Ryan Border’s Achilles Blog

This little video wasn’t really put together for the Achilles blog- the intended audience was friends and family. But, it is a good little snapshot for the 9week mark.

Youtube Link It’s 720p if you’ve got the bandwidth available

The first half of the video features my son in the Blue shirt; I’m following along with the helmet cam. He suffered a compartment syndrome (look it up) on his right leg earlier this summer, and went through 5 surgeries for it. So, for him to be riding is at least as much of an accomplishment as me.

We switched places at the top, and I gave him the camera. So, that’s me in the black shirt with the orange Camelbak. The day before this ride, I did a 6.5 mile, 3hr hike in the mountains, so I was definitely feeling it by the end-

And… here is a very short video clip from my first post injury attempt on the slideboard. Skaters would see all sorts of things to work on (including the sad video quality). Notably, I need to be much much lower, the weight transfer is pretty crappy, and I’m not fully extending each push. But it’s a start:

There have been a few posts/questions lately regarding exercises to strengthen the calf. It’s a bit of a chicken and egg problem- how can you build strength to do a calf raise, if you can’t do a calf raise?

Well, here’s one of my nascent attempts at starting to rebuild a little strength:

The weight is LIGHT: ie- lighter than most leg press or calf machines allow. It’s light enough that I can do lots of (30-50) reps, but exercise through a - for me - full range of motion. I’m sitting on the floor, in a cable-cross-over machine, with the cable at the very bottom. I’m using an ankle loop, that I bought at a sporting goods store. The blue cushion is my nemesis; it’s a balance/wobble device, that I’m working towards being able to balance on… but it works well to keep my foot off the ground.

As you can see, it’s definitely putting my feeble calf through it’s paces.

Day 54: 8 weeks post injury. That seems like a bit of a milestone.

I am happy to report that, in accordance with my plans and objectives, not much has happened lately. My primary goal has been to not re-injure myself, and I have so far been successful in that endeavor. Put another way: what I do now is less important than what I don’t do. I’m sort of celebrating the passing of each injury-free week at this point.

There have been lot’s of small incremental improvements.

* Walking: I’ve been in 2 shoes for nearly 3 weeks now. My stride and gait continue to improve. I still have to think about rolling my foot onto my toes sometimes, but it’s becoming more natural. I go for a dedicated walk, almost every day, usually around 2 miles. I do live in Utah- and so I’m starting to incorporate some serious hills into those walks.

Near the start of one of my routes (steeper than it looks)

Curiously, I’m finding it easier to walk uphill than downhill- which makes no sense at all. This has always been the case, even when I was FWB in the boot. I’m also doing some walking on uneven trails/dirt.

About mid way through a 3-mile hike

On the steeper downhills, I can now do a half-hearted jog, and I’m thinking this may be my future transitional route to running- slowly decreasing the decline, until I can run on a flat surface, and eventually uphill.

I guess the last thing to mention here is that I’ve incorporated backwards walking, on a treadmill, into my rehab routine. I find that it allows better awareness of how I’m executing the foot roll- and I can focus on keeping my heel elevated for as long as possible as my foot comes under me.

* Calf: The muscle tone is much improved. There is still a big difference between the two sides, but for the 8-week mark, I am honestly very happy with the state of my calf muscle.

Definite signs of atrophy. But given what I’ve been through, I think this looks pretty darn good.

Differences in the contour too; but I’m confident this will eventually come back-

* Strength: I really don’t know. I haven’t been testing the strength of my calf and Achilles. I can feel improvement while walking/cycling/etc., but don’t plan to stress it for a while.

* Flexibility: I have no problem extending my toes fully downward. Toes up flexibility is still limited (that’s good, I think), but I’m slowly working on it. I can push my knee to the wall (barefoot, heel on the ground) consistently now, which is a big improvement.

Flexibility is improving, but there is still a big difference between my two legs here.

* Conditioning: I continue to swim, and have been swimming with a masters swim team. It’s probably good for me to participate in something I am so inept at. My inefficiency in the pool makes this really hard for me, which is most likely just what I need.

I’ve also found a new machine at the gym:

It’s called an Adaptave Motion Trainer, and it’s been an awesome rehab machine for me. I’m able to go near cardio/leg failure, without hurting my Achilles. But, I’m also able to dynamically dial in - just with my stride- as much Achilles participation as I want, so I’m getting benefit there too. If you can find access to one, I recommend trying it.

* Cycling: I’ve ridden outside a few more times. Realistically, my cycling season is over, but it is still nice to get outside occasionally- taking advantage of the last nice days of fall here. For the most part, I’d say I’m just simulating the spin bike, using the wide range of gears available on a mountain bike to keep myself in a narrow rpm(high)/torque(low) range. I haven’t gone off road, or done much more than 10 miles at a time.

