Peter’s ATR blog

I haven’t written in a while, but here I notice it’s been 1 year since my ATR. Actually, I can’t even remember what “ATR” stands for anymore, so that means I’m doing well. I’d say I’m 97%. It’s a tad stiff in the morning, but I never really notice it. I’m playing soccer again, biking, and climbing. After my 4 month “fully healed” status, I continued slow progress to about 6 months where I was actually “fully fully healed”, as in I could play sports competitively. For those just joining the club, be assured that you will get better eventually. God knows 4-6 months sounds like a long time when you first get hurt, but after a year, those painful first weeks are soon forgotten.

Peter

- PS regards to comments on my last post, yes, it is me on the bike… and yes that is a regular shin guard over the boot.  And yes my name is “Peter” not “Bryan”.  Bryan took the picture - hence the picture name “biking with Bryan”.

The fact that I haven’t written in 6 weeks is good news; it means I’m not thinking much about my achilles anymore!  I feel like I’m done the ordeal, and thus I’m writing a “summary”.

At 4 months, I can say that I’m back to normal.  Not perfect, but normal.  Static calf strength is on par with the good leg.  Flexibility is no longer limiting me.  I’m doing drops on my mountain bike without the boot, running, jumping, hiking and even played a bit of (noncompetitive) basketball.  I saw my surgeon last week, and he seemed very impressed with how good it looked.  He basically told me to get out and don’t come back, you don’t belong here among the injured (although not in those words).  And also asked “who’s your physio?”  I didn’t tell him the 2 sessions I had with my physio were useless, but I did my own physio based on people’s recommendations from this site.

If you’ve just hurt yourself, you probably haven’t been following my story, so here’s a summary of my experience and the major points that I’ve learned.

Although some may consider me to have healed quickly, I don’t think it was especially fast.  It sure didn’t feel fast.  It’s about what I hoped for when I first hurt myself, based on the research I had done.  Pro athletes can return to competitive sport in about 4 months, so for me doing sports non competitively at 4 months is about right.  Here’s a summary of what I could do when:

Day -2: Went to hospital with injury.

Day 0: had surgery, when home same day on crutches.

Day 3: Discovered forearm crutches, and how much better they were than ampit ones.

Day 5: Went for my first bike ride around the block (with splint on, careful not to fall)

1 week: Back to work in the office on crutches.

2.5 weeks: Got the boot and went FWB.  Also started bicycling in the city and on easy gravel paths.  Also started gentle physio.

3 weeks: Life “back to normal” except for wearing boot.

~3.5 weeks: started gingerly walking around the house without boot (weight on heel).

6 weeks: started mountain biking (in the boot)

10 weeks: Ditched the boot, started aggressive physio.

11 weeks: First calf raise, allowed limp to disappear.

4 months: Fully healed, doing sports.

???:  Confidence to try full out sprinting again.

Looking back, this is what I have learned:

-Don’t be over cautious.  Realize that it is a very localized injury, and don’t let that one tendon hold the rest of your body back.  As long as you are responsible and understand that you must protect the tendon from being overstressed, you can do more than your doctor will admit.  This included for me the following things which helped immensely:

• Going straight to FWB and skipping PWB while wearing the boot.  As long as there is no load on the tendon it’s all good.
• Walking around the house on my heel with no boot.
• Doing as much as possible in the boot (such as mountain biking)
• Working out the unaffected muscles in your injured side as much as possible to make walking easy later.
• Starting light strengthening exercises early.  As long as you don’t overstress it past a safe level (thanks to Doug for this one).  This really limits atrophy over doing nothing.  The general rule given to me and others is that you can only stretch it using your own muscles in the front of your leg.  I measured this force to be about 30 lb, so deduced that I can also push with 30 lb with my calf and not put any more stress on the tendon than my doctor-approved stress.

- Don’t be under cautious:  I was getting overconfident with my crutches once and fell down the stairs and landed on my bad leg.  Fortunately the angle was such that it bent my foot the other way and didn’t stress my tendon.

- Be cautious of over-lengthening your tendon.  My doctor was very concerned about this.  Although it seemed weird at first, after reading blogs of several people who had their tendons end up too long, it’s a real concern.  Basically, don’t worry too much too soon about getting your flexibility back.  It will come back with time.  Your muscle gets tight with the surgery, and if you stretch it too much while it’s tight, it can loosen later and end up too long.  Having had a “over short tendon” recovery scheme, I can say that it has worked well.  There were periods where my bad calf was actually stronger than my good one at the limit of plantar flexion since the muscle could still contract well.

Overall, I think my experience is summed up by this picture of me biking in my boot.  Don’t let this injury hold you back!!!  Find things you can do.

Biking in the achilles boot.

Exactly 11 weeks post op and I did my first full weight calf raise!  Well, I didn’t go all the way up, but my heel definitely came off the ground.  So 11 weeks and 160lbs strength.  The agressive physio is definitely giving me much faster gains than I was getting before with my tentative self-physio.  A pleasant surprise, and I don’t feel like I’m on a plateau, more like a steady climb.  My limp is almost gone.  Flexibility is still bad, but gaining quickly.  I’m at +3cm now (toes 3 cm from the wall when knees touching).

