I really don’t get what is it i am doing (or not doing) that my leg just doesn’t have calf strength. I am really at my wits end. Saw the 2nd physio and he gave me some exercises to do but nothing that i don’t already know. Its all about balancing on one leg, calf raise with one leg instead of two , etc. He doesnt even need me to see him every week , just once every 2 weeks for progress update. Why? Why am i the only one with no progress after 5 long months? Average return to sports is 6 months, up to 9 months but i am at my 5th month and i seriously can’t see myself running at all (without a limp!) in another month’s time! What else can i do? every time i try pushing myself at the gym i feel like crying just because i simply don’t have the strength! WHy?

what do you guys do at each physio session (its 30mins here in the uK) and do you see your physio at least three times a week? I mean i will really do ANYthiNG just to get my progress monitored but i don’t see what value add my physio can do when he see me apart from watching me perform the exercises? (well my first PT will be even worse as there are no gym equipment at the clinic). Should i even suggest to the 2nd PT to see me three times a week and use that session to help me with my strengthening exercises, just so that he can help me push myself? I am getting very worn out and emotionally tired from seeing my first physio as there is nothing except to listen to my moans, comfort me, and see how i am progressing. I really want to be able to wear proper flats (NOT TRAINERS!) at some point, and i am not asking for more! Just being able to walk around without a limp, without my trainers (as wearing flats makes my leg uncomfortable) and not look like some alien limping around! I am not even going for any summer holidays this year as i can’t enjoy myself without being in my blood trainers at the beach!

i have been crying every other night and i don’t know how else i can stop myself from sinking further. i know its all mental, thank you all for your encouragement but i don’t have any complicated surgery, no signs of re-rupture, just no strength! Norm i know said my situation is abnormal but i don’t suffer from swelling now and no pain just simply can’t push off as i would like to. my goal is single calf raise by september is that too much to ask?

i am going to arrange for another consultation with a sports physio clinic which specialises in sports injuries tomorrow and if it means paying to see the PT 3 times a week 30 mins each and focusing on working to strengthen my calf under his supervision, i will do it. there is one near my work place so it means i can commit to it more. pls tell me what else can i do at home without machines/ equipment??

28 Responses to “Week 20 and VERY FRUSTRATED”

  1. soj9, your situation does seem unusual, but perhaps you’re just on one end of the spectrum of normal healing time. It seems as if your PTs aren’t overly concerned about your condition. Are you making progress, just slow? If so, doubling-down on your exercises (with or without PT) might be your best option. I would recommend simple walking at this stage, while focusing on your push-off and gait, for as long as you can muster each day. Throw in some seated and standing heel raises as you are able, also. You should be able to feel your calf muscles engaging as you do these things, and that’s the evidence that you’re working and building these muscles. I know you’re frustrated, but try to stay positive. Hopefully you’ll hit a turning point soon and start making great strides! -David

  2. Davidk- why do you think it’s unusual too? I am not saying I have no strength just not progressing enough weekly to see significant improvements. You are making me worry even more. What do you do at each in of your sessions and how long does it last? What do you do at home? Do you do more on top of your physio exercises? I can’t push off on the leg press machine on one leg at the moment. I’m not seeing results weekly like you have been posting and it frustrates me when I don’t know what else can I do at home. I have been placing weights on my thighs and doing toe raise on a chair but that’s easy and not very challenging on my calf muscle. Seated toe raise isn’t challenging at all either.

  3. soj9, if I’m making you worry, then I apologize and suggest you ignore my comments. My intentions were good. All I have to go on is your account of your situation–and it does strike me as unusual. But, if your own PTs aren’t concerned, then maybe nothing’s wrong and you just need to change your expectations. As for my PT, my sessions last about an hour each, with the last 15 minutes dedicated to RICE. I go twice a week. On my own I do exercises daily, plus I take walks and bike rides. Of late, long walks and bike rides have been the best rehab for me. Good luck to you. -David

  4. Soj, so sorry to hear you’re feeling frustrated. Do you have a pool and/or anti-gravity treadmill that you can access? I found that walking around at a reduced bodyweight really helped me with strength building, and also put me in a much better place mentally — feels great to walk around barefooted without a limp and really feel everything working like it should.