Dirt roads don’t count as “off road”

I still start almost every day with a ~20min session on an indoor spin bike. I’m now able to go hard enough to really elevate my heart rate and break a good sweat. The rare day when I skip this reminds me just how much it’s helping to improve my mobility, reducing soreness and stiffness.

* Driving: Fortunately, just prior to my injury, I purchased a car with an automatic transmission, and roomy footwell. I was able to drive it, “lefty”, starting about a week after my surgery. I switched from left foot to right foot driving concurrent with the move back to two shoes. I still catch myself - rarely - doing a left foot brake; I think it’s just habit. Within the last week, I’ve started driving my manual transmission cars again.

I’m happy to have salvaged a little bit of the fall driving season.

I’ve even toyed with - but so far resisted - the idea of getting back on a motorcycle. The one I ride the most is an old 1200cc kick-start, and I just don’t think there’s any way I can (safely) start it right now. It’s hurt me before; without this injury. Most likely, I’ll just be 4-wheeling it until the spring.

* Wound/Incision/Scar: you can see it in the calf picture above. It’s fully closed, and not causing me any pain or problems. PT continues to work on it once or twice a week.

*Nutrition: I’m still strictly adhering to the plan I started shortly after surgery. When this is over, I may never eat Jello again.

Common wisdom seems to be that the tendon takes 3 to 4 months to heal. So, I’ve got at least another month in front me before I’ll feel comfortable starting to push it hard. Until then, more injury prevention, small incremental improvements, range of motion work, and conditioning are on my menu.

I guess that’s all for now!

Let’s start out with a little humor:

A man walks into his living room where his wife was watching the Oprah show. The subject of the show that day was mixed emotions. After listening to what he considered to be a bunch of hooey he’d had enough. During the next commercial break he made a wager with his wife that there was nothing she could say to him to make him both happy and sad.

When he returned from getting a cold one from the fridge she said: “Honey, out of all your friends, you have the biggest d*#k.”

Today US Speedskating announced the US Masters Team for 2011/2012. This makes me both happy and sad.

Happy: because… I made it! This is the athletic accomplishment I am most proud of, the one I’ve worked hardest for.

Sad: because it is unlikely that I will be able to perform at that level this year, and because my chances of making next years team (based on this season’s times) are probably somewhere between slim and none.

Friday, October 14 was a beautiful day: sunny, ~80 degrees, very light breeze…

These gorgeous conditions broke my willpower.

I could take it no more. Even though I had kind of resigned myself to giving up on cycling until the spring… I had to go outside and ride my bike:

As much as I’d rather have been suffering on a gruelling climb in those big mountains behind me, I was very happy to just be out on a little spin around our neighborhood. I quit after 30mins, not because I was feeling bad, but because I wouldn’t really know how hard this was on me for a day or so.

This seemed like a great way to celebrate the end of week 7.

The next day, I didn’t seem to be suffering any ill effects. So, rather than hop on my spin bike in the morning, I decided to brave the roads again- and did a 10mile ride with 600ft of climbing. By normal standards, this wasn’t much of a ride. I had to use embarrassingly small gears. Getting out of the saddle was not an option. I went slow. But, it was sure nice to be outside cycling again-

Day 46.
I’ve been in two shoes for a week and a half now. To be honest, I’ve found that going to two shoes has been tough on a few different levels.

Up until now, I’ve had a clearly defined set of steps to progress through: cast, splint, PWB Boot with wedges, progressions towards a 90 degree flat boot, FWB boot, etc. But now that I’m here in the two-shoes configuration, the road ahead is not nearly as well defined.

Sometimes, it seems like I should just be “all better” now -

Future progress will come in small quantitative improvements, not discrete qualitative steps. The next "steps"- jogging, skiing, skating, mountain biking, etc., are so far off in the future that I can’t focus on them yet. So for now, I need to work on things like smoothing out my stride a bit, or going 0.1mph faster on the treadmill, or adding one more increment of resistance on the indoor bike.

Also, the steps up to now, have been relatively small. I went from 1/2" of heel lift in the boot to 1/4" for instance. There would typically be a day or two of discomfort, but each step was relatively easy to get through.

I did not have a hinged boot. So, the transition to two shoes was a huge one, going from complete immobilization in a fixed boot, to no restriction whatsoever. So, ~10 days after the move to two shoes, I’m still walking quite slowly, and need to be very careful. If I concentrate on:

• Laterally shifting my weight to the "bad side" (don’t bias to the good)
• Rolling my bad foot onto the toes, lifting my heel, before lifting the foot off the ground
• Taking a short step with my bad leg, so as to equal out the stride length
• Taking the longest possible (comfortably) step with my good leg
• Not twisting my pelvis as I step off the bad leg, push my "bad" hip forward

then,  doing all that, I can sort of walk (slowly) without much of a limp.   But, I’m still at a point where I very much need to think about everything.

