1st Physio Session
01/11/2010
Firstly let me say tat the reason I haven’t posted on here for a week or so WAS because I got a scare Last Friday and panicked . Friday was my 1st day PWB and approximately 1-2 hrs after getting up I put some weight on my AT leg and felt , what I can only describe as a “pop” (it was I thought above the calf close to the knee) and It frightened the life out of me . It didn’t hurt but I definitely felt something , so being a worrier I presumed it was bad. All day I kept feeling the AT to see if there was a gap …….and waiting for the leg ankle to swell or “something” .
Anyway it was something but obviously also NOTHING .
:o)
Back to today ,
went for my first physio session today and mostly good news.
Bad news first , he said I might not be able to drive a manual car for a while .
So I could be visiting a car dealer near you soon.
As I walk for approx 3hours a day as PART of my job , he said he couldn’t see me being able to do that this side of Christmas . This is something I not something I can fix by getting a new car but is something I hope MIGHT change over the next month of physio and exercise.
Good news,
He had a look and said the tendon was strong and the healed well.
He also said that despite being in the cast for 5 weeks there was a lot of movement in the ankle .
75% of my time with him he worked on the ankle and did NO work on the Achilles itself . he said that he had to get the ankle movements rang up before stated to work on the Achilles.
He got me to put my good foot 10cm from the wall and bend my knee into the wall , no problem .
My AT leg was a different matter , foot 10cm away from wall again, but my knee when bent in, to its fullest(had to stop due to tightness) was 25cm away from the wall ……..yes 25cm away .
This was disheartening but having gone through what it has , expectable.
He gave me 2 exercises to do .
First one is , bare feet , 1 crutch (on good side) and basically to walk !!!!
Slowly with the crutch moving with the AT leg . He said the crutch should take 1/3 of the weight , so that 2/3s on my “bad” leg while I bring my good leg forward !!!!
I have to do this EVERY HOUR ……. (no more sitting down for me )
Second one is, 2 crutches , AT leg between the crutches , good one, a step behind and basically to push my knee forward and stretch the Achilles, hold this for 15 seconds and REPEAT , this is to be done ever 2 hrs.
I also asked him the shoe/boot question.
In his opinion , the boot did its job with I was NWB to give me peace of mind but he’d get into a shoe now that I was PWB , (also alluded to getting back into the boot if needs be , as Norm here had suggested) .
Where he differed from the surgeons advice was , instead of 1 cm inside and 1cm outside , he said he’s put the 2sm inside the shoe and I‘ve to go back to him next Monday 8th we’d work from there .
An the end of the day it now feels like the more I put into it ,(not going O.T.T. of course ) in the next 7days the more I will progress
(experienced AT recovery posters please comment on this )
and this is the 1st time it has felt like that in the 59days since my op.
Opinions always gratefully accepted .
Phil
November 1st, 2010 at 4:39 pm
HI philc, This all sounds good. If you are diligent in your PT, you will see progress quickly, especially at the beginning. Starting PT and being FWB are important and exciting milestones in this journey. Most of use have gone from PWB to FWB in about 3 to 6 days. Once you’re FWB, be careful when walking.
November 1st, 2010 at 5:19 pm
All sound fab phil, your physio is far more advanced to mine, relly I’m not putting any weight on mine at the moment but relly working on ROM. You sound like your well on your way to being mobile again. I too am hoping for a return to work in the new year, but like you I spend nearly all day on my feet (primary teacher!) so I don’t want to rush into thet. In fact to be honest I’m hoping for a phased return. Enjoy the peace and quiet while you can. Now there is light at the end of the tunnel the enforced rest doesn’t seem quite such a torture. As for the worrying about re repture it is something that haunts us all. Take it easy and keep up the good work
November 1st, 2010 at 7:14 pm
Phil, your story and your GUSH on my blog are enough to drag me out of retirement!
Your rehab is extremely unusual, and frankly, parts of it scare me for you. Your flexion test at the wall — knee MUCH FARTHER AWAY from the wall than your foot!! — tells me that your ankle is stuck in PF, unable to dorsiflex anywhere near the neutral position. Most of us started wiggling up to neutral early on (2 wks in, for me and “my kind”), and others moved to neutral with cast changes or boot adjustments or heel-wedge removals, weeks before your “ATR Age”.
