Selecting a Physical Therapist

11 Responses to “Selecting a Physical Therapist”

  1. Hi, I’m almost 7 weeks post surgery and my tendon is very tight. I was in a open cast for 2 weeks , then the next 4 weeks no cast no boot, told I could move foot as much as I liked just NWB. I’ve been given the go ahead to WB but I can’t even come close to getting my heel to the floor. Any suggestions???

  2. I don’t understand what “I can’t even come close to getting my heel to the floor” means. A better explanation is needed and you probably also need to find a physical therapist.

  3. I think I understand. With a foot held up in the air NWB without a boot or a cast, the ankle naturally falls into “gravity equinus”, which is like the initial position of the first cast, or the first alignment of the boot. By the time most of us walked barefoot or in 2 shoes, we’d already spent a few weeks in a cast or boot in the neutral position. Inflexible didn’t get that treatment, so his ankle (AT and calf) haven’t had to stretch to neutral until now. And now he’s expected to get to neutral AND put his weight on it at the same time, which is “a big stretch” — and not the safest thing to accomplish on your own, either!

    Inflexible, I can think of a few tricks that I imagine might help (and which should have been suggested by your Doc and/or your PT — and I’d say GET one!):

    1) If you’ve got some footwear that will stretch your ankle gently toward neutral — like a hiking boot or a ski boot — I’d try sleeping in it, at least for one night, and maybe for several. If it’s too uncomfortable to wear (because of the stretch), get some heel lifts (hard-rubber wedges) and insert them to decrease the stretch a bit.
    2) Those same kinds of heel wedges in your shoes (preferably both of them) will make their angle conform better to your ankle’s comfy angle. As time goes by, you’ll want to remove them, maybe starting with an overnight sleep in that boot, before you load your weight onto it.
    3) You’ll naturally find that it’s easier to gimp-walk with your stiff foot in front, than it is to walk normally. As time goes by, you can step farther and farther forward with your UNinjured foot, which stretches (dorsiflexes) your injured/healing ankle more and more.
    4) There are also a number of stretches you can do on your own to persuade your AT and calf muscle to relax and lengthen enough to restore your former (and your other ankle’s) ROM. One standard is to loop a towel between your two hands, with the middle under the ball of your foot. Gently pull the towel toward the limit of your DF ROM, and give yourself a gentle stretch, several times a day.

    On the one hand, your dorsiflexion is way “behind schedule” compared to most rehab protocols with casts or a boot. On the other hand, it could be a serious mistake to try to “catch up” in a hurry. Short of re-rupturing, about the worst thing that can happen to your healing AT is that it gets OVER-stretched and heals significantly longer than it used to be. Several people here have experienced that (with and without surgery initially), and a number of them have gone through surgery to repair it, so Don’t Go There.

    It helps to “listen to your body”, but unfortunately that won’t always keep you out of trouble, because sometimes a stretch that feels fine or just “hurts good” at the time, will end up causing long-term problems starting a few hours later. So in addition to that “listen to your body”, try to be sensibly incremental from one day to the next. The first time you do a stretch, do a few and do them gently, and wait 4-5 hours or so before adding more reps or more intensity. It’s not worth risking long-term pain for a short-term gain!

    BTW, you may also find that the sole of your NWB foot has become super-sensitive to pressure. Many of us found some relief from squishy footbeds or squishy shoes (like Crocs). And many of us found that sitting barefoot and rolling that foot over a ball — say a golfball or a tennis ball — helps break up some “walnuts” and get that foot used to coping with some pressure.

    Good luck! The period of max vulnerability to re-rupture lasts ’til around 3 months in, so Watch Your Step!

  4. Norm…when do u suggest goin to neutral? I have been at 15degrees for a week now. I usually take the Boot off when I am laying around or sleeping. Should I keep it on more often? Thx!

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  7. hey guys, im so depressed… im a soccer player and will never play again… ive been in the boot for about 2 weeks Hard casts before that…and now and finally no crutches, yay!! im about to start PT soon but i know i cant afford $50 a visit twice a week… do you all think PT is really necessary or home exercises and swimming will do? Advice please… :)

  8. Hi dyzkz333,
    Why do you say that you will never play soccer again, was your rupture an unusually bad one and/or lots of degeneration in your Achilles? I am almost 44 years old and played competitive soccer since I was 6, before completely tearing my Achilles (7.5cm up from the heal bone) playing soccer a month ago. Although the doctor said I have a significant amount of degeneration in my Achilles, he does believe that I will be able to play soccer again (after extenstive recovery and PT, of course), although I will need to limit it to no more than once every 5-7 days. How long ago did you rupture your Achilles and how old are you? I haven’t got to the PT stage yet (now just 16 days after my 2nd surgery), so cannot give you much advice about that stage… Anyway, good luck with your recovery!

  9. Hi dyzk,
    I hope you get out of your funk mood and move ahead with your recovery. I really doubt that you will not be able to return to soccer. We are all in this together and I really hope you come to know that with determination and appreciation of the tiniest micro gains you will be back to your fitness lifestyle. If the PT sessions are unaffordable make sure you do your PT at home. Looks like normofthenorth gave you a bunch of tips. I am not a good example of a perfect recovery as I am now at 7 months and can not do 1 heel raise. My setback is a wound issue which you can read on my blog if you wish. I have not been to the PT facility since January as they were way too conservative because of my wound not healing. I continued PT at home on my own and am back cross fit and 1 day of private training. So if you know what to do you can do your PT on your own. Have a great weekend!

  10. I feel PT is another important dial in a string of small dials that help you with the recovery. (The large dial is of course the biochemical mechanisms involved in healing to begin with).

    First dial = surgeon

    Second dial = PT

    Third dial = your own mindset to grind it out day after day after day. You dah man!

  11. I’ve never used a physical therapist for an achilles injury, but I have for other problems.

    If you get a good one, then listen to what they say. If they say take it easy and do these odd exercises it’s for a reason! :)

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