Comments for And I was winning.......

Comment on 2 Year update by Oren

Oren — Mon, 15 Mar 2010 21:58:41 +0000

Hi Doc Ross,
Congratulations on passing your 2 year anniversary!! I am coming to my 2 year anniversary after rupturing my AT during a basketball game after almost shutting out my opponent in the 2 previous games (Did I really need to play the 3rd game?). I did my PT for 6 months (not intensive) and I now play basketball here and there but I still don’t have nearly the strength or confidence as I did before. It also still feels a bit tight and sore. Do you know if this is a normal occurrence for someone who has not finished his PT? is the leg lifts the answers? Are squats and leg presses bad for the AT? An osteopath also recommended messages for the scar tissue. Is there still hope after 2 years? I will still consult my physician but he has not gone through his so I would like to hear from you. Whatever advice you can give will be appreciated. Shame I did not read your blog before today.
Kind regards,
Oren

Comment on 2 Year update by Doc Ross

Doc Ross — Thu, 11 Mar 2010 12:53:14 +0000

Walshie..

How goes it?? Golf game better or worse?? Actually won VA state 45+ singles racquetball tournament, ranked #1 in VA…
Now I’m ready for some golf…
How are you?? any problems??

Doc Ross

Comment on 2 Year update by walshie

walshie — Thu, 11 Mar 2010 04:24:15 +0000

Doc Ross!

The man the myth returns.

I used to look forward to your blog updates..back in the days of tedious recovery.

Great to hear you’re doing well…was in Vegas playing in a Pro-Am last November..thoughts of the ATR Open were dancing in my head..oh the missed opportunities..

Comment on 2 Year update by doug53

doug53 — Thu, 25 Feb 2010 16:53:33 +0000

Doc Ross:

I can imagine that if inflammation from rejected suture material is severe enough, it could lead to significant tendon weakness. I suspect that isn’t a common problem, however. Does anyone remember anyone in this community of several hundred ATR victims who reruptured because of rejected sutures?

Assuming the sutures are absorbed in a relatively normal fashion, my reading indicates that there are three phases to the healing of a ruptured tendon. First, the inflammatory phase generally lasts a small number of days, when the wound is “cleaned up” by various white blood cells, (and it hurts a lot, as inflammation does, basically by definition). Second, the proliferative phase, when lots of collagen is laid down, lasts a month or so. Around six weeks out, the third phase, remodeling, starts, and lasts about a year, and the tendon becomes about as normal as it ever will.

I read about this in a review article in the Journal of Bone and Joint Surgery, 2005, 87:187-202.

If most of the collagen is put in place between roughly one to six weeks postop, I don’t see how that means the tendon should have a weak interval at six weeks out. Being pessimistic, I wonder if there are some doctors who tell their patients this to scare them into compliance with their conservative rehab programs.

Ever the skeptic,

Doug

Comment on 2 Year update by Doc Ross

Doc Ross — Thu, 25 Feb 2010 14:43:35 +0000

Here are my .02 on this.. ATR surgery usually use absorbable stitches. All sutures are classified as either absorbable or non-absorbable depending on whether the body will naturally degrade and absorb the suture material over time. Absorbable suture materials include the original catgut as well as the newer synthetics polyglycolic acid (Biovek), polylactic acid, polydioxanone, and caprolactone. They are broken down by various processes including hydrolysis (polyglycolic acid) and proteolytic enzymatic degradation. Depending on the material, the process can be from ten days to eight weeks. They are used in patients who cannot return for suture removal, or in internal body tissues. In both cases, they will hold the body tissues together long enough to allow healing, but will disintegrate so that they do not leave foreign material or require further procedures. Occasionally, absorbable sutures can cause inflammation and be rejected by the body rather than absorbed. This along with the healing timeframe of tendons there is a vulnerability at the 6-8 week mark. This is when scar tissue is laying down its matrix for strength. Also at this time is when ROM exercises are a must.
Again more of my professional opinion than based on research.

Hope this helps…

Doc Ross

Comment on 2 Year update by doug53

doug53 — Thu, 25 Feb 2010 13:42:46 +0000

At least one other person on this blog related hearing this odd statement. I’ve done quite a lot of reading and never run across anything to back up this statement, though.

FWIW, I was putting 140 pounds of pressure on the toes of my injured foot at six weeks. I very strongly suspect that would have been a Really Bad Idea right after surgery.

Next time you see him, maybe he could provide you with a medical study reference that backs this up.

Puzzled right along with you,

Doug

Comment on 2 Year update by obsessivec

obsessivec — Thu, 25 Feb 2010 00:29:28 +0000

Has anybody else heard this? My Doc said that my achilles will be at it’s weakest point 6 weeks post op. It seems it would be at it’s weakest point right after surgery. Any ideas?

Comment on 2 Year update by Doc Ross

Doc Ross — Tue, 23 Feb 2010 21:05:02 +0000

Jose,

sounds like you are doing well. It takes a full year for the tissue to recover. Your body is laying down connective tissue that will take 10-14 months to become fully repaired. Obviously it also depends on the degree of tear, type of surgery and your adherence to PTY. I did the Grand Canyon 10 mile hike, rafting and climbing at about 3 months. I would go slow with your race, your not nuts just ready to break free from this pain in the ass injury. Do not try to push it, no PRs yet.

I wore an ankle support up until 1 year and have not worn one since. Once you get your confidence back regarding your body you will not need it. There are pros and cons to bracing but I have found it depends on the person and their athletic endeavors.

Hope this helps. Make sure you are getting massaged regularly, definitely helps with healing, work out recovery, blood flow and just plain ol feels good.

Good Luck

Doc Ross

Comment on 2 Year update by normofthenorth

normofthenorth — Tue, 23 Feb 2010 20:19:11 +0000

After I tore my first AT and had surgery on it, my surgeon — he called himself “conservative” and he was right! — told me I could go back to competitive volleyball when I could do a bunch of single leg heel raises without grunting or sweating.

That’s what I did, and I decided very soon that (a) my heeled AT was the one part of my body that I had the MOST confidence in, and that (b) my other AT was the one I was most nervous about. About 7 years after that (and 8 yrs after the first rupture), I did actually tear the other one, and it’s maybe half-way back to grunt-free single leg heel raises. Not a hint of regret here, given how much satisfaction and fun I got from 7 years of volleyball.

I don’t think I could EVER “do single leg heel raises till the cows come home”, so you sure sound ready to me!

I’m sure I was nervous and maybe tentative when I first returned to the volleyball court, but that passed very quickly. I’ve never been a “real” runner, so I can’t advise you on which race, how soon, but I’d say “Get going!”

BTW, I didn’t use any braces or supports, and most people here don’t recommend them. Some people find the back of the shoe rubs and irritates the healed AT a bit, and your heel might need some extra padding but that’s probably the only two new problems I’d even think about accommodating. Listen to your body.

Comment on 2 Year update by 2ndtimer

2ndtimer — Tue, 23 Feb 2010 19:27:26 +0000

Jose,
I think your tendon is stronger than any support stocking.
If you have not run yet since surgery, going for a 10K race in 3 weeks might be too much too soon. I think you should take things more gradually.