First physio visit

With my first ATR, I didn’t start physio until 10 weeks - my doctor  didn’t trust physio - that was a mistake. By that time,  I had lost all my strength in my foot muscles and toes and had a limping walking style.

This time,  I’ve been able to correct some of those things myself (I’ve been doing the toe exercises since week 2) but now I’m FWB I decided it was time to head back to my physio. Thankfully my gait is looking good, and I only have a few tweaks to make. She worked on my foot and calf to clear some fluid that had appeared recently, loosened my hamstring and applied K tape to help clear that fluid.

I’ll head back in 2 weeks once I’m in 2 shoes!

Week 6-7 - PWB and FWB

I saw my specialist at 5 weeks, and he gave me the ok to start PWB at 6 weeks. As it happened, my right crutch broke at 5.5 weeks so I ended up bringing that forward slightly. (As an aside, if you wear through the rubber on the bottom of your crutch, a washer, some rubber and duct tape will do the trick - took me a couple of goes to find a fix!).

Last time, I never quite got the hang of FWB and there is no doubt that slowed my recovery. So I was determined to do it right this time. I watched a number of YouTube clips on transitioning from PWB to FWB. I started with two crutches, then I loosened my grip to minimise the weight through my arms, then I took my right arm out of the elbow hold and used the right crutch like a walking stick, then I dropped the right crutch completely…

I’m 6.5 weeks now and FWB. I still use one crutch usually to ensure I get a good walking motion. I slip into a limp without one crutch to push me through the step slightly. I use two crutches outside (uphill is challenging!) and when I’m tired too.

I also bought an “Evenup” for my good leg. I didn’t have one with my last ATR and it definitely makes a big difference.

So far, my right ATR feels streets ahead of where my left ATR was at this stage. I’ve got a lot more functionality in my toes  (thanks toe exercises), strength in my upper leg, and generally better mental connection to my leg. I think not being scared of my leg has made a big difference this time around.

I’m also spending some time with my foot out of the boot each day now, preparing for life after the boot! It sure is nice to get some sunshine on the leg!!!

Week 4: The boring stage…

Today, it is 4 weeks since my right ATR (and 14 months and 2 weeks since my left ATR). This stage is very boring – there is very little rehabilitation to do, and normal life remains quite difficult. Still, I know that soon (in just 2 more weeks) life will get interesting again. Under my protocol, I will start partial weight bearing (“PWB”) at 6 weeks. That stage comes with a few perks, such as being able to start stationary biking!

What is happening at weeks 2 – 6? (NWB in a moon boot)

An alarm on my phone sounds every two hours – and it’s such a relief to get out of the boot! I spend 5-10 minutes removing my sock, doing my ROM exercises, doing some toe exercises (I put my toes on the ground, then lift my big toe only 10x and then my other toes only 10x), and gently massaging my leg and foot. Always in plantarflexion, of course.


Bruising

Bruising at 4 weeks

I am doing my best to get out and about. There is plenty you can do outdoors on crutches  – I’ve even managed to go for a couple of ‘walks’ at the beach! There is nothing like fresh air! I also managed to get around a museum exhibit with the help of a wheelchair!

Out

Out and about

Home chores are quite difficult at this stage. Particularly if you don’t have home help, I recommend hiring an i-walk. These guys make it possible to tidy and vacuum the house while NWB! I find it quite hard on my knee, so I can only use it in short bursts.

I am doing my best to keep as active as possible, and prepare my body for the next stage. Most days, I do a circuit of upper body and core exercises, as well as a range of NWB exercises aimed at maintaining strength in my calf (left), glutes, quadriceps, and hamstrings.

Legs

NWB leg exercises

I am also keeping a close eye on my posture. I find it is quite easy to let my hip slip out of alignment, which I think contributed to some of the difficulties I had when I started walking after my left ATR. I’m hoping to avoid those delays this time!

Happy healing everyone!

Week 2 - Good bye to the cast!

Doctors visit

This week I had my plaster cast removed, my moon boot installed and my first appointment with my sports doctor.

Cast removal

Cast removal

My Achilles is healing well, so - as is normal in New Zealand - I will be treated non-operatively. The protocol I will follow is:

- 2 weeks equinox cast (done!)

- 1 week at 30° plantar flexion non-weight bearing in the boot (NWB). Range of motion exercises completed for 5 minutes per hour from this stage.

- 1 week at 20° plantar flexion NWB

- 1 week at 10° plantar flexion NWB

- 1 week at 0° plantar flexion NWB

- Partial weight bearing at 6 weeks transitioning to full weight bearing at 8 weeks. Boot can be removed at night from 6 weeks.

- Transition to shoes with a raised heel at 8 weeks

I followed a similar protocol with my last ATR, with two key differences (1) my doctor didn’t intend to reduce the angle of my foot until week 6 - until I pushed for that to happen, and, (2) last time I had heel raises inserted in the boot, whereas this time I have an adjustable boot - which seems much more precise!

Bruising at 2 weeks

Bruising at 2 weeks

If you are in New Zealand, I highly recommend going  to a private sports doctor (e.g. Axis Sports Medicine), rather than through the hospitals/accident centres. The protocols vary widely between specialists. When I went to the hospital following my first ATR they told me I would be in a cast for 8 weeks! And the specialist who removed my cast this time put my boot at 20° instead of 30° - luckily that was only overnight.

