Jul 28 2011
10 Months and Second Thoughts…
Hi! Thought I’d check in with my progress. I’m not surprised to see mostly new members of the ATR Club here and some familiar faces, too–Norm, Gerry (my "coaches"). You guys are the best:) Hope you are doing well, as well as Bronny, Liverpoollass, parisski and Theresa.
I’ve mostly recovered and can do everything except play tennis (not yet!), but my PT experience was hit and miss with what I would call "benign neglect." I think my PT thought my choice of non-surgical repair was risky (he called me a guinea pig at one point) and therefore seemed not very invested in my rehab outcome despite my providing him with background info, the UWO protocol, etc. In spite of that, I’ve done pretty well, and my PT thought I did better than some of his surgical ATR patients. But, I’m finding even 10 months later that I’m still not where I thought I would be at this stage in the journey. When I do too much, the back of my ankle still feels stiff, lumpy and sore. I can hike, bike, walk, run, ski, but I have soreness and need to apply ice afterwards. I’m still fearful of getting on the tennis court (a sport I love and miss). I have other concerns as well and I know, for sure, that a friend of mine (same age) who ruptured her ATR at about the same time & had the surgical repair is back on the tennis court without any pain, stiffness, etc. Maybe my PT made all the difference. Maybe I didn’t do the exercises correctly, or ice enough. I’ll never know. Will I make it back to a totally normal functioning leg which allows me to play a game of tennis without the threat of re-rupture, or even to wear a ballet flat without soreness? Time will tell.
For newbies considering which route to take, please take your time in weighing the two options. My experience with the non-surgical route (in the US anyway) is that the surgical solution (right now) is considered the "gold standard" by the medical community and you will spend considerable time explaining, educating, advocating for your non-surgical decision. I was considered a "trail blazer" and called a "guinea pig" and when I needed medical support, the only place I could turn was this blog. And, the people here are truly amazing with their knowledge, patience and support. I don’t know what I would have done without them. But, in my experience, once you chose the non-surgical route, you are largely on your own.
I wish all of you the very best in making the right decision for you to have a surgical repair or not. Think it over carefully. Good luck and good healing to all.
6 responses so far
First, I’d say “+1″ to virtually everything you’ve said, NR.
Second, I’m sorry you’re disappointed with the state of your leg at 10 months. At MANY months post-non-op on this (my 2nd) ATR, I’m also disappointed, by my still-wimpy (permanently wimpy?) 1-leg heel raise. OTOH, I’m pleased that my ankle is fine when I run, and I’m virtually free of other signs of weakness and odd pains — virtually free, since I’ve had a few funny twinges, but very few. No post-activity fatigue or icing, but my heart surgery on Dec. 1 has limited my activities.
I’ve just been conditionally cleared (by my Cardio Rehab nurse) to carefully try returning to some beach volleyball and “see how it goes”. That will be my first chance to see if I have a functional deficit — say, jumping at the net — from my second ATR AT.
My experience from my first, surgically-repaired, ATR, was more like your friend’s than yours, or than my recent one. At 10 months I returned to competitive volleyball with no deficit at all, other than a hair less dorsiflex ROM than before, which did no harm.
Of course, even with you, your friend, and both of my legs, we’re still way short of proving anything, or attaining “statistical significance”. While our small experience suggests that surgery gets you back to full speed faster (as almost all the US surgeons and “experts” say), the 2010 UWO study and Twaddle’s 2007 NZ study, etc., bring pretty big numbers of randomized patients to bear, in establishing that our experience is balanced by some others — in roughly equal numbers — that go the other way. (As you say, “my PT thought I did better than some of his surgical ATR patients.”) In those studies, strength and ROM were both identical with and without surgery, and re-rupture rates were very low and pretty similar, and “statistically” indistinguishable (though patients may see the numbers differently).
Here in Toronto, I had the luxury of full professional and institutional support BOTH times. In late 2001, I got surgery when EVERYBODY was getting surgery for ATRs. In late 2009, I skipped the surgery, when the best local sports-medicine surgeons — the ones who went to international conferences on Ortho Surgery — were starting to skip the ATR surgery, based on the latest evidence.
Ironically, the big international conference that changed my fancy Toronto surgeon’s practice was AAOS 2009, in the US, and a similar paper was delivered at AAOS 2010. It’s ironic, because it seems that most of the surgeons who didn’t attend, didn’t understand, or didn’t care, were Americans. So I think you’re quite right, it can be lonely for a US ATR patient who wants to get the advantages of non-op rehab.
