Month One Rehab Plan

On 2/1 when I ruptured my AT I went home and got online immediately to try to understand what I was up against in this recovery.  The first thing I checked out was youtube so I could view an AT surgery and watch some video’s of how others ruptured their AT’s.  The next couple days were pretty busy with Ortho visits and then surgery.  After surgery I felt pretty limited with what I could do.  I really didn’t want to strain the repair with much movement for a couple days.  What I did do was visualization drills.  I would close my eyes and imagine myself playing beach volleyball and running through a park to try to at least maintain the mental connection to my withering leg.  On about day three I started to combine the visualization with small range of motion.  In my splint there was about a half an inch in every direction that I could stretch.  My ROM exercises were the basic up down, left right, clock wise circles, counter clock wise circles and alphabet writing.   I would also flex my calf without moving my foot to try to slow the atrophy.  Doug53 mentioned a study about muscle atrophy in rats and the slowed effects through massage.  I went to target and picked up a $30 dollar massager and was able to use it through my splint.  Like Doug said, worst case is it feels good, best case it slows atrophy.  Once I was off the percoset (day 3 post op) I went to my buddys garage that has been converted to a weight room and worked out with my upper body.  I’m not sure if that was the best idea to create more work for my body.  Healing my AT and repairing muscle tissue from the work out may have been a bit of an overload.  At the same time, I didn’t care because it felt so good to still feel strong and maintain what I could.  I continued this routine for around five days.  At day six I started to include some rubber band work with my bad leg, swinging my leg forward to work the quads and then backwards to work the hamstring.  I would also attach small weights by velcro to my leg and lay on my back and simulate cranking a bike as well as spread eagles.  I looked a bit like I was in an aerobics class with the exercises I was doing.  I have read of people working out their good leg and wishing they hadn’t so I mostly worked the bad leg.  My good leg got plenty of work hopping around on the crutches and I didn’t need to get it fatigued in the gym.  I also didn’t want to increase the imbalance in strength between my good and bad leg any further.  For loads of detail and exercises to choose from go to youtube and search for achilles rehab.  I continued all of this until I got my cast on on 2/17.  With the cast on I began PWB and FWB along with everything else I’ve described above.  With my cast off (2/23) I was able to measure my calfs, the good one was 14″ while my bad one was 13″.  Around 2/23, on days when my AT was feeling good I started doing seated calf raises from my bed.  I would sit on the edge of my bed with no weight on my knee and lift my heel.  At first I had to spot myself by lifting my knee with my hands to get the full range of motion.  After doing this three times I could then do it without a spot.  Once my calf got a bit stronger I would work the eccentric (some call it negative) motion to enhance strength in both motions.  On 2/28 I included a bike ride with my vacocast strapped tightly.  That was a successful way to work my quadriceps and hamstring without causing any strain on my AT.  A stationary bike would be the best route, one of the rerupture’s I read about on this site was from a bike mishap with flip flops.  Now that my wound has healed I will add a pool work out to the list of rehab activities.  This will include ROM, walking forward and backward, heel raises and grape vine.  At first I will be in the water up to my shoulders and graduate my way towards dry land without the boot.  On a side note, my range of motion is greatly increased after a hot shower.  I may take a chance and do my ROM exercises in the hot tub.  My short term goals are to be able to walk in my boot with the dynamic range of motion and bench press my body weight ten times prior to 3/22/10.  On 3/22 D and I are going to Tulum (just south of Cancun) for a couple weeks and it would be nice to be able to use my calf to walk by then.  I see that trip as another turning point in my recovery as I plan to do loads of ROM and strength work in the warm humid air (while sipping on a cuba libre of course) :)

First post op visit 2/17

13 days after my surgery I was scheduled to see my Ortho.  At this point I was heavy into researching how other doctors throughout the world treat recovery’s.  I love the Internet and this site!  Think if this had happened to us 40 years ago…  My Ortho has a perfect track record of non rerupture’s after over 100 surgeries.  What he didn’t know was how his patients recovered once he turned them loose on the PT.  His protocol is very conservative, 2 weeks in a splint, 6 weeks in casts at different dorsiflection angles.  Effective for re rupture but not so good for 95-100% recovery…  Being an athlete in an explosive sport like beach volleyball I can’t imagine taking the chance of being in a cast atrophying away for weeks on end.  I even wondered why a cast is needed for this recovery at all.  With the amazing boot options out there why even consider a cast?  In fact I put together a pro con list to try to understand the benefits of casting. 

PROS;  Impact protection and taking chances while unprotected were the only two I could come up with.  Of course, the doctor sleeps better at night knowing you can’t get it off. 

