Intentional Damage.

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.

Wishful thinking…

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.

8 responses so far

8 Responses to “Intentional Damage.”

  1. normofthenorthon 19 Jan 2012 at 6:01 pm 1

    It makes sense, Ryan, though the optimum frequency still seems like a crap shoot — including the conflicting evidence from your friends. Here at AB.com, the one blogger I can recall who took a systematic weight-lifter’s approach was doug53, and his frequency was every 2 days, following the same rule of thumb I was “raised on”: If you’re still stiff 2 days later, you’ve done too much, and if you’re not stiff the next day, you haven’t done enough.
    I guess that rule of thumb implies (and depends on the assumption) that feeling fine (not stiff) means that your muscle-fiber micro-tears have substantially healed and been replaced with the stronger stuff. Do you understand that premise to be wrong? Or are you working so hard that your (calf) muscles are still complaining 3 days later? (At my age, that’s not very hard, but at yours. . .)

  2. ryanbon 19 Jan 2012 at 6:19 pm 2

    I think you’re exactly right Norm. You’ve got to tune your training frequency to the damage you’re doing and personal recovery rate. If you go to lift and are still feeling the effects of the last workout- then you’re hitting it too soon. You can either increase the rest period, or dial down the training intensity. My approach is to almost always give it a bit more recovery time.

    If my (muscle building) workout is such that I’m ready to go again in only 2 days… well, then I think I’m pretty much wasting my time at the gym. 2 days is usually the peak of my delayed onset muscle soreness. I’ve had heavy workouts where the soreness even peaks at 3 days.

    Working calves twice a week, I have alternating 3 and 4 day rest periods. I still find my workouts limited by strength and muscle endurance. Today was calf day, after my short rest. For the first time, I really felt that I wasn’t fully recovered. That’s a good success/step- being able to train my calf that hard (3 days ago). So, I need to either dial down the workout preceding my short rest, or do some re-thinking on my schedule.

    At 100% (not there yet) I would hope to be able to blast my calf hard enough that it’s still a bit grumpy 4 days after the workout. This would put me back on my old 5-day interval. That’s just not as convenient to structure around my 7 day (ie, weekly) work/skate/ski schedules. It’s all about priorities I guess ;-)

  3. mljackson60on 21 Jan 2012 at 12:03 am 3

    I wondered what happened when I first read the title of this post. Good points, as always.

  4. kiwiclaireon 23 Jan 2012 at 3:37 am 4

    All makes sense and I toatally agree that there are two phases to this recovery. What stretching regime did you use, if any? or did the length gradually improve with the strengthening exercises?

  5. ryanbon 23 Jan 2012 at 10:50 am 5

    Through the 1st 12 weeks, I did gentle passive (Achilles) stretching; much of it as per my PT. Static slant board, stretches against the wall (straight and bent knee), thera-band, etc. I probably did them every other day or so. Active stretching was done daily… lots of moving my ankle through it’s range of motion while watching TV and such. I was very careful. To be honest, I was probably less aggressive than my PT wanted me to be. I was a bit paranoid about “healing long”, and figured the full range of motion was something I could get back later.

    Since moving into “phase 2″, I’m actually doing less dedicated stretching. I DO try to do the strength exercises through a full range of motion, and do lots of eccentric, loaded, stretches during them. One way to look at weightlifiting is “loaded stretching”.

    My dorsi-flexion range-of motion is still slightly limited, compared to my other leg. It does continue to improve though, and I’m within a handful of degrees. The biggest difference is: when loaded, I’ve got pain at my dorsi-flexion limit… I can do it- but it hurts. I feel it skating. It’s not something that bothers me during my day to day activities- I might not even be that aware of it if I wasn’t skating. But, it’s still compromising how low (and therefore, how fast) I can skate…

  6. kiwiclaireon 24 Jan 2012 at 3:34 am 6

    yes I too was paranoid about healing long - especially being non surgical; doing the Twaddle regime I’ve been doing lots of active movement since day 10, but all below 90degrees and only passive plantoflexion; from 8 weeks in shoes I built up the walking thinking the range would come but reached a plateau at around 11 weeks and from there have started doing some passive stretching which has made a huge difference to my walking; I think I will continue trying to do dynamic stretching as well by starting hill walking, but feel I still need more strength. The Twaddle protocol says no stretching until you can do a single leg raise, but I still not there - need to work harder!

  7. Januson 24 Feb 2012 at 4:09 pm 7

    Very good stuff. Well thought out.

  8. andrew1971on 17 Sep 2012 at 11:40 am 8

    Apologies as this is the first time I read any of your blog ryanb, lots of sound advice here that provides food for thought, and I wish I’d read more earlier on too.

    I am nearly 16 weeks and 14 days from being at four calendar months, your comments reflect exactly how I am feeling, maintain agility and movement exercises but ready (really ready) to turn focus on a steady and consistent strength/stamina program now.

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