stalledminidriver’s AchillesBlog

I met one wag in my sports-med clinic’s waiiting room who used to work in a similar sports-med clinic. He told me that whenever they discharged an ATR patient, they’d always say “See you soon!” because so many ruptured the other AT. That also seems over the top based on my reading and experience.

Hi Norm,
I’m glad that you are still here helping people. I have gained much inspiration and knowledge from your help.
You know what they say. “Lies, damn lies and statistics…”
It could be that my surgeon has worked on a different “subset” than the general population. For instance, it stands to reason that if you are working on older athletes (like me and you) that have years of wear and tear, then their chances of rupturing the other side are higher. He was very specific, saying in his personal experience, if I returned to the game, there was a 20-25% chance that I would see him again in <3 years.
That being said, I don’t want to live in fear. The warming weather is calling me back to the courts. Now, if I can just find some comfortable lateral support.
Happy Healing,
E.

Humbland, I think it’s cloer to 2% chance of rupturing your other AT in the first 2 yrs after your first. The only study I know of is linked from this site’s Studies and Protocols page — look for “contralateral” in the title.
That study found that we ATR folks who ruptured “normally” (in sports or dancing etc.) are 200 TIMES more likely to have an ATR on the other leg than the population as a whole. Big increase, but starting with a small risk, so math helps. The annual risk probably tails off in the following years, but it obviously stays elevated, so the total risk keeps going up. (More math.) Most of us “both-siders” took longer than 2 yrs. Mine was 8yrs later, several were 11, one was 13, the longest I remember.
The good news: as one 2- sider said here, “Unless I grow a third wheel, I should be finished with THIS injury!” (Too bad there are so many parts that have to work so well: now my right knee is threatening to end my volleyball carreer, and the Docs and techs think it’s perfect!)

Hi Ryan, Norm and all,
It’s been a while since I’ve visited, I hope everyone is healing well.
I’m about 10 months from surgery and seriously considering playing tennis again. I have reasonably good strength in the repaired leg, The lateral stability is still “challenged”. I was doing a search on the site for ankle braces when I came on this discussion. My surgeon has done >300 procedures., including many athletes. He told me that if I return to my sport, there is a 20-25% of rupturing the other “good” side within 3 years. He said that the reasons were unknown…
It’s definitely food for thought.
Best,
E.

Hi norm, thanks for the advice, but start a blog that’s scary than the ATR I’m not the most IT savy person, but taking a positive out of this situ, I’ve got time to learn, watch out bill gates, and watch out Norm blog here I come, good luck to all take Claire, keep smiling

Don’t apologize for asking Qs, ripraproar, that’s why this site exists. (You can sometimes call it “20 Answers”!)

Many people phone their docs after a slip, and a lot get reassured on the phone, and some get reassured in person. A small minority actually reinjured their AT, some to the point of re-rupture. I’d probably phone, but you may be right about what the doc will do.

Watch Your Step, on crutches now and later when you get off the crutches, too!! Wet floors and wet crutch tips can be MURDER, so be especially careful coming in from rain or snow or whatever.

RICE — Rest, Ice, Compression, and Elevation — is all important to control swelling and pain. Anti-inflammatories are reported to be bad for tendon healing, so many docs recommend acetaminophen (Tylenol) instead — even though inflammation is mostly causing the pain and discomfort.

And start a blog and share your whole story in one place!

Hi Norm,, my mentor, how are you?
I went back to my consultant yesterday, showed him the protocol you have been following, he wasn’t offended and actually said it seemed good and said I should follow given the extent of the study, the bad news is I’m after further advice sorry, today I slipped on my crutches, I’m 16 days non op, achilles area is hurting a little andlots of strange pains and there’s swelling, here’s the question is there any point going back to doc, my view is I’ve never had an MRI so They can not judge if I’m back to square one, also I feel the doc as no option but to say keep in the boot , anti inflam pills and ice. Norm do you agree with both my statements and do you have any advice, sorry for all the questions.

Comment hung up in moderation. Not sure if SMD is around to approve it… sorry for the double post if it show up. But let’s try this again:

I’ve always found this page to be very informative:
achillesblog.com/atrpt.php

Scanning through it, one quickly starts to see the activities that are high risk: sports that have quick changes of direction (basketball, badminton, etc.) are at the top of the list. Soccer is well represented. Dancing!?! shows up a surprising (to me) number of times. Want to stay safe(r)? Avoid the things that show up most often on that list. Or be careful when you partake. Of course, it’s no guarantee.

There are only a couple of cycling AT injuries- and as far as I can tell, they’re cycling *crashes* that caused the ATR. Cycling is pretty safe from an AT perspective.

I won’t be taking up Basketball anytime soon.