CONS;  Can’t do light PT or ROM exercises, can’t  ice or ultrasound, swelling management (casts end up too tight or too loose sometimes), can’t massage, can’t make small adjustments to a cast to individual advancements in rehab, can’t clean your leg/wound, can’t get air and vitamin E to the wound, the slower the wound heals the longer it will be before you can safely consider pool rehab, cost (I’m out of pocket on this) and what it did to me psychologically to have a cast on. 

So 13 days postop I end up in a debate with my Ortho about the need for a cast when I had already ordered my boot (vacocast) which by the way, I LOVE.  My Ortho was so into casting that he offered to put it on for free and meet me half way on the timeline.  I was stuck, do I refuse his offer and strain the relationship or do I take the free cast.  He even told me in the debate that it would give him fewer grey hair’s if I were in a cast.  So, I figured take the free cast, keep the relationship healthy and save him some grey hair.  At first I liked the protection of the cast especially since my AT was pretty tight at the new angle of 5 degrees.  After two days the tension subsided and I then began PWB with crutches.  The angle made it tough to work on PWB so I took some towels and wrapped the heal with ace bandages to create a walkable cast.  After two days of this PWB I began FWB with little problem.  After two days of FWB I was ready for the next step.  That morning I spent a little time reading Doug53’s comments on his cast less recovery and was ready.   On day six of the cast 2/23 (19 days post op) I took a trip to the garage doctor and removed my cast with wire cutters, pliers and some gentle work with an box cutter.  This project took around 45 minutes and went without incident.  WHAT A GREAT FEELING TO HAVE THE CAST OFF!  I immediately started the next phase of my rehab with a shower, some ROM and some vitamin E for the wound.  I have photo’s and will create a link for them soon.  My wound was 2.25″ and looked the same as when the cast was put on.  Since then I can literally watch the wound seal up and heal.  Getting air and vitamin E did wonders for my wound.  Now with the boot at 0 degrees I was tight again for a couple days.  I went back to PWB until it was able to handle FWB.  To not over do it I would work a combination of FWB and crutch time.  My swelling has really fallen off now and I ice after a heavy day but it’s mostly in check.  I sleep with my leg on two pillows (without the boot) still but don’t really need to.  The recovery is really taking off now!  Yesterday D and I went on a bike ride to one of the local breweries for dinner and a beer in the sun.  Riding a bike works well with the boot on even though it is in a fixed position.  It is a bit risky but the boot is pretty close to the protection of a cast and I am being very cautious.  I love the freedom of being able to ride a bike again!  Today (3/1) my AT feels fantastic and the scar is sealed up enough to try a pool work out without worrying about infection.  Infection would be a big set back so I may wait until tomorrow (pool water can be nasty).  I have delayed my second post op visit as I don’t need his help or have any questions for him right now.  I want to spread these appointments out just in case I need him later.  The three post op visits are included in the price of the surgery so I want to milk it.


I asked my doctor and almost every nurse on their advice on how to eat best for tendon repair.  The overwhelming answer I received was protein, then followed up by a well rounded diet of fruits and veggies and stay away from simple sugars.  I am convinced this is the answer they give for most any recovery.  What I do know is get off the drugs asap, don’t smoke, and limit alcohol.  I was pretty hard core about this plan for the first three weeks of my postop and have slipped a bit lately with some ice cream, wine and beer.  Fiber is super important especially when your on percocet and bed ridden.  Percocet is definitely a constipator so know that going in and go to Tylenol when you want to poop again.  Some of the food I had in the cooler next to my bed was hard boiled eggs, spinach, sliced turkey, wheat bagels, sliced almonds, Gatorade, orange juice and smoothies.  The smoothies were fantastic and I enjoyed them twice a day for quite a while.  The smoothie ingredients are a variety fruit, banana, vanilla yogurt, milk, orange juice and low calorie protein powder.  The protein powder is called muscle milk light, I got the vanilla creme flavor.  The powderis loaded with vitamins and minerals and tastes pretty good.  The best source of natural protein is, and always will be eggs.  Eggs contain all of the essential amino acids required for us to survive.  Essential amino acids have to be ingested, our bodies can not fabricate these.  Enough about protein right…  Vitamin D is another interesting component to survival and possibly repair.  It is essential for life and the best way to get it is through sunlight and fortified milk (since the 1920’s).  The further you get away from the equator the more likely your are vitamin D deficient.  The downside of being deficient is largely understudied but what we do know is most of us are lacking this vitamin.  This is why I mentioned sitting in the sun when possible in the healing environment segment.  Unless you eat loads of salmon and drink lots of fortified milk or are in the sun (with a fair amount of exposed skin without sunblock) for an hour a day you are deficient.  For more info on this topic go to itunes and in the podcast section click on health, search for nutrition diva.  The program is called Dficiency and is worth the 10 minutes she commits to it, and it’s free.  I tried to drink plenty of water and even took vitamin pills.  I’m not sold on multivitamins but the risk is pretty small in taking them.  I would love more info on diet for tendon repair.  If anybody has info on this please forward it to me.  Thanks

