Here is my UPDATED conceptual ‘Living’ Protocol in pdf format..Seeking advice (Word template avail.)

Please let me know what you think - any tips, ideas or suggestions would be appreciated.  I went to 2 shoes this week with wedge in one shoe.

Please CLICK PIC below to view a pdf of my relatively aggressive and current, living protocol - which my Ortho loved.  Go at YOUR pace!

If you would like a Word Doc of this to create you own, email me, since I could not figure out how to put the word doc up.

My protocol is based on my goal, which is to start teaching Golf again in January and Tennis in May. I am suppose to finish a DVD this spring as well. What do you think?

Thanks, good luck and wishing everyone the best,

Moving Patiently Forward!

SPECIAL THANKS TO Dennis, Norm, Superjewgrl, Kellygirl, Hillie, Nicky, Upstate and Kkirk for helping me when I first came to this blog.  You made a world of a difference - Thank you!


39 Comments so far

  1. hopalong on November 4, 2013 10:29 pm

    Hi Ron
    Love it. A very useful document for others to use as a template.
    Thanks for sharing.

  2. craiger9er on November 4, 2013 10:33 pm

    Wow - very impressive. You’ve compiled a TON of information (not just in this post) and placed it in one spot where it’s easy to find without a ton of searching. Nice job on all this and I look forward to more posts on how you’re reaching these goals. Keep up the good work.

  3. Ron on November 4, 2013 11:38 pm

    Thanks Hoppy,

    I’m sure it will get buried, but hopefully, newbies will read a lot of different posts and run across it, eventually - if they need it. I know I read hundreds of posts because I had nothing but time on my hands for the first 2 weeks. LOL.

    With that said, I give most of the credit for my posts to the entire community.

    Thanks again, and I wish you the best.

  4. Ron on November 4, 2013 11:45 pm

    Hi Craig,

    Thank you, sir.

    I think I just have WAY too much time on my hands, and having 6 months off is killing me. LOL.

    I will try to keep up, but I just realized that going to 2 shoes is scary. :-) Guess the hardest part is not the first week, after all.

    I am also trying to NOTt hold myself back - if that makes sense. Wish I could get drunk (just once), but I can’t because of the Warfarin (1 beer is not drinking). LOL

    Will keep you updated, and happy healing.

  5. kellygirl on November 5, 2013 12:07 am

    You have made excellent use of the last twelve weeks! I hope this doesn’t get buried because it is full of great information. Your protocol looks excellent and I wish you all the best!

  6. normofthenorth on November 5, 2013 1:54 am

    Love the organization and the presentation and the info, Ron — and thanks for the thanks, too. You made me briefly consider pulling together a blog page with links to my fave web pages, from this site and others. . . but then I thought about how many hours it would take to do a HALF-decent job and I said Naaaaah! :-)

    But I do wonder why you call a rehab protocol way slower than — not to mention “Hillie’s” even faster Exeter protocol — “aggressive”. When the published results from those much faster schedules is so excellent, what’s the justification for being so much less aggressive?
    I know it seems so reasonable to ASSUME that slower is safer, but now that the evidence is so clear that it’s not so. . . Specifically, why not get to PWB at 2 weeks post-whatever (like UWO) or even a week or 2 sooner (like Exeter), and then get to FWB at 4 weeks post-whatever (like UWO) or even sooner? I’m not aware of any slower protocol that has produced results as good.

  7. Ron on November 5, 2013 3:32 am

    Hi Kellygirl,

    Thanks a lot. Means a lot coming from you. Just hope I don’t start chickening out now. LOL.

    Wish you the best, and thanks again.

    I’ll keep you posted

  8. Ron on November 5, 2013 3:41 am

    Thanks Norm,

    I would love to see you put that together, it would make great reading.

    I was using the term aggressive in a positive light because it seems that a lot of the newer people getting on lately seem to be moving a little slow (I guess in the back of my head, I was talking to them).

    I consider my protocol a little aggressive, but keep in mind that I am dealing with DVT’s and other things.

    Maybe I could have been at PWB in 2 weeks, but to be honest, I was way afraid to try. Yep, call me chicken-George. LOL.

    You really should put something together in a one or two page pdf, it would help a lot of people.

    According to the Exeter Protocol, you move to 2 shoes at 8 weeks, but I am moving into 2 shoe now (at 8.5), so I am pretty much on schedule, right?

    Thanks Norm,
    Talk to ya soon,

  9. Hillie on November 5, 2013 1:08 pm

    Hi Ron

    The template is excellent Ron. Similar to the Exeter version, albeit at a slower pace, but much more written down on the associated exercises, very useful for early stagers here. Suddsy posted a good one too. I did as much exercise but at the clinic they vary this a little at the patent and physio’s discretion, so only the basics were printed on the standard template, with the actual routine noted on file.