Norm and Ryan, thanks for the great replies to something I’d been meaning to ask for a while.

Hey SMD, good to see you’re continuing to do well. Nothing wrong with cycling, sounds like you’re enjoying it so why not warry on.

I recall reading your blog, you were at 16 weeks and I’d just discovered this site (thanks to referral from another ATR jimminyc) and you’d just had that experience of a fall and subsequent scare during some walking in fields for a show of some sort (mini show?).

What pulled me to your blog was that I too was injured during badminton.

At 33 weeks I hit the court’s again, at 39weeks now I am slowly getting back into it (I was never a great player, but slowly returning back to the old form), I also go to the gym 2x per week now.

Like you, the stat that worries me a little everytime I exercise is the fact that I am more likely to injure the other achilles now by a significant factor.

Even though I do still worry, I worry less now than I did 6 weeks ago and this trend will continue no doubt.

One of the things I learned by reading this site is that some people have snapped their achilles just by walking - Norm said it best on my blog, it will either happen or it won’t and nothing will

Hillie, the short answer is “I don’t know”. I’ve read (at least here, including from doug53, who’s an MD) that most people who’ve suffered from tendon problems pre-ATR are “cured” by the healed rupture. Both effect seem a bit weird, but every time these claims are repeated, there’s a chance for people to pipe up and say “Well that was sure wrong for me!” — but instead we “always” get responses like Lisa’s, where people have either experienced the same thing or heard it from sources who might know something.
Most of us do find that our healed-ATR AT is physically bigger (thicker) than it used to be (or or non-op), and not just right where it was torn, either. So maybe there’s a kind of “graft effect” from the scar tissue that grows to reattach and fill the gap, etc., that’s stronger than original.

At least one of our recent RErupture folks here was told that the second rupture was actually in a different spot. I don’t remember all the “proof”, and that could be a tempting diagnosis for a surgeon who likes to think that his repairs are super-strong. . . and I have a jaundiced view of both MRI & US. . .

I also don’t know wh

Speculation Hillie: ATR’s are very rare. Spending time on this blog, it’s easy to forget that…

Throw a wimpy (post ATR) calf muscle into the equation, and I expect they would become very very very rare. Not impossible, just highly unlikely.

Like a broken bone, I suspect a repaired ATR may also be stronger than before- connected with a bunch of scar tissue, extra collagen etc. You’re right though, away from the injury site, the tendon should be no stronger than before. Keep in mind though, the first ATR usually happens - almost by definition, at the tendon’s weakest point. The original tendon that remains should be somewhat stronger than what broke the 1st time.

Then through in the psychological factor- try as they might, I think most ATR patients subconsciously protect their “bad” side for a long long time into the future.

Throw all that together- and it’s not surprising to me that a long term (post healing) re-rupture is almost unheard of.

Norm

I have read many times in the past months that a second rupture on the FIRST leg, after you’ve healed is almost unheard-of. I don’t know why this is, as I can’t see why there can’t be a rupture elsewhere in the same tendon, even if it is a year or more later.

You have a greater depth of knowledge re ATRs than most of us, so can you advise why this is?

H

Yeah, as I was being rolled into surgery on my 2nd leg, the doctor told my husband, “well, the good news is, she only has two legs”. OTOH, I’m only 17 weeks out from the first and spend a lot of time hopping and twisting around on that one while NWB on the 2nd. And my PT said in people that are prone to this, the rotator cuff can also be vulnerable. My poor dog’s been waiting months for a rousing game of fetch so breaking the news to him is gonna be tough!

Ya, what Ryan said. The study that showed 200x the “background” risk followed ATR patients for around 2 years, and compared their rate of ATR on the other leg, to the population as a whole. The good news is that the injury is rare enough that even 200x the normal risk for 2 years is way short of a sure thing, or even a likely event. But the risk is there. And it doesn’t vanish after two years, either. Several people who’ve checked in on this site did their other-side ATR more than a decade after their first. Mine came 8 years after the first.
The study’s on this site’s Studies and Protocols page — search for the weird word “contralateral” (=~ the other side).

The best news is that a second rupture on the FIRST leg, after you’ve healed is almost unheard-of. As two-timer here posted, “Unless I grow a third wheel, I think I’m probably finished with ATRs now.”

> are the odds of ATR much higher for the ‘good’ leg now??

Only about 200x. (no, I’m not joking). That’s an X, not a %.

Keep in mind though, that a lot of folks who rupture their AT have bilateral issues (tendon degradation, ankle weakness, possibly poor blood supply, etc.) Rupturing one tendon in no way “causes” the other one to rupture- rather, rupturing the 1st is a warning sign that you may have a disposition towards breaking your AT (duh). People with such a disposition are obviously at much higher risk of breaking the other one too.