I love Johanna’s story, at achillesblog.com/johanna , where she just barely reversed the practice of a big fancy hospital in Stamford, CT (IIRC), where the ignorant and arrogant surgeons virtually broke her spirit before they gave in. I’m not sure she’s returned to give us a long-term clinical update, to confirm that her leg also “won the fight”. (I’m also curious about whether that hospital returned to its Bad Old Ways after Johanna went through, like the Red Sea after it parted for Moses and the Israelites!)
For you, I’d say you should be quite safe to play tennis now if you want to. Whether you’ll be sore and icing afterwards is another question, and also whether you’ll be happy with your mobility on the court. Re-rupturing at 10 months is virtually unheard of, and (forgive me!) if it IS hanging by a thread for some reason, you might as well tear it and get it fixed.
In the long run, for future US ATR patients, I’d expect the non-op choice to become more fashionable, unless some big studies reverse the recent trend in the evidence. Mind you, even in Toronto, it’s HUGELY to the average surgeon’s advantage to have his ATR patients choose surgery. My guy turns away so many surgeries that it didn’t cost him a nickel to do the Right Thing, but he’s an unusually busy superstar. My Daddy used to say “Go to a carpenter, he’ll tell you to use wood!”, and I don’t think that’s just about charlatans and Bad People.
Hi Norm! I agree that location does make a difference, in my experience anyway. It may take American docs and physical therapists a much longer time–especially considering how litigious our society can be–to consider the NS option as a viable alternative. I do think I raised awareness of NS among those who treated me, taking a page from Johanna and her success with her surgeon. But frankly, I would rather have had their 100% support and commitment to get me whole again.
I think you’re right that I could probably play tennis–at least hit the ball without any running around. My ATR is 100% healed and has been for at least 8 months. It may be more of a mental block because it doesn’t feel right yet.
I’ll keep plugging on. I’m determined to get back at least close to where I was pre-injury and hope to report soon that I’m back on the court again and icing is a thing of the past!
Glad to see you’re doing well after your heart surgery and getting clearance to get back to beach volleyball!!! That’s great news, Norm.
Ya. I’d probably do some running around on the tennis court, but maybe that’s just me. Meanwhile, I still haven’t interrupted the sailing and cycling (and kite flying) long enough to try any volleyball, so maybe it’s NOT me!?!
I hear you, Norm. I will need to get over the mental thing and just go for it on the tennis court. I’m giving myself a full year before I do so that I’m in good physical condition as well (that’s been equally challenging). I’m looking for a personal trainer to help with that…
I read a post here by Scott who talked about the “full” feeling in his leg at 13 months and that’s exactly how I feel. Even at rest, it just feels different & I’m interpreting that to mean it’s not 100%. But, maybe that’s the permanent feeling. Everyone is different, as you’ve pointed out consistently, and no two ATR recoveries will be exactly the same.
For now, I’m pleased I can walk on two strong legs and most of my physical activity is restored. I’ll be thrilled when I can do everything I want to do without running for an ice pack afterwards. Patience…
Hi Northrancher,
Glad things are going on the right path. I am currently at about 10 and half months (can’t believe it’s been that long) and am pretty much back to normal. I can’t say my AT is as it was before the rupture, but I’m not really expecting it to be. I had knee surgery about 15 years ago and it never felt the same again so it’s not an unexpected situation to be in. I can do everything I did before but it just feels different. A bit vague I know, but thats the only way I can explain it.
My calf is still about 1/2 cm smaller but I can do calf raises etc. The only time it feels weaker is when I run but I’m sure the strength and stamina will come with time. I haven’t really pushed it but as I’m on the summer break now I might give it a bit more effort.
I have to say I’m really happy with going down the non surgical route as my body doesn’t cope well with surgery and I am pleased with the progress. The starting runnning was a worry but I think it’s the mental strength that we have to regain. Most of us ruptured because we go for things with determination and I think we loose a bit of that to the fear we may do it again. We just need to forget the what ifs and go for it. Non of us knows what’s round the corner. So go out and enjoy your tennis, take it easy at first but I’m sure it’ll help you bring the strength back, after all the other leg became that strong from the activities you do. Good luck with the tennis and let us know how you get on. LL
Hey El Norte Ranchero, My ATR was July 30, 2011 while playing tennis. As it happened, the Dr. my HMO assigned in San Diego was a Canadian, and had participated in a study that showed good outcomes for non-surgical treatments. My MRI showed a “high” rupture near the top of the tendon where it attaches to the calf muscles (badly torn but not completely ruptured, so no surgery). At present I’m 9 weeks out, walking around in a boot, and I found the blog. Your posts interested me because I wonder about how a non-surgical recovery is going, and also because of my fears of ever repeating this mess (sometimes my other achilles feels sore). Wondering will I ever return to the tennis court, which has given me so much fun over the years. Is fear a good thing when it comes to ATR? Anyway, thanks to you and the others for posting. Dave B.