Dec 01 2011

25 weeks no surgery- finding this very tough and very slow

Published by mtbrider at 6:55 pm under Uncategorized

So almost 6 months in, I look back and see good progress. Not as much as I would have liked though. After being told to expect  6-12 months recovery from most people, and being a very competitive person, I was ready to have this sorted in 6 months. What I have realised is that my mind is not in control of this injury, my body is. I need to listen to my body and what it is telling me more than I usually do. It is a complete mind change for me. When riding I liked to remember the saying ‘pain is weakness leaving the body’. Definitely not the attitude for an ATR.

I have read peoples blogs but recently I read them and feel I am behind so many people out there it is makeng me feel pretty down, so I read this site less.  At the end of the day 6 months ago I could not walk so I have moved forward. It is probably a good idea to write down what I can/can’t do now, for my benefit and hopefully others too, so:

I can walk without a limp from about half an hour after I wake up to about 7:00 at night. resting makes things stiffen up. I can do two footed heel raises easily but the weak calf aches in a non-painful way when doing this. I am doing 2 foot heel raises, transfer to injured leg, hold for 5 seconds, drop back down slowly 3 sets of 15, 4 times a day (this is with support by having my hands on a bench.

I can do 1 foot heel raises to about half the normal height when my foot is about 30cm back from  the bench, leaning on the bench  1 set of 15, 3 times a day. I can run for short distances (chasing my 4 and 2 year old kids round the back yard) slowly with some discomfort. I can ride my road bike to work about 10 min away of a flat road with no pain at all. I can walk on tippy toes ok-ish. Stairs are ok but get I pain in the back of my heel.

I still have pain, primarily at the bottom of my achilles/heel junction. I mainly get pain there when on the font of my foot walking. In the evening the pain aches there even when sitting down. My PT is ok although she is meant to be very good. Maybe I am just bummed at her that my progress is so slow. Basically I have never had a massage from her, no utrasound. Got some acupuncture from her my that did not help.

My exercises from her for the last 10-12 weeks have basically been 2 foot heel raises up and down and also two foot heel raises up, pause on bad foot only, down on bad foot slowly. I am getting so bored of these. She says I need to get more strength in my ankle/leg (be able to raise it higher when doing my heel raises , start doing 1 foot raises) before I can start really strengthening it with outer exercises. She acknowledges I am a slow healer.

Is is worth getting second opinion or should I just keep going along slowly and see gradual progress as progress nevertheless. Are there other exercises people can recommend? Summer is here in NZ and I and to be part of it!

Will be checking this site more so replies would be great!

Happy healing and take it easy all!

10 Responses to “25 weeks no surgery- finding this very tough and very slow”

  1. ryanbon 02 Dec 2011 at 3:23 am

    MTB- how is the tendonitis doing? You also didn’t mention your flexibility… is your passive ROM now the same as your non-injured leg?

    Reading your list, it all sounds very familiar. You’re ahead of me on the Calendar, but it seems like we’re at a very similar point recovery wise (I’ve just been lucky; able to avoid some of the complications you’ve had to deal with).

    Things I’m working on now:
    1) Balance. Standing (1-leg) on an inflatable pad (google “bell fit inflatable balance board”). I try to do it with my knee bent, in a skating position, which puts additional load on the Achilles. I’m good for around 15 seconds now.
    2) Calf Press. I do these light, single leg, at the gym. I use the leg press machine, the seated calf press- basically, any regular calf machine that I can set light enough for my weak leg. Once of my favorites is upside down on a smith machine, lifting the bar with the ball of my foot. Single leg, standing calf raises, in the pool (water depth determines resistance) are a good one too. The pool ones are especially good for increasing the height/ROM.
    3) Walking. I’m not doing as much as I used to; but I still think this is probably one of the most important things to do. Hiking sounds more exciting that “walking”; and I did/do try to get out on the trails. My trails are mostly snow covered now…
    4) Cycling. You say you can ride your road bike for 10mins. I bet you can ride your MTB out on the easy trails now. You’ll be using that granny a lot ;-). Within the last week, I got my road bike out for the 1st time, and am (barely) able to get out of the saddle on it.
    5) Mini-tramp. I’m not quite there yet, but it sounds like you might be about ready for it…

    Try to keep focused on the positives. You are through the worst of this, and have made it to this point without re-rupturing or healing long. What’s ahead of you now is mostly an exercise in strength building and conditioning… that should be the the fun stuff to do.