    Also, how’s your diet? It’s really important that you’re putting the right things in your body to help the muscle building process along.

  5. Hi, know I’m not as far on as you but do know that feeling of frustration and that you’re never going to achieve the next milestone. I felt like that before FWB. It felt like it would never happen. I know its so good to set goals but when it gets frustrating I found that just not expecting it to happen by a certain date and getting my head down to consistently exercising/trying things out worked better. Just kept telling myself its not going to be for ever n just keep going. Any exercises you’ve got done frequently will be making some difference however small. David’s advice about walking sounds good. Good luck and try to stay positive. Keep us posted with your progress.

  6. Have a read of dcoughlan’s page too. Sound advice I think. Take care n good luck.

  7. I am six weeks post-op and have been FWB basically since my cast came off at week 4. I’m going to PT 3x a week at the moment and my sessions last about 30 minutes. To be honest, most of the stuff I do is stuff I can do at home and haven’t seen the value of what I am doing there. For now, my physio has me doing the following:

    30 rotations to the right
    30 rotations to the left
    30 seated heal raises
    30 toe scrunches
    30 second heal stretch (x2) - basically bringing my foot as close to neutral to match my other foot while seated

    The above I can do by myself at home (which I do 3-5 x daily). In addition, they have me use half a foam roller to move my foot side to side and front to back. They also have me on a wobbly footboard (while seated) in which I move my foot front to back, then side to side and finally completely around - all for 30x each. Those actually engage my calf muscle and I see the benefit of that particular exercise, especially since I don’t have the equipment to practice at home.

    I then lie on my back and do leg raises with weights to work my quads. I finish with my physio massaging my incision to break down the scar tissue (which I do at home as well).

    I am not impressed with the exercises I’m doing thus far but I know that it is still early and I am seeing improvement in my ROM so it is progress.

    I hate walking with my boot - my gait isn’t smooth at all and I don’t understand how people can walk smoothly in a boot. My ankle doesn’t move much and it feels awkward. However, it is much more preferable to a cast so I shouldn’t complain too much.

    I am thinking that being on this board and reading about other people’s lightning speed progress can affect you mentally. We are constantly comparing ourselves to others and feel frustrated when we aren’t moving as quickly as others. I’m guilty of it and I have to remind myself not to compare but it is easier said than done.

  8. Good view of boot-walking on RyanB’s page and YouTube. Your PT should be able to show you too. It should work well! Strike the heel, roll to the toe, pushing your knee forward, not locked… toes pointing forward, as normal as possible.

  9. Sony, when you sit, do you have more DF ROM on your injured leg then the other one? Some people do Heal Long, and that usually improves DF ROM but decreases PF strength. Up to a point, it ends up OK, more nuisance or curiosity than serious problem. My left (ATR #2, non-op) is like that. Past that point, it’s a problem, and some consider (or get) a reop to solve it. Still early times to predict where you’ll end up.
    One other indication of healing long is that your Gastroc muscle seems higher, more contracted, than your other one, at same ankle angle. (2-leg HR w/ a rear-view mirror…)
    Another thing: even worse than fixating on others’ schedules, is glorifying them! 6 months back to sports is much faster than average, IMO! Think 12-month marathon and you’re closer. And the frustrating plateau earned its name honestly. Many of us got stronger over the SECOND year… this is not a sprint!
    That doesn’t prove that everything’s fine, but it may turn out that it is fine, just slow in coming and frustrating as @#$%&!

  10. Hi, I don’t stop by very often, but your blog here struck a nerve.

    Even if you can afford a decent PT 3 times a week, don’t. A really good PT will set you up with a challenging program that will last you 2 weeks, maybe keep in touch by phone, text or email.