Return to work

With both of my ATRs, I have had 3-4 days off work on sick leave and returned to work the following Monday. In New Zealand, ACC covers taxis from home to your workplace and to your medical appointments. This makes it much easier to get back to work, as my driving leg will be out of action until about week 10. At work, I have a leg rest (also from ACC) so I can keep my leg raised. I also try and spend some time on the ground - a funny sight in an office - to get my leg above heart level.

Taxi to work

Taxi’s everywhere!

Headspace

This injury is very challenging, both physically and mentally. I think I am quite a positive person, but this second ATR is definitely hard. One tool I use to help with that is the Headspace app. The app provides guided meditation and mindfulness programmes on a variety of topics. It has a rehab programme, which helps keep you mentally focused on recovery. I’ll try anything and everything to get back on two feet as soon as possible!

Exercise

In terms of cardio, I plan to start stationary biking at 6 weeks and swimming/water walking at 8 weeks. But, based on my last ATR, I need to do more to minimise muscle wastage in the interim.

Upper body and core exercises can be easily modified to be non-weight bearing (although you need to up your push up count when you are doing them from your knees!). I’ve also been getting in plenty of calf raises on my *good* leg.

Last time, I lost a lot of muscle in my glutes and upper legs - so, this week, I will be seeing a personal trainer to set up a programme for me so I can minimise that muscle loss. That should speed up my return to walking, running and netball!

Happy healing!

Week 1 - questions, equipment and diet

I spent most of Week 1 on the couch at home. After my first ATR, I found I was very tired and slept a lot during the first week. This time around, I’ve had more energy but I have forced myself to rest as much as possible. I was able to get out of the house a few times - there is nothing like sitting in the sunshine at the beach to lift the spirits!

Beach

Questions

When I ruptured my left Achilles I had so many questions, but of course my number one question was "Should I be having surgery?". In New Zealand, ATRs are generally treated conservatively. While some hospital-based specialists still recommend using a cast for up to 8 weeks (avoid them!), most specialists now recommend an early weight bearing conservative protocol. The details of the protocol used in New Zealand are here: https://www.axissportsmedicine.co.nz/patient-information/achilles-tendon-rupture/ . The AchillesBlog website contains plenty of links to studies demonstrating the effectiveness of conservative ATR treatment. As my left Achilles healed well without surgery, I had no concerns about following this protocol again. Surgery is hard on the body and has risks, so why do it if it doesn’t have better results?

This time around, my number one question was "Why am I so unlucky?". Again, I turned to the AchillesBlog website. Research suggests that 6% of ATR patients will experience a contralateral ATR (see https://www.researchgate.net/publication/8919074_Contralateral_tendon_rupture_risk_is_increased_in_individuals_with_a_previous_Achilles_tendon_rupture ). Personally, I had previously experienced tendonitis in my right Achilles, so I knew I had some pre-existing degeneration in that leg. I also have a family history of Achilles issues. I returned to a high level of training, whereas I expect a number of ATR patients reduce their level of participation in sport compared to their pre-ATR levels. Finally, in the 4 days before my injury I did an intense leg workout at the gym and ran a 15 km race. All in all, those factors clearly outweighed the rehabilitation work I did on my right leg when recovering from my left ATR.

Equipment

There are some critical pieces of equipment that I recommend getting as soon as possible:

Shower chair - I recommend a stool rather than a chair as its less cramped in the shower. This shower stool was $40 - ordered online and delivered in one day.

Shower chair

Shower cover - I used a simple bin bag and duct tape after my first ATR. This time, I invested in a reuseable cast cover - it certainly makes showering easier and is nicer on my skin!

Shower cover

Chair with wheels - you can get all sorts of equipment (through ACC in New Zealand), however the humble office chair is very useful - at least initially - as most people have one available. I use it for cooking, washing dishes and carrying items between rooms.

Chair

Diet, pain killers and supplements

For both ATRs, I have chosen to increase my intake of fruit and vegetables, and remove all processed foods, alcohol and caffeine from my diet. I have also chosen to use painkillers minimally, as there is some (mixed) evidence that they inhibit recovery.  With my left ATR, I chose to take a multi-vitamin and have a protein shakes daily. With my right ATR, I have chosen to add collagen, turmeric, fish oil, and glucosamine/chondroitin supplements. (Of course, there is mixed evidence of the value of supplements, so do your own research).

Supplements

A useful series on nutrition for injury recovery is here: http://www.precisionnutrition.com/nutrition-for-injury-recovery-infographic

Oops I did it again… ATR #2

A little background:

I’m a 28 year old, female, lawyer, based in New Zealand. I play premier level netball.

I ruptured my left achilles tendon playing netball on 9 August 2016. I was treated conservatively, which is the normal course of action here in New Zealand. I put a lot of work into my rehab and made it back onto the netball court in April 2017!

I played the whole season of netball this year with no problems. Gradually, my jump came back. I also started training for a half marathon, and battled through shin splints and hip pain. But, I never made it to the half marathon…

On 25 September 2017, I was playing Fast 5 netball and felt another *kick* - this time in the back of my right leg. I was so frustrated I balled my eyes out - right there on court!

Soon enough, the squeeze test and an ultrasound confirmed what I already knew. I was back in a cast. On the plus side, I am a much more skilled operator of crutches this time around!

Last time, this website and in particular AgnesATR’s blog was so helpful. Now, I feel like I have some knowledge to share.