Most of the information and discussion here at Achillesblog is focused on what I’ll call the 1st part of our rehabilitation- the early part as we go through NWB, PWB, FWB, and to two shoes. There’s talk of post surgery issues, sleeping with a boot, how to shower, driving, etc. I suppose this should be expected- visitors here are most often those who have recently injured their Achilles, and we’re mostly looking for info to help us with our immediate problems. As we recover, and start to get on with our lives, we tend to spend less and less time here.
In my mind, recovery form an ATR comes in two very distinct phases. During the first, the tendon itself is healing. During the second, we need rehabilitate ourselves from all the damage done; both from the injury itself, and also from the extended inactivity during the 1st phase. The goals and objectives during these two phases are very different, and I believe they require very different approaches.
During the 1st phase, the primary objective is to let the tendon heal. This means not over-stressing it. Some doctors go so far as to immobilize the joint for extended periods of time.
A secondary objective is to start thinking about the next phase of recovery, and doing what we can (within the constraints of the primary objective) to prepare for it. My approach was to keep the joint as active and mobile as possible, but limiting the load on the tendon (paying special attention to peak loads). I worked hard on retaining joint mobility- including some pretty aggressive stretching in all directions except dorsi-flexion. I pushed my early schedule- getting to two shoes in just over 5 weeks; the idea being to get the calf moving again, get my leg weight bearing, get the ankle doing it’s job - all as soon as possible to minimize atrophy, instability, loss of balance, coordination, and strength. However, during this phase, I also did my best to protect the Achilles from high loads.
The sources out there seem to indicate that, after surgical repair, the tendon takes 12-16 weeks to heal. Unfortunately, there really doesn’t seem to be a whole lot you can do to accelerate that time. On the other side of this coin- barring some bad complication or re-injury - we should all have good confidence in the strength of the tendon at around the 4 month mark. Overcoming fear of re-injury can be a real challenge.
A few words about weightlifting: You don’t get stronger lifting weights: you get weaker. The whole point of lifting weights is to create controlled damage in the tissue, making it weaker. You get stronger afterward, resting and eating. The most common mistake I see people making is over-training; breaking their muscles down, without allowing sufficient time to recover between workouts. Too much rest will yield sub-optimal gains. Too little rest will stop your progress in it’s tracks. There are lots of variables that go into the needed recovery time: personal physiology, how hard the workout was (extent of damage done), nutrition, sleep, etc. When I was lifting really hard, 5 days seemed about right. I was lifting every day; but any one muscle group was only getting hit every 5th day. I’ve lifted with guys taking anabolic steroids; and note that those drugs seem to do wonders at reducing their recovery times.
Many bodybuilders will tell you that calves are a tricky muscle to build. One of the reasons being: they’re almost impossible to rest. They get worked, at a low level, just by walking around, climbing stairs, etc. So, there are a lot of different philosophies about building them up- some advocate training them more often, doing “less damage” on each workout. Some take the opposite approach- training them very heavy and intensely. I’ve seen both approaches work for different people.
Back to the ATR… At around 4 months, our tendon is mostly healed. What we’re facing is: restricted range of motion, atrophy, lack of strength, lack of balance, ankle instability, pain, etc.
At this point, many of us have been engaged in physical therapy activities, but it’s important to recognize that (if your therapist has been doing their job right), what we’ve been doing up to now has been phase 1 stuff; with a focus on protecting the tendon. The types of exercises we do are done often; sometimes multiple times per day. A phase 1 approach is not the best way to achieve phase 2 success. What’s needed now, is a shift in perspective; almost a 180 degree turnaround. To rebuild strength, we need to stop protecting the tissues… we need to start doing “intentional damage”.
I’m not quite convinced that the tendon is 100% at 4 months. Then again, with an atrophied weak calf, it probably doesn’t have to be. Plus, we can take advantage of the fact that muscle fatigues with use, the tendon is more susceptible to peak loads. So, with high reps, it’s possible to take the muscle to failure without undue risk to the tendon. Working my calves, I rarely do less than 15 reps per set. To further reduce peak loads, I’m careful to never “bounce” an exercise; everything is very slow and controlled. Using this approach, it’s possible to hammer my calf- work it until is burning, pumped, and failing… without undue pain or stress in the Achilles area.
I do these dedicated calf workouts twice a week. If anything, that’s approaching a little too often, but with the lighter weights, and higher reps, I don’t think I’m doing the kind of extensive muscle breakdown I might have been able to do pre-injury. As I progress, I anticipate further tweaks to my schedule and approach. Like any weightlifter, I face the challenge of resting my calves- they get worked every day to some degree, just walking around, riding my spin bike, skating, etc.
The calf is built up of several muscles - the gastrocnemius and soleus. Both tie into the Achilles tendon. The top of the gastroc ties into the lower end of the femur - just above the knee. The soleus attaches below the knee. The gastroc is the larger of the two muscles, and is the primary muscle used when your leg is at, or near straight. I think of the soleus as the “helper” muscle, but it has to do all the work when your knee is bent. It’s important to rehabilitate both- do a good mix of calf work with straight and bent legs.
Another final tip: I try to do an equal mix of single and double leg exercises. The single leg stuff forces me to do all the work, even through my weak points, with the injured leg. There’s no “cheating” with my good leg. It gives me good indication of my progress and strength. Two leg exercises allow me to compare, side-by-side what I’m doing with the two legs, and helps me ensure I’m using the weak leg properly. Also, doing two leg lifts lets/forces my injured leg to go through it’s full range of motion.
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