  2. mtbrideron 02 Dec 2011 at 7:20 am

    Yeah, cheers ryanb for the reply. It should be the fun stuff but as I am getting the same exercises week after week it is getting pretty boring.

    Tendonitis is still an issue, not as much but it is still there, especially in the mornings and evenings. I like the mini tramp idea. I have got the kids a tramp for christmas- will that be sweet? What do you do with that- just jump up an down tow feet for 5 mins or something?

    I don’t do gyms - but I now do pools. I have the water up to my chest and hop up and down th length of the pool on on my bad leg for 15 min then do 15 min each of breastroke/freestyle/flutterboard kicking.

    So yeah, thanks for your thoughts and could you please elaborate on the tramp idea.


  3. mtbrideron 02 Dec 2011 at 7:30 am

    Oh, and my ROM is about 90% normal. Otherwise all other movements are sweet. Toughest movement I have is both feet together with my knees best as far as they can go. I get tightness/pain in the top of my ankle, which is on the inside of the leg/ankle joint.

    The biggest issue with me is the pain in the back of the heel, which is the tendonitis - or so I currently believe!

  4. ryanbon 02 Dec 2011 at 8:26 am

    If Stuart was around, he could elaborate a lot more on the mini-tramp. He used it quite a bit, and was a big proponent. My thought was to start out with jogging-in-place on it. Though, 2-leg bouncing on it might be easier… I guess I’d try both. My plan (when I get there) is to use the mini-tramp as a transitional tool to plyometrics (and maybe running). Before I’m ready to absorb impact on hard ground, I think I’ll be able to do so on the tramp. And the wobbbly’ness of it, should help improve ankle stability (I think).

    I’ve got a “skiers edge” machine in the basement too, which I think can serve a similar purpose: a “smoother” transition to plyometrics. But, I don’t think it will be as good for ankle stability. I don’t expect it will be too hard to find a used mini-tramp on the cheap- they seem to be one of those things people buy for exercise, never use, and then they end up at the thrift shop.

    I do have a big 12 foot diameter tramp in the back yard. If we get a warm spell, I’m about ready to go experiment on it. For bouncing, I’m sure the big tramp is better. I don’t think they’d be very good for jogging though- the response on them is just too slow, and the vertical displacements too large.

    Keep in mind, I haven’t actually tried any of these things yet, I’m just thinkin’ out loud ;-)

  5. suthrnmanon 02 Dec 2011 at 12:53 pm

    Hey mtbrider, I will be at 22 weeks this Sunday (non-surgery after re-rupture) and your situation sounds very similar to mine. I had a bit of the tendonitis you described and I took it really easy for a few days. A few days rest seemed to help a lot on mine.
    My concern is that the tendon feels to the touch like it is split top to bottom where the healing is taking place (the rupture) and fairly hard and thick above the rupture. This bothers me to feel it, but I am walking w/o pain. I don’t want to re-rupture again, so I am content to go slow and give it time to strengthen.
    I have come to greatly appreciate walking and don’t want to jeopardize what progress I’ve made.
    I would just encourage you to take it slow and enjoy life. I wish you swift and complete healing. suthrnman

  6. bcurron 03 Dec 2011 at 8:18 am

    With a mini tramp, start by walking on the spot as normal. Then move to light bouncing but without your feet leaving the tramp. Then move to jogging on the tramp. Then some small jumps. Then small jumps with a 180 twist, then jogging. Ou don’t have to progress rough them all, it’s just an idea of the order I did them in with my PT.

  7. normofthenorthon 03 Dec 2011 at 7:19 pm

    MTBR, I wish I had some “magic” to add, but no. I’ve been virtually 100% pain-free this time, but my return to strength has been between “too slow” and “not enough”. Even with a relatively smooth and 100% successful recovery (like my first one), it was still 10-11 months before I felt willing and able to return to “real” sports (like volleyball), so you can probably expect to have to wait a few months for the rest of the progress.