    Interestingly, for what is a relatively cautious protocol, by week 10 you are only behind by about 2 weeks, except for holding onto that crutch for so long. Normally this might have gone by week 3 or 4 (and therefore full FWB) but I understand your concerns about DVT and your ankles. Also, your initial pf at only 15º is a shallower angle than many where 30º is called for. I seem to remember that you spoke to the OPED guys - was it they who suggested moving the boot to ROM mode only after week 8, rather than after week 4 with a hinging rom of 30º to 15º at that time, opening further to 30º to 0 two weeks later? Maybe this was to spare your ankles - I don’t know what the problem was and I am certainly no practitioner.

    May 2014 looks good for the tennis and I wouldn’t be surprised if you do it earlier than this so long as you don’t go crazy from the start.

  10. Ron on November 5, 2013 8:43 pm

    Hi Hillie,

    Thanks for your input, and as usual, it is great.

    Yes, my protocol is based on a slightly scaled back version of the Exeter because of my DVT’s,
    previous\current ankle injury, and the fact that I am off of work for 6-9 months (which could be a problem in itself – I need to keep the pressure.

    After my injury, I thought it was a calf muscle injury, so I taught golf and tennis classes for almost a week, but on the last day, sprained both sides of my ankle (badly). At the ER, my ankle was the size of my calf and my calf was the size of my thighs (/w DVT’s). I sprained that ankle 100 times over 35 years\8 sports, and broke it about 20+ years ago with fixing it - thought it was just another sprained ankle.

    As of right now, I am FWB with no crutches (but keep them on my protocol to remind myself that it’s OK to pull back - if I push too hard, but will PWB if I get really sore or overdue my PT). I also plan to be in 2 shoes at 10 weeks and step it up from there. I also realized that it takes a lot of nerve to move forward at any stage. LOL.

    Regarding the DVT, the quicker I am walking, the better, so the faster protocol is actually preferred. However, for some strange reason, I was set at 15 PF from the start. I don’t think my foot can go to 30 PF because of above ankle issues. As a consequent, I was at 0 by week 5, but maybe that’s part of the reason why my ankles are a mess right now, too. They never healed from the sprain after the injury.

    With the above said, I just switched PT’s again. The first one was too new (text bookish), and the second one was too old (very conservative – wanted me to stay in boot for another month).

    The new one that I am going to see this Friday is supposed to be just right. LOL. The Ortho got involved on my behalf, so we’ll see. Not being settled into a PT routine is also a minor setup back, but it should be resolved by the weekend.

    I sent the new PT my protocol (without links, etc.), so he will know that I am ”somewhat edjumacated” about this matter. LOL

    Bottom line is that me and my PT have to be on the same page because I am getting edgy and need to get back to work.

    Your points all make sense, and that is why I love this community so much.

    Thanks again, and I will keep you posted - and keep asking questions.

    Have a great week, and Happy Healing!

  11. normofthenorth on November 5, 2013 9:29 pm

    Good luck with the new PT, Ron. Since it’s so rare to see anybody prescribing an ATR protocol that’s so fast it’s harmful — and super-common to see too-slow protocols prescribed — I favor prescribing the fast successful ones, and NOT calling them “aggressive”, except in the nicest possible way.

    Perhaps it should go without saying that every transition should have a little “(As Tolerated)” added to it, but very few patients should have any trouble tolerating the transitions in a successful well-proven protocol from a good-sized study (like UWO & Exeter).

    Ron, I will gladly defend your right to go slowly with your own AT if you choose. My only “beef” is calling a slower-than-optimal protocol “aggressive” in a guide for newbies.

  12. Ron on November 5, 2013 10:37 pm

    Thanks Norm,

    Got it. With that said, I like your advice and removed the “somewhat aggressive” part in the post.

    This way, newbies will know it is not that aggressive., but if I am in 2 shoes in 10 weeks, I think that’s great progress.

    One thing I would like to see is someone that has employed the exeter protocol on this blog - a year later. I know Suddsey is doing it now, though.

    According to the Exeter Protocol, you move to 2 shoes at 8 weeks, but I am moving into 2 shoe now (at 8.5), so I am pretty much on schedule, right?

    Thanks again,

  13. normofthenorth on November 6, 2013 4:31 am

    There are a number of dimensions in the speed of a rehab, Ron, and it’s hard to prove which ones are the most important. The timing of moving to 2 shoes doesn’t strike me as an especially important one, compared to PWB and FWB, the introduction of the different kinds of exercise and PT, and the various changes in angle angle.