I doubt that your AT has healed permanently super-short, but it’s all been contracted, protected from dorsiflexion, for a Very Long Time. On the one hand, it’s got to get to neutral and past it, in order to function properly. OTOH, if you get too aggressive in stretching it out now, for the first time, . . . POP and Go Back to Square One!
The standard gentle ways to stretch an AT-and-calf are (a) “actively” — i.e., foot in air, just wiggle your toes up toward neutral with your own leg muscles, and (b) “passively” — i.e., foot in air, with a towel held in both hands, looped around the ball of your foot, gradually and gently stretching your toes toward your face.
In all of these techniques, we’re talking about maybe 5 or 10 pounds of force max, until you get to neutral and beyond.
This is NOTHING LIKE walking barefoot with one crutch, with 2/3 of your weight on your healing foot! 5 pounds, 100-odd pounds, BIG DIFF!!
I don’t see how, or why, you should be keeping your AT-and-calf contracted with 2 cm of heel wedges in shoes, and simultaneously walking barefoot — ZERO heel wedges — PWB with ONE crutch every hour! (BTW, AFAICS your ankle doesn’t care if the wedges are inside your shoes or outside, same angle.) To me, these two approaches are from different planets.
Add to that your keenness and understandable impatience, and that “it now feels like the more I put into it . . . the more I will progress”, and you’ve got this experienced AT recovery poster worried about your still-vulnerable and very-sheltered AT!
Personally, I’d start with (and stay with) the more standard gentle stretches (”a” and “b” above) and hold off on the barefoot walking and the stretches on the floor until you get some ROM back into your ankle with the gentle approach.
Sorry to be a wet blanket, but to me, this sounds like a medical/PT “improv” that wasn’t clearly thought through. We’ve already got one blogger here (maybe Brock?) who re-ruptured by following his PT’s advice to do calf raises way too soon. I lost a month after my first ATR following my PT’s directions. These things sometimes do happen, unless we avoid them.
The biggest advantage of following a tested “recipe” instead of improv expert judgment, is that the recipe’s good statistical results PROVE that it doesn’t have even ONE scary high-risk step. It only takes one to mess up your plans.
In addition to “Stick with a plan that’s been tested, and produced good results,” here are my other fave principles for ATR rehab:
- DON’T apply “no pain no gain” aggressiveness to this rehab, especially during the first dozen-or-so weeks.
- DO gradually escalate the intensity of your exercises and activity, but DON’T do MUCH more TODAY than you did YESTERDAY, even if it feels OK while you’re doing it. Crank it up a notch, but do it gradually, giving your leg time to “digest” each new notch of intensity. Getting through a brand-new “stretch” without re-rupturing doesn’t prove that you can keep doing it safely, much less that you can try the next notch today.
Good luck, good healing, and Watch Your Step!!
November 1st, 2010 at 8:02 pm
Phil - listen to your body. When it feels tired take it easy. its a fine line of course (between doing nothing and pushing yourself), but if you start off with soreness and it doesn’t ease up within a few minutes then the muscles probably really are tired
For example, I wanted to go gung ho, but actually i can’t go to the pool every day, it gets too tired and that is when accidents happen.
I agree with Norm that your exercises seem odd. I started with barefoot weight shifting side to side (that stretches you down the calf but gently), then moved on to the towel stretch he mentions. I think its hugely beneficial to have a physio that you trust so i’d even consider changing if you don’t have confidence in this one. good luck! I can’t imagine how you have coped without work to take your mind off things and occupy some of that endless time that I suddenly had!
November 1st, 2010 at 8:03 pm
Thank you for your imput as always its informative and make sence .
One or two things,
“knee MUCH FARTHER AWAY from the wall than your foot!! — tells me that your ankle is stuck”
the reason I stopped was my achillies got tight , not my ankle .
“gradually and gently stretching your toes toward your face.”
he did this with his hand and said there was good movement and strenght there .
“I don’t see how, or why, you should be keeping your AT-and-calf contracted with 2 cm of heel wedges in shoes, and simultaneously walking barefoot ”
he said i didnt need to stay at the 2cm and could go 1cm , but i thought it might be too much .
You have me concerned now (well meaning concern on your behalf i know) and having walked over here I might hop back to where I came from……
thanks as always
November 1st, 2010 at 8:15 pm
thanks bronny.
the physio was recommended to me.
i dont know “really” if he is good or not but until i read norms post I just thought I had progressed well .