    One more thing: My ultimate calf strength (=~ 1-leg heel raise) didn’t seem to be responding much (if at all) to all the exercises you describe, and I started doubting that it ever would. Recently I’ve returned to volleyball (long delayed by my heart surgery), and my ATR calf has started “hurting good” in ways it didn’t seem to from the exercises. Maybe the more explosive activities will trigger some strength increase that the gentle stuff didn’t. Of course, I’m NOT suggesting that you rush the pliometrics at 25 weeks, but for some of us there may be a natural progression that eventually gets us at or close to 100%, but not as fast as we’d like. Maybe — maybe in my case, anyway. You’re still “young”, so your odds of getting to 100% are pretty good.

  8. nivergvupon 04 Dec 2011 at 3:25 am

    Hey Mtbrider……I think if I was in your shoes that I might be looking at new therapist……From speaking with my therapist she says that massage is so important to break down the scar tissue and to make sure that the new scar tissue is laid down in an organized strong way! Seems like you may be missing out. The other thing is that there are so many execercises out there to help strengthen and stretch that I don`t think there is any need to be doing the same few excercises over and over…..Not sure how it works in NZ, but I think that you should be able to find a therapist who works with you a little better……..Good luck!

  9. normofthenorthon 04 Dec 2011 at 6:47 am

    nivergvup, the problem with attachments tends to go with surgery, and mtbrider skipped that part. Surgery means that 5 or 10 different layers of tissues get sliced apart and stitched together, then they’re all supposed to heal to their “opposite number”. But some of the new scar tissue binds adjacent layers together, keeping them from sliding over each other. In the non-op cure, the only thing that’s separated and needs to reattach is the AT itself — not even the paratenon (”sheath”) that surrounds the AT is torn in a normal ATR.
    There’s lots of inflammation and healing processes swimming around the area in both cases, so I think it’s possible for a non-op patient to develop a problem, but I think it’s very rare. In post-op patients, it’s more the rule than the exception. (In THIS case, the logic and the evidence — admittedly anecdotal — seem to coincide! ;-) )

  10. 2ndtimeron 06 Dec 2011 at 4:18 am

    I do not check in often anymore but I noticed your comment and I have to say: I find a bit of a bragging contest going on this site. Lot of comparing numbers. Yes, most people get this injury because they tend to push themselves hard. Maybe it is good to cheer themselves on. But.

    It seems that to cure this injury is no hard science at all. I have the inkling depending on where the rupture happens the recovery is different. It can be down close to the heel or up close to the muscle? Or maybe not even a 100% rupture for everyone?
    Also recovery with or without surgery seems to me very different. Also age, and other complications may make it different for everyone.

    I felt a lot of the same as what you describe. I had tendonitis, swelling.

    I ruptured mine quite low. I had no surgery. I got out of the boot after 11 weeks of immobilization and started walking without gradual getting used to it. No one told me not to. A week later I spent a whole day walking around on a trip. And then things started to go downhill. I had pain in the tendon. My physiotherapist later said I should not walk more than an hour at a time. I had developed inflammation. When I tried calf raises it felt like my tendon was going to burst. But I soldiered on I thought no pain no gain. (I have not discovered this blog at the time - knew no one with this injury) I spent whole days walking in spite of the pain 4 months after the injury. (It is very hard to “rest” when you spent several months not being able to get out of the house!) I tried heel raises on one leg. I was feeling bad so I made an appointment with the ortho. But before i could see him I re-ruptured it… just a wrong step.

    I was terrified. Then I talked to someone who re-ruptured it 4 times. She did not have surgery first either.
    So I asked for surgery. I gave in to my injury and was lucky to be able to spend the next 2 months on a sunbed in the garden. I refused to walk again on crutches. I wanted no more swelling. My surgeon was very cautious, did not let me out of the boot for 11 weeks. My calf muscle after 2 rounds of immobilization was gone.
    But when I started walking I felt absolutely no pain in the tendon. No swelling. I was delighted. I had to fight the muscle atrophy though, and discomfort as a result of the lost padding of fat on the sole of my foot. It was a very long process but there was constant small improvement so I felt optimistic. I did the physio happily as I felt no pain at all. What a difference!

    However even though I can run or hike 2 years later - calf raise on one leg is still very hard. I stopped pushing myself for that. I do some regularly, but do not try too hard. I accepted it is something I will not be good at for a while. I did muscle stimulation, massage at the physio for 4 months but I find it is mostly time that heals.
    I work out in the gym 3 times a week and do things I enjoy. I have been swimming twice a week and find it very helpful.
    Heel lifts are not a necessary part of my life. I have learnt to listen to my body.
    I hope this helps you. Be careful with tendonitis.

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