On the other hand, factors that play into that disposition can also be things like: strong calf muscles (cyclists), active lifestyle, competitive badminton or volleyball player, etc. Statistically, us old speedskaters seem to be at high risk (I think: because we *don’t* use our calves much when skating, but develop stupid strong quads and back muscles, which enable us to overwhelm the AT off the ice).

If you had a freak accident that severed your AT (say, in a car crash) then I doubt there is much increased risk at all.

For the vast majority of us- the increa

I found myself going thru some of your old blogs, i am about 30 weeks now and seem to be at same stage of progress you were then: normal activity but no running & no badminton (yes that’s how i did mine too). And doing more cycling! @Normofthenorth: are the odds of ATR much higher for the ‘good’ leg now??

You’re not daft to think that cycling poses lower ATR risks than badminton, stalledminidriver — it’s the simple and obvious truth! Mind you, virtually ALL your risk of a second ATR is now focused on your left leg — the one you’ve been calling the “good” one!

For lots of us (including me), that risk didn’t keep us from returning to the high-impact, high-ATR-risk sports that got us into this club. But if you’re happier and saner cycling rather than chasing and smashing a birdie, please be my guest!

Great news from the other side of the forest SMD. I will certainly be making a return to the Macmillan Dorset Ride (60 miles) next summer so good luck to you also! I see Andrew is thinking about venturing back to badminton soon, not sure I am that brave yet, although my 5 year old has recently started playing at school so I might give him a few pointers at the local sports centre! Take care!

Congrats on the milestone! I’m 2 weeks ahead of you, and am anticipating getting back on the volleyball court next spring. Good to see you’re prgressing fine, and setting goals for yourself.

I just did my first ever Century Ride at the end of Sept. It was a great feeling. But, I was with some cyclists who were obviously in better condition than me (especially my left calf!!!), and they pushed me to the point of exhaustion a few times! It’s all good, as I made it, and can check that box on my Bucket List. Well, I think I’ll be signing up for more Century Rides, tho. It’s a great goal to strive for, and I know you’ll be able to reach it. Just make sure you get enough miles in on your bicycle before hand (especially some longer rides to help your stamina!).

Good job, and keep up the positive attitude!

Congratulations! I’m sure it’s a great feeling. I’m only 3 weeks in post surgery, but love to read others success stories. Good luck on your training (for the century cycle and badmiton). I’m hoping I can just get back to hiking and climbing at some point… And maybe a little golf on the side.

I recall when I first came on here - you had not long tripped on a rut on a field and consdiered it a near miss re-enforcing the need to keep using the boot on uneven surfaces and now not even a year in you’re pushing that one legged heel lift milestone.

Fantastic - certainly gives me a little extra to aim for, 16 weeks to make it so.

Personally, I am definitely going to play badminton again, maybe even try some doubles before year end, a stretch given I can;t even run properly right now, but my level is not high, it’s more about the beers after

That cycling challenge sounds exciting - keep us updated on your progress.

Californiaguy- statistically speaking, once the ATR heals, it is very (exceedingly) rare to rupture it again. However, again just statistically, if you’ve ruptured one side, your are at a much higher risk (like 200 times higher) than the general population for rupturing your other side. Now, before you panic too much, keep in mind that we’re talking very low numbers. Something like 6% of people who rupture one side, will rupture the other. This is compared to something like ~0.03% risk for the general population.

Why the higher risk? I can think of lots of explanations, all of which I have zero data for: they’re just conjecture-
1) You might weaken your good side from over-use during the ATR rehab.
2) Some ATR’s result from chronic degeneration- the type of thing that tends to be symmetric.
3) Genetics. Some people are just pre-disposed.
4) Activity- ATR’s are often the results of hard sport activity. Go back to it, and you elevate the risk again, makes sense that athletes are at higher risk.

normofthenorth,

why do you say that the “risk isn’t so much to the healed AT as to the Other one”? do you think the injured one eventually comes back better than before after a few years. I would think that the injured one would always be weaker than the good one. I guess you would know since you broke both. Also, since you’ve returned to your sports, do you wear any type of athletic ankle brace?

Some of us happily returned to our “high-risk” activities (like my volleyball and SMD’s badminton), while others didn’t. Purely personal decision. The risk isn’t so much to the healed AT as to the Other one…

Ahh SMD good to see you are receovering well, good advice on the cycling - I need to lose a bit of timber as well so cycling seems like a nice way to do it.

It’s well worth re-enforcing the fact that things do get more normal and things do get easier over time, the first 6 weeks are the worst.

Stalledminidriver at 28wks (6months) and edging so much closer to running or perhaps a return to badminton?