That’s all for now.

Here are a few shots of my calves at 11 weeks post op.  Definition is coming back slowly but surely!

Hi Everyone,

I’m wondering if anyone has been regularly measuring and keeping track of your calf strength over the recovery period.  I would love to hear from a few of you.  Here’s my experience (from memory, I didn’t do a scientific log book in pen and get it witnessed or anything).  Measurements are taken using a regular bathroom scale, pushing down with the ball of my foot.

Weeks 0 -3: In cast, unkown.

Week 3: ~30lbf - tendon pain limited.

Weeks 3-7: Steady linear gain to 80 lbf, tendon pain limited.

Weeks 7-10: Started to become calf fatigue limited on multiple reps, about 10lbf gain per week

Week 10.5: 120lbf, calf fatigue limited

Next milestone is to get to my wieght of 160lb, which means I can do a calf raise.  At this rate that’s about 4 weeks away.

Just a quick update on my progress since getting the green light from the surgeon to step up my rehab.  In 5 days since ditching the boot and doing some stretching and strengthening, I’m now walking with only a slight limp.  I can do 3 sets of 15 calf raises while standing on both legs equally (1/2 my weight on each leg), so I’m gaining some strength.  I’ve gone from -5cm of flexibility (knee is 5cm from the wall) to -1.  +15 is normal, so I’m 1/5 of the way there in less than a week.  Another 3 weeks at this rate and I should be there.  I’ve been making slow and steady strength progress since I got the splint off at week 3, but I feel like I’ve reached an important milestone as I can now use the muscle for walking.

On a side note, I wasn’t too impressed with my physio session.  The guy was fairly new, so when I told him my injury, he went to his computer and printed off a standard re-hab protocol from the internet (one that I’d already found on this site).  I tried to walk around the physio office, and had a really heavy limp.  “Why are you limping?” he asks.  Uhhh… isn’t that what he’s supposed to tell me???  I just had by tendon sewed up, remember?

Anyway, I’ll go back for one more session, but honestly this site and others’s blogs has helped me more than the physio session so far.

Also, I survived biking at Whistler Bike Park, including one fall off my bike where I landed from about 1 meter up on my bad leg (boot on) with no damage.  Yay boot!  Oh, and the biking also seems to have healed my back.  Sweet!

Here’s a pic of my biking setup with the boot I’ve been using since about 6 weeks post op.

I officially hit the 10 week mark (ok 10 weeks post ATR, I guess I’m a couple days short of the op but whatever), so I’m finally cleared for 2 shoes.  I went to work today for the first time without my boot.  I have a very heavy limp.  Physio starts this afternoon, so I’m on my way!  Oh, and my back still hurts.  I’m going biking at Whistler tomorrow anyway, hopefully I don’t snap a back tendon or something.

Well, I guess I really am closer to 30 than 20.  I can’t even lift big rocks and shovel dirt all day without my back going out.  I suppose the good news is that my Achilles isn’t the part of my body that hurts the most anymore.  2 days ago I decided that I was going to go out and help build a trail on our local mountain.  4 hours of hauling 200lb rocks and shoveling dirt (wearing my boot of course), and what happens?  I strain my back.  My lower back muscles feel hard as a rock, and twice the size the’re supposed to be.  I was noticing over the last few weeks that my back was starting to hurt.  I think it may have to do with the muscle imbalance caused by one leg being longer than the other due to my boot.

So here I am, NOT going to whistler for some downhill biking, but it’s my back holding me back, not my Achilles.  Getting old is a drag, and I’m only 26!  Sheesh, and it’s only going to get worse.

Well, after about 5 weeks, I’ve hit the dreaded “plateau”.  I’m still making steady progress, but it’s slow.  I’m still in the boot, my surgeon wants me in it until week 10.  But at home I walk around without it.  My strength is improving.  I’ve been swimming regularly now, and doing “aqua therapy”, walking around in the shallow end.  It feels good to walk “normally” in the water.  On land I’m still walking on my heel.  I can do a calf raise with my bad foot in the shallow end with the water at my waist.  One more week and I start official physio and can re-start doing range of motion stretches (my surgeon had ordered me to stop stretching it since it was progressing too fast.)  I suppose I’ve done good at that; I haven’t gained any flexibility in the last 2 weeks since my visit with the surgeon.  It’s frustrating just having to wait, since my flexibiliy is really what’s holding me back from walking properly.  One more week, and then I’m out of the boot and can start stretching again.  I’ll still put the boot back on for biking though.  Maybe I will get a lighter brace of some sort eventually, but for now I am addicted biking in my boot.  Maybe for road riding I can go without the boot sooner, but doing jumps and drops and such I think I want to keep the boot on.  I’m thinking of going to Whistler Mountain Bike Park next week.

Hello fellow victims,

I’ve just noticed that there is one point just under my incision scar that seems to be stuck to the tendon. I think this is somewhat normal (and bad). I think I need some massage to free it. Can anyone recommend a massage method I can do on myself to free the skin? I suppose I could go to a massage therapist, but I figured it should be something I can do easily enough to myself. Does it take lots of time to slowly loosen, or is it sort of a “pop” thing where you break the adhesion forcefully?

Thanks,
Peter