    Perhaps it was your first few weeks that set you back (if that is the case), I don’t know if your rehab schedule encouraged early mobility.

    Spend the rest of your ‘therapy cash’ on seeing someone who will help you to chill a little, clear your head and see a way through.

    Now, take a few deep breaths, have a good evening. I’ll check in later.

  11. And one MORE AB.com loginID that my Android keyboard’s auto-correct turned into something very different!! Soj9 to Sony?!?

  12. 20 weeks is still early days in terms of full recovery.

    My physio used to tell me if the OS says you will be back at running/sport etc in a certain time like 6 months then double that and that should be about right.

    Find a good physio and work on the program at home. My physio during recovery told me not to come back for at least 4 weeks. The people he sees often are ones who don’t follow the program outside of PT.

    If your phone has a video camera, get the PT to tape some of the program if that helps when you see the PT.

    Also, rehab and recovery involves both working the achilles/calf and rest in between. If you don’t seem to find any improvement, try switching up the work vs rest ratio. For example, take an extra day off for rest before going back to your routine. Muscles fatigue quicker during rehab and if you are constantly working it, you may find that instead of improving you start to plateau. On the positive side, you may find after an extended rest period a clear improvement once you get back into your program.

    When I was doing daily single legged heel raises, I actually found my biggest improvement came after I stopped for about 3-4 days as I went away on a holiday and decided to do absolutely nothing apart from walking. When I resume, gain more height in my heel raise!

    BTW I am 1.5 years since surgery and am still finding incremental improvements in ROM, heel raise height, strength etc.

  13. Great post, btt222! Should be a Sticky! :-)

  14. This is a frustrating injury for everyone. I’m at 12 weeks, still in das boot, which is incredibly frustrating. My PT routine is pretty much the same as atr2014’s. I only go once a week right now since the only thing the PT provides is massage and ROM work. I do my own ROM work at home.

    Hang in there, get some rest, do something that makes you happy.

  15. What a relief to read these posts. I am 7 1/2 weeks post op and my boot just came off yesterday and I had my first P/T yesterday also. I can hardly walk though I am trying and have lowered my expectations of when I will be doing things normally. Had I read these posts prior to surgery my expectations would have been more realistic. My doctor wants me in “sneakers”, but I have no idea what to buy. Any ideas from anyone?

  16. SOJ9 - I am 9.5 months from surgery and still hit plateaus of seemingly no improvement. For me, some things have gone faster than others, other things much slower. But from this point, I can tell you that the overall arc is one of progress - even when you can’t see it at the time. Your body is still healing that tendon, and time is one big key to healing. This marathon certainly gives us lots of opportunity to practice patience and positive thinking. If FWB doesn’t allow you to walk without a limp, the suggestion of pool walking or an Alter-G treadmill might just do the trick! Wishing you a 6th month of more visible healing!

  17. @ Librarian — don’t worry, the first few days out of the boot are awkward for everyone! I’d first ask your doctor for recommendations — “sneakers” is a pretty open category and the right pair for you is going to depend on things unique to your foot, like the height of your arches, the width of your foot, and how you place your feet when you walk. If your doctor has no recommendations, try a specialty running store. Employees there usually have fitting experience. And if all else fails, the “Shoe Dog” find-a-shoe feature on the roadrunnersports website is better than nothing. Good luck!

  18. Librarian, were you walking well in the boot? Is the bottom of your foot tender? Is your stride only impaired by the length of your stride with your good foot? If so, just keep walking with that stride shortened, and it will gradually lengthen as you gain strength, ROM, ankle/leg muscle tone, balance, and confidence.
    If your sole or heel bottom is tender, try squishy gel footbeds or Crocs to cushion it.
    In addition to DC’s recommendations above there are many discussions on this site about recommended - and not - shoes for ATR rehab. Search?

