pauls’s AchillesBlog

I DO think there is a preventative “therapy” to use… but if you’ve got niggles, it may be too late: strength training. Strength of connective tissue can be improved- it’s just slow to respond. I am absolutely committed to a strength training program - for the long haul - to help continue the recovery of my ATR… but even more importantly, to ensure that the “good” Achilles remains strong, and better prepared to handle the loads I might put on it.

I wish there was some good ATR preventive therapy to use if you do get niggles, or any signs, etc. I’m not convinced there are. If it’s going to happen, I’d rather get it behind me than delay it. . .

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I think the first time I started running again was around July 4th which was 12 weeks after surgery.

When I started I would “run” 20 paces and walk 40, run 20 & walk 40. I alternated one day of run/walking and the next day was only walking. Every few days I added 20 paces to the run and 20 to the walk until I hit 100 paces running. After I hit 100 paces I switched to time (2 minute run - 1 minute walk) and gradually built up my endurance and strength. The best approach is a gradual increase in distance & time. Don’t worry about your speed or keeping a steady pace.

My weekly routine is Sunday - off, Mon - morning run, evening kickboxing, Tues - morning run & evening karate, Weds - morning run, evening kickboxing, Thurs - morning run & evening karate, Fri - off, Sat - morning run & morning kickboxing.

I’m also taking several supplements on top of a fairly healthy diet.
Morning: Multi-vitamin, fish oil, “Lig-a-tend”, Magnesium, zinc, Vitamin C, vitamin D, 25 grams whey protein.
Evening: Fish oil, “Lig-a-tend”, Astragalus (for immune system), magnesium, zinc, 25 grams whey protein.

“Lig-a-tend” is a

Pauls– I did my first run 17 weeks. (again, my surgery wasn’t ATR so may be different) I started with a walk/run ratio of 1 min walk/ 2 mins run for about 30 minutes on a flat and gentle surface for the first week (I think I did 2 runs the first week) Then I started on roads w/o hills 2-3 times a week for a couple weeks. Being a trail runner, I kept hiking in the woods and started running every smooth and flat section of trail I could find between the hiking (this is New England…most of our trails are covered in rocks and roots, so those smooth surfaces were few and far between)
I’m in my 6th month now and I run 5x’s a week– I ran my longest run of 15 miles this weekend on trails. I still have to be careful on the really tricky sections of trail because my AT foot is still weaker. I know we are all different, but running post AT is possible…listen to what your AT is telling you and back off when it starts to bother you. (mine still hurts more AFTER a run than during it, so I use ice post run and wear my compression sock for a few hours)

I ruptured in October 2011 and started running again in mid-February 2012 - this was once I knew I could walk/hike all day without any ill effects.

From memory I think I was already up to about 12 miles sometime in March so it didn’t take long to get going again once I started. No point in rushing it though.

I don’t think I’ve ever heard of a rerupture after 20 weeks, maybe even 15 or 16. Of course, at 67, the memory isn’t what it used to be…

Hi Pauls,
sounds like you’re doing incredibly well! My rehab doesn’t reccomend running for up to five months due to possible re rupture. I re ruptured at 13 weeks non op and am now 3 weeks post of with a tendon graft. I am in a boot and following UWO protocol roughly…
FWIW my surgeon says he sees more re ruptures after surgery as people think the repair is stronger. I wouldn’t wish a re rupture on anyone, your tendon sounds bionic…Don’t forget you’re only 13 weeks hey?

crutchesintx, on September 18th, 2012 at 1:03 pm Said:

“Awesome. Congrats! Probably feels real good to get that sign of by the doc”

Could not agree more.

I tried running today, my ankles not ready for that I definitely lack the ’springyness’ that comes so naturally on the strong side - I look like the peter kay description of a “dad run” ….but I can see already how confident you are, you’ll be running again in no time.

Great milestone, great feeling, keep pushing but be mindful of the communication and feedback your body provides as you power through…don’t be afraid of rest if it aches

Happy continued healing.

Awesome. Congrats! Probably feels real good to get that sign of by the doc.

Andrew- cycling was a very important part of my rehab. I got on a spin bike starting around 4 weeks, was first riding outside at around 7 weeks, and was trail riding at 9 weeks:

achillesblog.com/ryanb/2011/10/30/mountain-bike-video-9wks/

I started on the pavement, using my mountain bike. Living here in Utah, it’s very hilly - the wide ratio of gears on the mountain bike allowed me to keep the pedal forces down, using higher RPM.

From the very beginning - even at 4 weeks on the spin bike - I have always used my regular clip-in shoes.

It was quite a while longer (months) before I was able to pedal with full force, standing up. Now (@1 year) I don’t feel limited on the bike at all- though my heel will occasionally get a little sore after really long/hard mountain bike rides.