    Gentle cautious walking in 2 shoes could seem almost indistinguishable from cautious boot-walking (and probably LESS beneficial than fast aggressive boot-walking), from the viewpoint of the foot. IIRC, Exeter is a week or two ahead of UWO in the early stages (getting to PWB and FWB), though it sounds like it’s converged with UWO at 8 weeks when they both “wean off boot”. Mind you, Exeter’s hinged Vaco boot gives more of an ankle/calf/AT workout in the last few weeks than UWO’s fixed AirCast boot. But you’re right, all other things equal, the difference between 8.0 weeks and 8.5 weeks doesn’t seem significant.

  14. Ron on November 6, 2013 5:26 am

    Thanks Norm,

    It will probably be more like 9 weeks when it’s all said and done, but I definitely get your point, and it makes sense.

    I just don’t want my fear to preclude me from being more aggressive when there is not reason not to be, if you know what I mean.

    Waiting for my shoe wedges to arrive so I can dump the Vacocast. Now I am not getting it with Vacocast ROM option because I’d rather we walking in 2 shoes than does some ROM work in a boot. LOL. It does feel scary good to walk around the house with no shoes or boot, with 1-2 crutches, though.

    It will be interesting to see what this third PT says on Friday (week 9). Good thing UIC has 20 of them. :-)

    Thanks again, and as usual - great advice.
    Have a good one.

  15. CliveC on November 6, 2013 6:10 am

    Suddsy and I swapped notes a few months back through this blog and found that he was a surgical case, while I was non-op. He was on a protocol similar to that from a London specialist, which was almost identical to my Exeter version. His rehab began this year, mine was over year ago. Both patients, I believe “are doing well”.

    Suddsy, how is the recovery going?

  16. Hillie on November 6, 2013 6:39 am

    Apology for any name confusion. That’s what happens when you allow a colleague (and former atr person) to use your computer!


  17. Ron on November 6, 2013 6:00 pm

    That’s great information Clive, and good to hear.

    I am pretty much on the same path, and started doing some no boot walking this week (8.5 weeks in), so I guess I am a few days behind. Just ordered my wedges for my shoes and will walk into my PT appt. on Friday if I have them. Let the work begin. LOL.

    Thanks and best of luck to you, sir.

  18. Ron on November 6, 2013 6:01 pm

    No worries H,

    Have a great day,

  19. Ron on November 6, 2013 6:47 pm

    Well, I finally committed to 2 shoes. So far, so good, but could use any advice out there.

    Thanks, and happy healing,

  20. kellygirl on November 6, 2013 6:55 pm

    Yay! That’s pretty exciting. I wore a brace when I went out to the grocery store to show people why I was walking around so slowly. Idk if it’s still shorts weather where you are though. I think, just be careful. Make sure that you have a heel pad to get your heel above neutral–makes it easier to walk. Enjoy your new found freedom from the boot but don’t go crazy!

  21. Ron on November 6, 2013 8:39 pm

    Thank Kellygirl,

    I will be careful. While on the one had this is VERY exciting, on the other hand, it’s somewhat scary.
    However, I do not want to be TOO careful and fall back.

    Sounds strange coming from a guy who was afraid of nothing up until now. LOL.

    Thank again, and wishing you the best,

  22. alanweibel on November 6, 2013 11:49 pm

    Looks great Ron. Lot’s of good links in there for exercises too!

  23. Ron on November 7, 2013 12:34 am

    Thanks Alan,

    I just updated my protocol because I moved into 2 shoes faster then I thought I would (or maybe wanted to - fear). LOL.

    Your blog is awesome! Please keep us posted.
    I can tell you put a lot of thought into the entire process, asked 100 questions and are ready to rock!

    I look forward to your next post.

    Thanks again, and good luck!

  24. steve on November 7, 2013 12:03 pm

    HI Ron,

    I started walking in two shoes 1 week ago today. It was tremendously scary for the first 3 days. Saturday was my breakthrough. I was forced to do quite a bit of walking and the more I did, I found myself not worrying as much. Take a longer stride with your bad foot and a shorter stride with your good foot. I found that to be helpful. I’m finding that it’s getting better and stronger each day. Good Luck!

  25. normofthenorth on November 7, 2013 1:38 pm

    “Take a longer stride with your bad foot and a shorter stride with your good foot.” My advice to new 2-shoes folks, but you said it best Steve! :-)

  26. steve on November 7, 2013 3:49 pm

    Thanks Norm!

    We were in Palm Springs this past weekend at a party. I was constantly concerned that some drunk idiot would fall over on me or kick me accidentally. Once Friday passed, I started feeling more confident. Saturday was spent slow grilling baby back ribs and serving drinks to our friends poolside. Things I used to do before this stupid injury back in late July! I’m finally starting to feel somewhat whole again!

    Good Luck All! It’s a long journey, but there a bunch of rewards along the way!


  27. Ron on November 7, 2013 6:56 pm

    Thanks Steve and Norm,

    i really appreciate the tips What did you guys do around the house? Walk barefoot, or did you always keep shoes on with the wedge?