  19. Apologies if this is not in the right place but I am after some advice. I am 7 weeks post rupture - ultrasound showed complete rupture, ends in close proximity in PF and 5mm gap in neutral. I originally found this site whilst sitting in A&E (ER) which informed me of my options regarding treatment - many thanks to all who have posted….Conservative treatment in Aircast - 5 wedges with a programme of removal. This week was to be a final check before weaning off the boot however over the past couple of weeks I have felt what I described a dent and when I showed this to the consultant he sent me for an ultrasound which I had today. This is now showing an increased gap in my tendon (poss 3 cm but not sure I get the written report tomorrow) with scar tissue filling the gap between the tendon ends and no tendon connection…. so sadly things have got worse not better. I have not slipped tripped or fallen although I have had wicked night time cramps - I did mention these to the consultant at about week 3 as I was concerned whether they would pull the tendon but he was not overly concerned……… has anyone else experienced a rerupture from cramp? Is it even possible or did I just not heal? I see my consultant again in 2 days to discuss next steps… Is surgery now the only viable option or is it possible to pursue the conservative route effectively? Again does anyone have any experience of rerupture with conservative treatment? Currently I have reverted to 5 wedges and temporarily lost my smile - on the upside I know where to hire a knee scooter:)

  20. Liza - all the indications were right for you to go down the non op route at first but having read many reports from scientific studies it appears some people, not many, do not heal and they were taken off the trial and given surgery. Some non ops have re-ruptured and gone non op again with success but you will need to make that decision in consultation with your doctor. I am not the non op expert here but it seems your doctor has been following a more modern protocol which is very effective. If your doctor suggested non op in the first place and was using a modern protocol then I would trust his/her advice. I have heard of many having cramps in bed but non have re-ruptured to my knowledge if they were wearing their boot but a cramp is an involuntary shortening of the muscle. They are self sustaining and you only get relief by actively stretching the muscle. I feel is it may have been possible for your calf muscle to open the gap but I really don’t have anything substantive to back that up. I have found taking magnesium supplements and calcium (it aids the uptake of the mg) helps cramps. Mg is slow to return to the body but quick to leave so start now. It helps with the electrical signals in the muscle.

  21. Soj9: Hopefully I can shed a little light on this. I am an orthopedic physical therapist who has a practice in California and I am also going through therapy for my Achilles repair (at 4.5 months now). I hope to helpfully ease some stress you may be having.

    1. Return to sports in 6 months is nearly impossible. Most surgeons will tell you that you should not return to light jogging until 6-8 months, light plyometrics at 10-12 months, and return to sport in 1 year.
    2. I myself am at almost 5 months and I cannot do a single leg heel raise. I can get maybe 20-30% of the way up. This may be due to healing long but more likely due to just weakness. I also see how I am doing by checking how many steps I can take without my repaired heel touching the ground (i.e. toe walking). I use to make it 1 step but I am now up to 3 or 4 before my calf can no longer hold me up.
    3. Therapy sessions: my patients are in therapy for 60-70 minutes. I will do 20-30 minutes of manual therapy (scar tissue mobilization, joint mobilization, and most importantly neuro re-education). The remaining 30-40 minutes are for progressive exercises and then ice if needed at the end.

    I struggled a lot with the lack of strength in my leg. My surgeon used a new technique and was very protective of the surgery. Because of this, I was not allowed to do anything really except for walking in a boot with heel lifts up until the 10 week mark (4 weeks initially in a cast). One of the things I have noticed is that healing and strength gains come slowly. I recommend you try doing a single leg heel raise on a shuttle system or Total Gym. The Total Gym is at an angle and can be adjusted to correlate to various % of body weight. When I first started, I could barely do level 4 (it goes from 1 which is almost parallel to the floor, to level 10 which is at a much steeper angle). I am now up to level 9 and 3 sets of 12. So I am slowly getting closer to full body weight.

    I would recommend you do something similar to that to improve your strength but also give you a sense of a single leg contraction.