Hi Andrew, This week was on a paved trail on my MTB with my son, we averaged 12mph so not fast but a some points go up to 22mph. the trail is pretty flat not much in the way of hills. So a great way to build up strength without too much pressure on my Achilles. The week before I rode my Road Bike only managed 4 miles as this was very hilly and hurt on the hills, so I will stick to the flat for a while to build up the muscles and work up to the hills down the road.

I had NO pain at all even after I had finished the ride. HAPPY DAYS!

Congrats Pauls

As I am contemplating increasing my cycling activities, I wanted to ask a few questions which I hope you don’t mid:

What type of bike was it, was much resistance involved?

How did the ankle/calf perform over the duration?

Paul- if that pain is at the crease of your ankle (on top), then it sounds similar to something I had. It turned out to be the result of pretty bad ankle pronation - arch of my foot was collapsing, allowing my ankle to collapse to the inside. I don’t know if my foot was just weak form inactivity, or if one of the functions of the Achilles is to support the ankle in this manner (I suspect the latter). In any event, while I built the strength back up, a good set of orthotics, with a lot of Arch support really helped get rid of that pain.

Nice result there Paul, congratulations.

When I get that pain in the top of my foot I slow down and shorten my stride as it’s a pre-cursor to the limp coming back - as Starshep said, better to walk correctly and steady than incorrectly and fast (I always feel I am tempting fate by doing so), no swelling though (I assume that is a good thing).

Nice early progress though, enjoy and happy healing

Pauls:
Great to hear about the minimum swelling and lack of tendon pain. I would suggest that you concentrate more on walking without a limp than on walking speed for now. The speed will come. A limp is a nasty habit to break. My therapist always made me slow down if he detected a limp.

Nice!! Congratulations… normalness now in sight!

Wow! That’s great news and I have to say I’m envious of your ’speedy’ recovery
I have sharp pains down one side of my injured foot and was told it was because the other muscles and ligaments are overcompensating for the weakened Achilles but that it will get better as I build up strength. Apparently cycling is really good for that so keep going!

Congrats, Paul! Doesn’t it feel great to be able to get out and about after all that sitting?! My calf hurt during early cycling sessions occasionally, but now I can go to fatigue with hills, etc., at 17 weeks. Keep it up!

Outstanding! 8 weeks is when I started “walking” again. Take it one step at time and you’ll make steady progress.

Excellent work there Paul, 9wks and walking a mile and cycling, I walked a mile today in two half mile stints and the pain I had detailed was apparent again with a quarter mile to go, I am given to understand it’s a mobilisation thing.

my physio said it’s not good to try and push past it, but walking up to that point where the front of the foot/ankle junction starts to ache would help loosen it up as ling as I am able to walk further each time then it’s the right thing to keep doing.

Congrats on the progress thus far

thank you Sheena I will be 9 weeks on Friday, not that I am counting

At ten weeks I think you’re doing very well??

Sounds great! I thought you were on a slowish track, but I obviously had you confused with somebody else. Don’t forget to Watch Your Step!

Good for you! Must feel great to be getting so much closer to “normal” again.

Wow they do seem conservative? I hope you take it to the level you are comfortable with? I push it, but only until it gets sore or throbs then back off.
I feel that you have to go it somewhat on your own. I am going to use the PT when I start to just help guide the strength training. The rest I will do myself!
I hope you get well soon!

Good news Pauls - I had my physio assessment today and at 12 weeks, was sent away with the basic exercises and told not to cycle (even on a stationary) for another two weeks - I get the feeling my hospital have experienced some re-ruptures in the 8-14wk range when (in their optinion) the rehab became more aggressive.

So when they tell you these things you can’t help but feel more cautious towards pushing the boundaries in these ‘dangerzone’ weeks - I hope all continues to go well for you and I will be watching your progress with great interest

Awesome! Sounds like it was a good day for you!

Keep up the good work, and you’ll notice big changes and improvements soon!

Can u link me a website that has one of these neuro muscular therapy machines - I’d like to see if I can find one here in the UK.

Hi Frustrated Coach,

The neurological machines works off DC current which is the same electrical pulses that your body uses, so in effect it doesn’t know any different where as a Tens unit is like sticking your fingers in a power outlet. Your not ment to do it and your brain can’t process that type of current.
Alot of top athletes use this treatment for recovery and in their training program to inhance training. I damaged
My shoulder last Christmas and using this treatment we managed to get it healed and built up 1/2inch of muscle on my deltoids in 10 treatments! It’s like doing a monster gym workout. Not going to say it doesn’t hurt, not in a nasty way just a funny tingly way. Hope this helps. If you need any more help on this let me know, as it a great way to help your recovery and more!

What is the difference between neuro muscular therapy and tens unit? I have a tens- can it work the same?

Yipee ! that’s great progress!

Congratulations!

