Feb 10 2012
Guess it’s time to make everything better
Now that I am full weight bearing in my 6 wedge boot. I suppose it’s time to begin the reclamation of my tendon, and the perfection of everything else. Not being able to drive is a bitch, and I’m close to ignoring that mandate from my doctor.
I’m about to embark on some Cissus and Vit C supplementation along with my normal multi vit regimen.
Trying to get as much blood flowing to the repaired area as possible with lots of reverse stretching. My torn bicep healed much faster than normal with an aggressive protocol.
This sucks for now, but my repaired arm is stronger than the uninjured one, maybe the same will happen for my leg.
Once an ATR heals, that leg may be stronger or weaker than the uninjured leg. I saw one study that showed a few % deficit was average after a year or two, with fairly wide variation.
OTOH, the healed side is virtually guaranteed not to suffer another ATR, while the uninjured side is at much higher ATR risk than normal. One study posted on this site showed ~200x higher risk than the population average, even with only a few-year followup. Those of us (like me) who’ve torn both ATRs are certainly a smallish minority here, but we’re not as rare as we’d all like.
I agree with Normofthenorth. After asking questions to five Orthopedic surgeons, the consensus is that a surgically repaired and fully healed Achilles is not likely to rerupture.
However, the intact Achilles is at high risk for rupture, and Norm is certainly not as rare as we would like.
According to the surgeons, there are two types of ATRs. A typical case is the young (under 35) professional athlete. These cases tend to heal faster and are less likely to suffer a tear in their other tendon.
The other case - ATR in people over 40 - is almost always related to underlying conditions. Basically, the tendon tissue was brittle, unhealthy and overused, and this resulted in the rupture. It would have happened whether you were playing hoops, or running accross the street. These are the people most likely to rupture the other tendon.
I fall into the latter group, and have quite a bit of tendinopathy on my intact tendon. The doctor prescribed therapy and PRP treatment. He said even with the treatment, I am at risk for rupturing the other tendon.
On this note, I think I will follow Norm’s footsteps for rupture two, and go the non-operational route. Norm, can you post a link to your blog? I could not find it.
It’s at achillesblog.com/normofthenorth . That’s the system for all the blog pages here, though a tiny minority of people use a different name to post comments, than the name on their blog.
A couple of little quibbles, housemusic:
1) When you wrote “a surgically repaired and fully healed Achilles is not likely to rerupture” you could have left out the “surgically repaired” part. A fully healed Achilles is not likely to rerupture, regardless of the protocol followed.
2) I’ve never heard that distinction between younger and older ATRs being key, and frankly I don’t believe it now. The claim that younger folks generally get back to 100% sooner than us fogeys after an ATR also seems dicey — either wrong, or drowned out by the huge variation between individuals of any age.
When I started PT after my first ATR, I met an undergrad coed — ~35 years my junior — who had torn hers about 2 weeks before mine. We’d both had surgical repairs. Like many people here, I was fascinated to learn her experiences, as a preview to what was coming for me. Unfortunately for her, after a few weeks it became clear that I was recovering way faster than she. It’s a tiny sample, but I don’t think it’s very exceptional.
For sure, there are two kinds of ATRs: Those caused by the AT being over-tensioned by some combination of muscles and weight/momentum, and those that were externally cut, by sheets of glass, screen doors, etc., etc.
That second kind of ATR presumably carries NO special risk of rupturing the other side — unless you work with broken glass, or are a huge klutz, etc.!
But anybody whose muscles and weight/momentum overpowered ONE AT, obviously had one AT that was much weaker than it’s supposed to be. Our bodies are generally pretty well designed, and one general principle of that design is that every tendon is substantially stronger than the muscle that pulls on it — if not, we’d be rupturing tendons all the time while pushing ourselves to go faster, higher, stronger. (Instead, our calves just won’t pull that hard on the AT, and they usually “give out” first if our ankles are forced to flex.)
In our cases (young or old), that design principle was violated, for some “underlying” reason or other. A study that’s linked from this site — which didn’t discriminate between younger and newer ATR patients — found a huge excess risk of rupturing the other side in the first few years after a first ATR.
Whatever the cause of the first ATR, unless it’s something one-off (like a lightning strike), it has a good chance of affecting both legs. Statistically, that excess risk showed up like gang-busters in the study. (Go to the “studies” page and search for “contralateral” to find it.) The risk wasn’t 200% of normal, it was 200 TIMES normal, and they only followed up for a few years — way too short to even count my other-side ATR!
3) Although a substantial minority of ATR patients have had prior AT problems, they’re in the minority. Most of the ATRs — first and second — come out of the blue, like my two. Your tendinopathy may or may not predispose you to an ATR on the other side.
The main reason doctors deserve to be believed on these topics is NOT because their direct experience gives them a shortcut to the truth, since their experience is usually too limited to reveal the truth — and they may well be “filtering” it in unscientific ways, like most of us humans. The main reason to believe doctors is that they may be up on the literature and have read and digested and remembered the best studies. In this field, there are a relatively few “best studies”, and most doctors — even Orthopedic Surgeons — don’t consider our injury or its repair especially interesting or challenging, so many of them don’t bother keeping up. ATR surgery has often been called “the tonsillectomy of the leg”, and rightly so. That (along with professional bias and maybe a touch of self-interest) is why, IMHO, so many Orthopedic Surgeons keep rushing ATR patients under the knife, despite the best studies.
200 times, argh!
Hi Norm,
I found and bookmarked your blog. As you can imagine, I am terrified of a contralateral rupture, and if it happens, I want to skip surgery. Thank you so much for your post! It should be required reading for our club.
Housemusic, to borrow an expression from my late Daddy, “for the same price” as being terrified, you can probably just go about your activities and let the future unfold. If it’s going to happen, it may well happen even if you give up your favorite “high-risk” activities, it will just happen later on. What to do and what to give up is a supremely personal decision, of course, but I am a firm proponent of resuming the activities that we love, even if they may hasten the rupture of your other AT.
If it happens, it’s a bummer, of course. But as one of the guys here posted a year or so ago, “unless I grow a third wheel, I should be immune from ATRs now!”
Coming in very late to this conversation…
Srcamm, I think it’s quite difficult to increase bloodflow to a specific tendon, especially one that’s injured and unable to do a lot of work. I agree that increasing the bloodflow is a very important thing to do, but I think the most effective way to do it is to simply elevate your heart-rate (aerobic exercise). Anything you can do with your legs - for me, it was the spin bike - should be doubly effective; but just staying as active as you possibly can should bring the necessary oxygen, nutrients, etc., to promote the tendon healing.
I’m not sure exactly what you mean by “reverse stretching”. All I’ll suggest is to be very careful about any aggressive dorsi-flexion stretching during the early (first ~12 weeks) of your recovery. Poke around on this site for info about “healing long”.
Good luck!