Healing environment

I read a study about the recovery rate of patients in relation to their view from their bed.  A view of the outdoors vs no window promotes a substantially quicker recovery.  The study was on the soft side but I do know the power of the mind is worth tapping into.  With this in mind I opened every window shade to allow as much light in as possible.  With D’s help I set up a table outside my closest window and covered it with bird seed.  Knowing I would have a variety of friends to share my time with was great.  I have never been too much into birding but this experience of observing the different behaviors and species has been a good thing.  I tried to go outside when the sun was out even if it were for just 10 minutes.  Not only does the sun feel great but it also is the best source of Vitamin D.  Next, I placed a cooler next to my bed and filled it with the healthiest food I could imagine.  This way I didn’t have to drop my leg below my heart to get a drink or a snack.  Also, the cooler top is a nice place to place note pads, laptop, books etc.  It was also important to me to use music for it’s calming effects.  I don’t know if it’s healing but what’s the risk if it isn’t?  Laughter is also a great thing to tap into in this potentially ”down” time.  I am lucky to have had tivo prior to the ATR so I had a collection of Seinfeld, Simpson’s, South Park, Scrubs, Frasier and even some stand up that I could use to lift my spirits when needed.  A lot of this is online now for free if you have a laptop and a good wifi connection.  I was so into achillesblog that I really didn’t watch much tv or listen to my library of podcasts.  Some podcasts I have found to be amazing are Radiolab, DR Dean Edell, This American Life, Nutrition Diva and TED Talks.  My mother was a nurse for many years so we talked every day in detail about this process.  To her benefit, she encouraged me to split my focus to other topics besides the ATR.  She understands me well and was good at getting me to lighten up a little when I would get to obsessive :)   When I got home from the gym where I tore my AT I teared up a bit knowing how life changing this was going to be.  From that moment on I have done nothing but focus on what I could do to recover to 100% in the shortest/safest fashion.  If you find yourself getting down try to switch your focus to what you can do vs what you can’t.

After the knife

From the day I ruptured until 18 days later I spent 96% of the time in bend with my leg elevated above my heart.  I actually ran the numbers…  A friend of mine (my college roommate) went through a ATR and stated with no uncertainty that the first 10 to 14 days were the most important for recovery.  Leg up and rest as much as possible.  So that’s what I did.  My girlfriend was a champion in my recovery.   She went shopping and cooked for me, laundry etc.  What was so important to me was that she is a great listener.  To have somebody to bounce ideas off of as well as share in my evolution of knowledge was priceless.  I imagine it got old hearing me say Doug53 is doing this and NormoftheNorth recommended this study.  It was only through this process that I was able to build the confidence to create my own ATR rehab.    I literally spent the first two weeks postop reading every study and blog I could find that was relevant.  Sometimes even at the expense of sleep.  It was through this obsession that I came up with obsessivec.  The swelling was pretty bad but I was able to ice through my splint.  I really am impressed with the countless others who started PWB and FWB as soon as the day after surgery.  Sure the injury wasn’t painful but the swelling when my leg was below my heart brought the pain for 10 days postop.  I took percoset for the first couple days but missed a dose on night two only to find that the pain was tolerable so long as the leg was up.  I got off that stuff immediately once I knew the pain was a 4 out of 10.  It’s tough for me to take a passive role in my recovery so I wanted to do everything  I could to foster healing.  Since my goal was to get back to 100% of my original strength and ROM I felt it couldn’t be a casual approach.  My focus at this point turned to education about ATR, nutrition, visualization and creating the most healing environment possible.