Get a heal pad shoe insert from your local sporting goods store. It will help some and not a bad use of about 10 bucks.

I’ve been walking for almost a week now and jacuzzi helps and today I iced down leg to reduce swelling. That helped too.

Welcome back to two shoes!

Crocs are also very comfy when you get into 2 shoes. And ya, squishy gel inserts inside the boot. Rolling your bare foot gently over a ball (tennis, super, whatever) also seems to help de-sensitize it.

Don’t forget to build up your other foot enough so your hips are even when you walk.

Have you tried one of those gel shoe inserts? I bought a heel gel thing .it was a thinish blue shoe insert , made my boot way more comfy under the heel area.

Great news Pauls,

I did exactly the same, got rid of the crutches in the house wk6 and on or around wk7 for everywhere else….but I never really walked more than about 50mtrs, the RoM setting in the boot made walking distances uncomfortable until I reached the neutral setting.

In terms of the heel pain, I used a thin towel folded in half then in half again, this also created a washable inner for the liner that kept the boot liner clean and fresh

I agree with RipTorn. I bought a gel insert for my heel & it did feel lots better. I also found when I’m walking, that I was not using the ball of that foot to help absorb the shock & consequently the heel was taking the brunt of the weight. Had to be more conscientious about rocking forward when I walk & using the ball of my foot more in the boot. Otherwise, it feels like the heel is bruised & trying to walk bare foot on a hard surface was painful. Another helpful exercise when I took the boot off at home was to toss a small towel on a slick floor & place my foot on it. Then I practiced toe scrunchies where you grab the towel with your toe and pull it backwards to build up the toe & promote plantar flexion. You can also practice picking up marbles, socks, or tissue with your toes if you’re around carpeted surfaces. Good luck.

About the same deal. Out of cast and off with the boot in seven weeks. Today I went to local sporting goods store and bought a gel ankle insert to ease the feel of a bruised heel with thorns. A good investment for $10 bucks.

Try it and you’ll enjoy each step even more!

Paul,

I got started Graston 2 x’s a week in PT after I was cleared as unrestricted by the Dr. for the full range of PT modalities. It hurt like the devil and I have a hgh pain tolerance, but it really worked to keep the ankle free of sticky scar tissue. My therapists even show me how to do it on my own at home for when I was done, with the “dull” end of a butter knife.

Each therapist had their own style, some sections of the leg hurt more than others, just do what you can bear, and if it hurts, have them just lighten up on the pressure. I will say it worked for me.

About a year ago, it seemed lots of people were getting it to break up scar tissue. It hurt a lot AND usually helped a lot, too. I don’t recall a lot of “newbies” mentioning getting it.

Ya, uscgdiver, all the modern (>2007) randomized trials (4 of ‘em) showed comparable results for non-op and surgical treatment, and they all used ONLY patients with COMPLETE ATRs! The UWO study is the newest and biggest, and the full text is here on this site — look for “Studies” on the Main Page.

It seems logical (and most Docs believe) that non-op should work even better with partial ATRs, but I’ve never actually seen any evidence that it’s true (or false). Logically, surgery should provide a huge benefit for complete ATRs, but the evidence shows Not So Much, either none at all or relatively tiny on average, depending on how you treat the data and the statistical significances. So I’ve come to distrust logical “proofs” in this field. When your theory disagrees with the facts, it’s not smart to blame the facts!

uscgdiver,
In some cases, a full tear may require surgery but often it does not. I, normofthenorth and several other bloggers on this site are living proof of that. Studies done, most notably by the UWO have shown no statistical difference between recovery rates and re-rupture rates when using the latest fast recovery protocols for surgical vs. non-surgical repair. Unfortunately, the viability of non-surgical repair does not seem to be widely known. Even at my PT facility, one of the most respected in Chicago, none of the therapists had handled a non-surgical repair and I was quite a novelty.

If you would like to know more about non-surgical repair and the UWO study, normofthenorth’s blog has a lot of information on it.

No worries - you’ll get there. I snapped mine kickboxing and went back the day after surgery. Stay involved, be smart but push it right to the edge but no farther. That edge will continue to get farther and farther away. Try this post of mine if you need a kick: http://achillesblog.com/skutr/2012/07/04/12-wks-i-cant-and-wont-quit/

Blessings - Skutr

Hey Paul,

Wow, great shots of the surgery and they really did put a fork in you!! Your scar and ankle are looking really good. My leg still looks like that.

To address your comment on not having surgery, I only had a partial tear. With a full teat they have to go in an re-attach so the tendon will mend, and pull your gastrocnemius and soleus muscles back down. With my Achilles still attached, the Dr. just took all the pressure off it it and it realigned and began healing on it’s own…ah the amazing body.

Don’t push too much, listen to your body and try and follow the Dr.’s and PT protocols and the time will go by faster than you anticipate.