My primary objective to this point has been to get to two shoes, to get walking, spinning, and re-engaging my calf muscle.  The hope was to minimize atrophy-  and I’m confident it’s now been halted.    I’m not rebuilding (much) strength in the calf yet- but muscle tone is quickly improving,  and it’s no longer shrinking.   When it’s time to start rebuilding strength, I’m hoping that ~5 weeks of atrophy is going to be a lot easier (faster) to rebuild than, say, 10 weeks.

I had my 6-week checkup with my surgeon.   He seemed very happy with my ROM, strength, and healing.   I gave him a copy of my recovery log-  he was a little surprised by a few things (all the kayaking, for instance), but encouraged me to stay on the path I was on.

He actually questioned the value of PT for me- since I was doing everything on my own, but at my request, he did get me set up with a PT facility.

My first PT session was last night, which consisted mostly of an evaluation.   They gave me a few stretches and exercises to do, all of which I’ve already been doing for weeks.   There was one big surprise, when they asked me to stand/balance on one foot.   I didn’t expect to have much problem with it, but found myself almost incapable of doing so on my bad foot… so that’s something new for me to work on.

“Barely” is infinitely better than “almost”. And, I can barely do squats now.

They asked me what my goals for PT were- I told them, as a start, I needed to be able to do this (hold this position) balanced on my bad foot:

Needless to say, I’ve got a long ways to go-

Today (Oct 7) is 6-weeks exactly from my surgery date.

I figured you guys might like to see where I’m at so far:

Yep, Still got a little hitch in my giddy-up.

And, since we’ve been comparing scars lately - ahnadlass is still clearly in the lead - here’s mine (@week 6):

I wanted to ask you guys a question about “healing long”.

Right now (approaching the 6 week mark), I think my tendon is healing at the correct length. I can fully articulate the ankle. In the pool, water up to my shoulders, I can even do one-leg heel raises and seem to have a full range of (concentric) motion; I can get all the way up on my toes.

My question is: am I out of the woods for “healing long”? If I don’t re-rupture, is it reasonably safe to say that this is the length I’m going to heal at? Is healing long something that get’s initiated early, as things start to mend?

Or… since the tendon is still weak, is the risk that it will now “stretch” into a longer length before getting strong? Am I actually at the start of the “healing long” risk period as I enter PT and begin working it harder?

It doesn’t seem like there is a very good understanding about what exactly causes somebody to heal long… stretching too early seems to be a risk factor - that’s one thing I’ve tried hard to avoid. But I’ve also heard of folks coming out of a cast (no stretching/movement at all), only to discover they just healed long.

My gut tells me that the non-surgical route might be higher risk for healing long; just because surgery - if done correctly - should ensure healing is initiated with the two broken ends of the tendon properly positioned relative to one another. But, I’ve got no data to back up that hunch: is it correct? If healing long is the result of over-stretching a partially healed - but still weak - tendon, then I wouldn’t expect much correlation at all.

A long time ago, I was working towards a pilots license. One of the lessons that always stuck with me was that the most dangerous pilots are not those fresh out of flight school. Rather, the most lethal time to be a pilot is around 100hrs of flight time. This happens because confidence grows faster than capability. New pilots are very cautious. Experienced pilots have the capability to get themselves out of a jam. But there’s a danger zone - maximized at around 100hrs - where what I’ll call the “confidence gap” is at it’s highest, and that’s when pilots get themselves killed.

Danger Will Robinson, Danger!

I share that story, because my sense is that I’m now entering one of the most dangerous phases for my ATR recovery. I continue to make steady progress, and am feeling pretty good. I worked my boot-walk back up over 2 miles. I’ve continued to work the spin bike almost every day. The swimming continues to go well. I added some “water walking” at the pool; which helped me to get comfortable with a walking motion (bare-foot) in slow motion at very low load/weight levels on my foot. And, on day 37… I dropped the boot.

But, as good as I feel and as happy I am to be making continued progress, I *know* that the injured tendon is still very weak. All it would take is one bad trip, fall, or other impact; and I could be back at square 1. So, my primary goal for the next couple of weeks - at least - is to be very diligent and careful. I don’t really worry about hurting it while spinning, swimming, etc… If I hurt it, it will probably be doing something dumb: tripping over a dog, slipping in the shower, mis-stepping on a stair. So, the challenge is to see if I can maintain that same focus on avoiding these types of mishaps that I’ve directed, so far, towards the active rehab steps.

I’m also back to driving with my right foot.

I see my surgeon in a couple of days, as I approach the end of week 6. I anticipate I’ll start PT at that point.