    Lastly, you may need PNF (proprioceptive neuromuscular facilitation) to help “wake up” your muscles. Your therapist should know these techniques. I am not sure about the UK, but some therapists in the States are lazy and just try and get as many patients in as possible. The manual/hands on therapy is really where are specialty is. Anyone can do exercises at a gym. But if you never put your hands on someone, you can supervise a ton of patients who are basically just working out.

    Lastly, I can tell you from 15 years of clinical experience, everyone and every case is different. No one heals at the same rate which is why myself and any good therapist never follows a “protocol”. All changes and progression must be made based on how you are doing, what deficits or gains you have had, etc. Its frustrating but you can’t compare your progress with others. I have a patient of mine who has better calf strength and had surgery about the same time (i.e. he can do a heel raise) but he still has a limp, ROM limitations, and weakness in his hips. I, however, walk with no limp, have great hip stability, and can kick his butt with balance exercises.

    Anyway, hope this helped some. Its a very long journey and most do not feel “normal” until 1 year has gone by.

  22. Greg, on a side-note, are you still doing scar massage at 4.5 months? How long do you recommend this? My PTs were never big into this for me, although I used to do daily on my own up until about week 15 and have since stopped altogether. Thanks! -David

  23. Wow, dmbfan32

    Thank you for this post, this really hammers home how we all heal differently and reaffirms how a 1yr recovery really is the correct goal, hence the ‘marathon tracker’! The way you have written reply this is a breath of fresh air and I hope it helps you and gives you piecs of mind soj9

  24. dmbfan

    A good summary of the work involved during rehabilitation.

    However, most PT’s do follow a protocol - they use it but tweak it according to the specifics of the patient and his or her injury. I’m not even sure that they would vary their routine between surgical and non-operated cases, unless the side-effects of surgery were causing difficulties.

  25. wow! am overwhelmed by the responses here. i guess through this i am not alone! because i have been reading all the success stories so far, which meant to give people hope but at the same time gave me unrealistic goals and expectations.

    Norm - i suspect i am healing long My dorsi is better than my good leg and when i PF, my toes curl and look awkward. I change physio on Monday (one day after i published this post) and i will be seeing her next week for twice a week. This clinic is good as its 5 min away form work and allows me to use the gym anytime e.g. wobble boards, wedge box etc for me to practice/do my own assigned exercises. At least there is some hope. I understand i should save the therapy cash but i think if it helps me and force me to set aside an hour to two hours a week on having supervised exercises it will still do me good whether or not its just psychologically or mentally.

    This week i was given a series of exercises i could do at home,and at the clinic, and I have tried hot yoga which seems to help a bit. Definitely feeling a bit stronger but still no calf raise and that is my aim for end of this month - single calf raise and able to walk in normal shoes

    Interestingly - UK don’t seem to have ;Total gym, anti gravity treadmill etc that have been mentioned above.MAybe there are out there but its specialised machines which are not common in gyms/ or in the 2 PT clinics i have seen. The one i am seeing now is a specialised clinic for sports injuries.

    THank you all for your encouragement but i guess there is hope and the hope i get from seeing my PT who makes sure that there is progress each week if not i know that when i am left alone to do the exercises on my own i won’t be able to have anyone notice the difference (though i get a bit better day by day) . HOwever still experience occasional swelling end of the day

    Oh my PT also gave me this pulse strip which sends signals to the leg muscle causing twitching motions which is supposed to help with reducing swelling

    anyway thank you all once again for your kind words!!! much appreciated!

  26. @davidK: it really just depends on how well your scar is moving. I think I returned to work way too quickly and because of that I am behind a little. I still has some restrictions along the scar. It should be able to move in every direction equally. If it feels tight, it still has some restrictions. Some PTs believe in just letting stretch out over time, others like to get rid of it. Mine does not limit any ankle motion but it still feels thick so they work on it but just not as much as previously.

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  28. Hi no problem as this blog is made available publicly as well. Would you mind letting me know what the Facebook group is about? Useless to know others’ experience as well!

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