairway stretching 2-legged heel raise, but do it on something that’s only an inch high, like a board or a fat report, etc.

    The only scary part of the stairway-step stretching 2-legged heel raise for me at this stage, is getting set up. I always have to remember to start by putting my GOOD foot on the step, instead of the other way!! (If I start with the “bad” foot, then it has to hold my whole body weight while I place the “good” foot, and that’s exactly what it CAN’T do yet!!)

  12. marina said,

    on March 3rd, 2010 at 7:55 am

    I do a bunch of nice exercises every day at my PTs gym and at home. Most difficult ones is the one that I stand in front of a wall, put my bad foot behind the good one and in some distance of around 6-7cm and then I push with my bad foot (lift the heel and stand on toes), transferring my body weight to the good foot until my nose touches the wall.
    The second one, is like this: I stand with my knees bended (like in a basketball defence position), transfer my weight to my bad foot and do a heel raise with this foot. 2 days ago, my foot got stack on the ground, now there’s a bit of a progress, I can lift it up for some nano-seconds :-D

  13. normofthenorth said,

    on March 3rd, 2010 at 2:28 pm

    You’re way ahead of me with that second exercise, Marina! It also sounds creepily close to the single-leg heel raises that got me in trouble 8 years ago, so don’t overdo!

    I just got a bunch of new and more aggressive exercises from my guy yesterday. Haven’t done much today, got to get onto it!

    My physio paid a lot of attention to the difference between a high heel raise and a REALLY high heel raise, which surprised me. He thinks I’m better off applying much less resistance or weight, to make sure I can REALLY extend onto my toes, instead of just getting close. (We were working on a horizontal gizmo, against resistance bands, not lifting my weight.)

    He also prescribed DUPLICATE exercises: For every stretch or strength exercise I’m doing with STRAIGHT knee(s), I’ve got another identical one with BENT knee(s), and vice versa. He says there are two “heads” to the calf muscle (gluteus maximus and soleus), and each way isolates or “works” ONE of them. Straight knee = GM, bent = soleus.

  14. chocolata said,

    on March 3rd, 2010 at 4:00 pm

    What a wonderful experience it was for you to have those nano-seconds! Well done, marina!!
    Keep us posted, and take care ;-)

  15. marina said,

    on March 4th, 2010 at 3:50 am

    Yes, Norm I know exactly what you mean with that knee thing. Yesterday, he added a couple of new exercises, pretty difficult ones. I think it feels much better now with these, last couple of days my swelling is doing very very well, but I’ll give the credits for that to the ice. When comparing to my good foot, it’s much more similar now!
    He told me I should try the treadmill, walking only, for a couple of kms, so I’m going to the gym again this Saturday. Plus, I’ll start using my bike.
    I’m feeling pretty tired, but I’ve gained some body weight since I’m not playing anymore and that makes me feel stronger and I have much much more durability than before.

    Thanks chocolata, indeed it was! I have to teach that new tendon how to work and it’s pretty painful. I’m confident though, that eventually I’ll succeed!

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    • marina has completed the grueling 26.2 ATR miles to full recovery!
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    • Name: marina
      Location: Athens, Greece
      Injured during: basketball
      Which Leg: R
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