Surgery 2/4/10

So monday 2/1 I ruptured my AT and thursday 2/4 was my surgery date.  My girlfriend went in with me to the hospital for support and to drive me home.  They recommended not eating after 12am and drinking after 7am prior to my surgery.  My surgery was at 3pm.  I did set my alarm for 6:30 am to pound some gatorade.  It’s good to have any advantage you can going into this sort of event.  I did not get sick as a result.  They knocked me out through the IV and it was nice.  I woke up rolling on a gurney being pushed by a nurse.  It took 2 or 3 minutes to be able to even talk coherently.  After sitting there for about 10 minutes D (my girlfriend)  loaded meup and hauled me off.  My Ortho talked to D but not to me.  He told her the surgery went well with a 15 minute tourniquet time.  He used #2 fiber wire to secure the tendon (non absorbable).  He told me later that to be sure the suture is secure he pulls on the fiber wire hard enough to lift my leg off the operating table.  The incision was 2.25″ running vertically.  I didn’t get the surgical notes but  intend to at my second postop.  My rupture was at the upper third of the tendon closer to the muscle.  There is very little info that I have found on the differences between a lower, middle and upper rupture in terms of recovery time and success.  If you have info on this please forward it to me as I am very curious about these differences.

No insurance 2/2/10

I spent the night with my leg up on two pillows stacked on top of each other.   My team mate Ortho recommended Tylenol over Advil to keep my blood thin so I took a few but still wasn’t in much pain.  I called my buddy who is fantastic at negotiations and business and asked him to come with me to the appointment on 2/2/10.  I knew I would have a lot on my mind and wouldn’t pick everything up when it came to my billing options.  He (John) had told me that if you pay cash they sometimes give you a large discount.  After ten minutes with the Ortho we spent the next two hours going from one billing specialist to another to assess what would be the best avenue to go down.  As it turns out, if you go through insurance they give a discount for that too.  It was about the same discount, roughly 30% off the up front cost if you pay cash up front or go through the insurance billing route.  I was told by my team mate the whole event excluding PT would run around 10k.  Because I told him I was paying cash he said he could get the MRI waived.  Pow, 2k off the top!  The rest of the costs went like this…   Initial visit to the ortho $120 bucks….   hospital house fee  2k….  15 minute surgery 1.2k…. anesthesiologist $670 bucks…..  percosot $20 bucks…..  borrowed ortho boot and crutches.  Total= $4010.  The surgery fee included three postop visits but did not include casting fees.  All of the amounts show above are after the 30% discount.  If you are paying cash, NEGOTIATE!  Also, become your own advocate in every process of this mess.  Having John come along with me helped out tremendously.  Bring a smart friend to take notes and ask questions if you can.  With strong pushing, I was able to get in for surgery on 2/4 instead of 2/9.  If nothing else, the sooner you get in for surgery the sooner the clock starts on your recovery.  Also, it just makes sense to me that the less time you spend ruptured the better.  My swelling was pretty minimal from the beginning so I was surgery ready pretty much from day one.  Norm of the North (ATR blogger) talks about a recent study that suggests the non surgical route is just as effective for recovery.  It takes a bit longer but doesn’t cost 4k and there is no threat of infection.  Look into it before your decision.  I wish I had.  Also, one of the questions I asked was “if I don’t have insurance are there any low income options?”  In fact, there were but I had already told them that I had insurance so I couldn’t go that route.  I work for myself and have a low stated income that may have enabled me to take advantage of their program if I hadn’t mentioned my catastrophic insurance plan.  Don’t be afraid to ask, it may be worth $100 bucks a word…

Ground Zero 2/1/10

I’m a 38 year old male from Oregon and have been an athlete my whole life.  In high school I played football, basketball and was in track and field.  I also was in track at the U of O for the pole vault.   Track may have been the beginning of my left achilles rupture.  I long jumped, triple jumped, high jumped, hurdled and pole vaulted.  All of these events are for the most part exploding off of the left leg.  I now mostly play beach volleyball (doubles), snowboard, wakeboard, waterski and hike.  I joined a hoops league to try and get some of my old hops back (used to jump 38″) but was very concerned about getting banged around.  At 5′9″ 160lbs I have to be conscious of the big bodies out there.  With nobody behind me, I went in for a rebound, was successful but just couldn’t land it.  I came down on both legs evenly only to have the left achilles blow out.  There wasn’t much pain associated with it but knew it was serious.  After trying to plantar flex with no success I couldn’t help but think of my buddy who just did the same thing a year ago playing indoor soccer.  I have a catastrophic insurance policy that doesn’t kick in until $7500 dollars so I was instantly wondering what advantage there would be to going to the ER.  I sat there long enough talking over my options that the game I was playing in ended.  Fortunately one of my team mates was a Ortho and took ten minutes to do the Thompson test.  Yep, he said, “your ruptured”.  He then told me he would get me into an appointment with his colleague.  A harvard graduate and ex pro fullback who happened to be a surgeon.  I didn’t even consider the nonsurgical approach but after reading so many of these fantastic blogs I might not go the surgical route if this happens again.