  28. normofthenorth on November 8, 2013 2:46 am

    Ron, I didn’t use wedges in 2 shoes, a la . The main thing holding me back was super-sensitivity on the bottom of my foot. That made shoes uncomfortable and barefoot unbearable unless the floor was clean carpet! If I accidentally stepped on a stray fingernail clipping or a thin flat phone cord, I’d feel like I’d stepped on a board with a nail sticking out.

    I think I first tried gel insoles, which helped, and then I switched to a pair of (cheap Chinese imitation) Crocs. The squishy rubbery plastic under-foot made the whole house seem squishy and comfy to my super-sensitive foot. (I also rolled it over a tennis ball while seated on a stool.) As the sensitivity faded, I added in more barefoot walking, but mostly I still walk around the house in Crocs several years later.

  29. Ron on November 8, 2013 1:50 pm

    Hi Norm,

    Got it. Thanks alot. Off to PT.

    Have a great day.

  30. Ron on November 11, 2013 6:16 pm

    PT Help…

    My DPT is good, and says that there is a new protocol for PT (new to me, anyway). He has me really working my non injured leg (heel raises, etc.) in an effort to work the injured leg. He says that based on new research, it helps both. Does that make sense?

    On another note, I only lost 1 cm in my calf, which I guess is good, and my DF is at 3, but my toes are inflexible on both feet. Don’t know if that is good or not, but 2 shoes is a pain in the foot. LOL.

    He also said that the foot\ankles, knees and hips are connected and that I have to build them all up.


  31. hopalong on November 11, 2013 7:41 pm

    Hi Ron
    Funny old thing, but my PT said the same! Working the good leg/foot would refire the neurones to the gammy leg! Sort of made sence, but I was a tad sceptical! Esp As he didn’t have me doing much else as I was at Equinous.
    By the way how are the shoes? Have you gone for high ankle boots outside as some have suggested? Crocs inside, and heel raises for both? Heel raises how high? Would be interested, as that’s my next big step on this long road!
    “To cross the river you need to take small steps” to misquote some Chinese sage!
    Cheers Hoppy ( more like limpy now!)

  32. Ron on November 11, 2013 8:18 pm

    Hi Hoppy,

    I am not a boot guy, but do have the crocs. I also bought the Gel inserts per Norm, as well as an adjustable wedge from Amazon. This one is great because you can change the degree of wedge.


    I bought large and with this, you can try different levels to find the height that you like. I took the top 2 off.

    However, I started with 2 bare feet around the house before I put on 2 shoes.

    Also look at my post on FWB to 2 SHOES, I received some great tips on that one. Norm had one regarding DF and walking in 2 shoes, which was informative.

    Thanks and good luck,

  33. upstate2519 on November 11, 2013 8:30 pm

    Ron, I did a MS in Sports Medicine eons ago; one of my professors (Lou Osternig) was well for having shown that exercising quads/hams on a good leg when the other was immobilized translated into less atrophy for the injured leg. It makes sense that the same principle would apply to ankles/achilles.

  34. Ron on November 11, 2013 8:41 pm

    Thanks Upstate,

    It’s making more sense. Just making sure that I am not being milked here, because that means more PT. LOL

    Have a great day.

  35. thelifechangingpop on November 12, 2013 8:28 am

    Hi Ron I’m relatively new and this info is invaluable, thank you thank you. This is another source of light at the end of the ATR tunnel.

  36. Ron on November 12, 2013 6:58 pm

    Hi Thelifechangingpop,

    I feel your pain (mentally and physically) regarding this injury - as do most on this site.

    I felt lost for the first few weeks as well, and asked a lot of questions and did a lot of research.

    The people here are great and will always give you advice and tips.

    I just wanted to put something together to help newbies - at least - get started.

    Good luck, and keep in mind that PWB and FWB are just around the corner, and they are life changing as well.

    Keep us posted.

  37. kimc on November 25, 2013 5:04 pm

    Thanks for sharing your protocol, Ron. I brought it, along with the Exeter and UWO protocols to my first PT visit. Very helpful.

    I have enjoyed reading your posts! Thank you.

  38. Ron on November 25, 2013 8:50 pm

    Hi Kimc,

    You are welcome. Glad I could help.

    I am putting together a video of ALL of my PT work and will post it soon.

    Thanks and wishing you the best,
    Patiently Moving Forwarwd

  39. sittinginthestands on January 29, 2014 5:44 pm

    Hey Ron - I’ve been reading some of your comments and one of them led me to this page where I have saved a copy of your ‘First 12 weeks Protocol’. Its a great breakdown and very easy to follow. Like you, my ATR is R leg due to basketball. I’m just finishing up week 9 and was hoping to try driving in week 10! Thanks for this and I hope to follow your footsteps in your recovery milestones and success!




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