I had read about the towel stretches and so forth .
When Im doing the stretches he told me to , it doesnt hurt as I dont push it too much , and walking on the foot isn’t hurting either (mind you iam being VERY carefull while walking and putting as much weight on the crutch as possible).
going back to square one is NOT an option i can continplate , it would be the end of me mentally.
as my wife said to me today as she drove me home ,
“you would get the WORST sports injury there is !!!”
November 1st, 2010 at 8:23 pm
Good luck, Phil. My comment about your ankle being stuck didn’t mean the joint, just the angle. It’s presumably stuck because your AT & calf muscle are “stuck” in a tight, short, contracted position, not happy to stretch out far enough for your ankle to dorsiflex. The trick is to get the muscle to extend, and the AT to stretch, without over-stressing the “weakest link” in the chain, which is presumably the repaired-and-partly-healed ATR.
In fact, other “links” can also be over-stressed. In my case (in 2002, 1st ATR), I overloaded the connection between the AT and the heel-bone, which took a month to stop hurting a lot. It didn’t hurt at all WHILE I was overdoing it, hence my cautious and incremental principles.
November 1st, 2010 at 9:08 pm
The first PT I saw was, to be blunt, a lazy jerk. My first and only appointment with him was 2 weeks after surgery and he asked how the incision was. I told him it was still draining and he said “OK,” and went on with hurrying through the explanation of the ROM exercises he wanted me do. He never saw the incision BUT he wrote in the chart that the incision “looks good.” He was the first one I fired. The second PT I saw, after my third surgery, was very highly recommended by a couple people, none of whom has ever had an ATR. I never saw him for more than 15-20 minutes, even the first time, always seemed in a hurry to get me out of there, presumably so he could see the next person. He was a nice enough guy but didn’t seem to concerned with what I wanted to accomplish. The exercises he gave me were minimal and never did any good at all. He was the second one I fired and it took quite a bit longer than the first. My third PT, the one I go to now, is a runner and a cyclist and has competed in triathlons. He’s also a backpacker and a skier. My first appointment with him was 60 minutes and subsequent appointments have never been less than 30 minutes and often 45. I made great strides with him but got lazy about doing the exercises after I wasn’t going to him anymore. That’s not his fault.
The fact that someone is recommended is, I have discovered, not necessarily useful. Our veterinarian raved about the guy who did my first surgery because he did hip replacement on her dad and he came out great. I wouldn’t let that clown near me with a dull butter knife. One person can have a great experience with someone and another can have a horrible experience.
I will echo what Norm and Bronny said. I personally would be looking for someone else and be actively interviewing and finding out what their approach is.
As for your wife’s statement, she is so wrong it isn’t even funny. When I was in high school we had a kid who truly gifted at gymnastics, probably heading toward being on the Olympic team. The school gymnastic team put on a show during half time at a basketball game. Rod did some semi-fancy stuff and then let loose with some really wild twisting double flip for which his timing was just a hair off. He landed on the back of his head, broke his neck and was paralyzed from the waist down, permanently. ATR the worst athletic injury? Not even close.
November 1st, 2010 at 9:33 pm
Thumbs up to your progress.
Is it a NHS physio you’re seeing? If so, make sure your treatment programme is being delivered by a orthopaedic specialist physio, preferably a band 6 or above.
Again don’t be afraid to challenge them, ask questions, get them to explain their treatment rationale.
It’s worrying to read that you won’t be driving or working before Christmas, I. Was hoping to go back at the beginning of December preferably as a phased return. Luckily the occ health dept have a physio who will assess my fitness to return. I work in a hospital and am on my feet quite a bit, I also rely on the car to get me to work. As mine is a right ATR I don’t think an automatic would help.
What have others been told about driving and return to work?
November 2nd, 2010 at 12:45 pm
Wow Phil that is a scary story. I’m about the same post op than you.had my 3 P T today.I would never even get on my crutches with out boot if my foot is not through neutral or at least neutral.I had the toe tendon thing and to put no stress on ankle bone my toes are very down .my PT is only concentrating on getting foot throu neutral.
Using the towel type metode (dog lease) and rubber band around toes to push down with.i am now wedge free ,after 3 PT sessions . i force myself to stay in boot to keep stretching AT . If AT is cold it takes 10 min to get in boot heel down After exercise or bath i can get into boot immediately .I’m close to neutral i think