Happy continued recovery

Good post. I have also been looking into biking. I think I will definitely be picking up a mountain bike in the near future and will use this for exercise and strengthing the leg. Also, to just get out of the house and enjoy the outdoors. Where I live we have a ton of mountain bike trails, from flat to hilly. I really never thought I would venture out onto them as biking wasn’t my thing. My have things changed.

Starshep, I have no doubt really that I will go back - but I’ll definitely be skipping a season (this winter).
One reason I know that is that at Easter, while I was still NWB and in a cast we went to Center Parcs for a long weekend break. I was stuck with a mobility scooter to get around the park while the others had loads of fun. When they played badminton I found it very difficult to sit on the sidelines and ended up standing at the edge of the court, on crutches and hitting a few shots with the racquet… Not at all easy unless you have three hands!!
Having said that, I will be very nervous going back in a years time.

Stalledminidriver,
Regaining confidence is such a huge issue in recovery. Take the return to badminton in slow steps. Just bounce the shuttlecock with the racquet while standing in place. Practice moving around the court while no play is going on. Work up to doing some volleys in non game situations. If you love the sport, no reason why you can’t give it a try when you’re ready.

Hi SMD,

Great to hear from you, especially so for your continued recovery without incident since the ‘trip’ several weeks back now.

This is such a horrible injury, it’s not like you can see it coming like a trip, a collision or a fall and it’s not something that heals as quickly as a break, a cut or a fracture……but because of it’s random nature and the profound effect it has on not only on our lives but also those around us - it’s not something we want again, but again the reason for the injury is so random it could happen anywhere, not just on the court…..and it’s that reasoning that helps keep me sane

Like you I share a passion for badminton, like you my snappage occured playing the game. Personally, I can’t wait to get back, but I fully intend to be more active than before I want to reduce the opportunity for my part time fitness to turn into another ATR.

Keep it going sounds though you are moving in the right direction.

I am posting again here SMD, hope you don’t mind, it’s to bump up the story on the ATR site.

A reminder for me (because I feel I could do without the boot) and to us all as we approach or enter the ‘two shoes’ stages of our recoveries that the boot is more than useful to have around ready to use on those uneven surfaces… help avoid those ‘near misses’ or worse.

I trust your healing and progressing well, because our injuries and ages are so similar, I would love to read an update from you

Same thing happened to me at badminton on may 28th this year, there’s only a few months between us too and although I played badminton since I was a kid.

I’d taken a 10yr break to do more football, got back into badminton about 3years ago but generally I was only playing 1 a week for a double session of doubles… ashamed to say though, that was my exercise for the week, 6′2″ tall and 17stone of timber lugging around the court……. this injury was a wake up call to do more once I am able….I’ve already set some goals.

Your post about the daleks made me laugh out loud being a long time Dr Who fan. From someone who is only about 52kg I can assure you it kills my hands and arms too dragging my sorry self up those stairs on my butt!

As daft as it sounds, keeping that boot handy will probably pay dividends, prevention is better than cure….it’s certainly somehting I am going to consider for the 16-20wk period.

Good news with the limp slowly dirfting off into the sunset, my missus will be pleasd if I have to walk slower (which I will) because I usually like to march around and she like to ‘look around’ as we move from a-b.

andrew1971 - When I had Ultrasound on my ATR in week 2 the Doctor described his view of the achilles as ‘Mush’. I kid you not! He said that all he could do was confirm it had been a total rupture as there was absolutely no definition to the scan. I saw 4 different specialists through the NHS (I never saw the same one twice) and only twice did anyone actually look at my leg before sticking the next cast on. One of those was my last visit (when I was discharged to the cario of the physiotherapy department) and the other was because I befriended the plaster technician and she insisted on my behalf!

The best advice I can give is be patient. Read Normofthenorths blog (he’s quite prolific and full of great advice), try to persuade your Doctors to give you a boot and physio asap - but don’t be too downhearted if they won’t listen. I tried and failed to persuade them for fast treatment but did get my boot in the end.

It worries me that by the time I get to see my specialist I will of been (non-surgical) in an equinus cast for 5 weeks… already I am 1 week behind….. this is not the specialists fault - but the ultrasound was unable to see me until half way through week4 of my recovery.

By the way, I insisted on only seeing the top ankle specialist, thats a good thing, the bad thing is that he’s only doing ‘outpatient’ appointments on a Tuesday and I suspect I will need an ultrasound before each appointment which can only be on a Monday or a Friday…..interesting that I have to manage my own appointments here at the Alexandra Hospital in Redditch UK.

I realise that you are further down the road to recovery than this entry - but I myself and 3 weeks into an equinus cast (non-surgical) I too did mine on a lunge to the front of teh court playing badminton and my full tear is 8cm from my heel.

At nearly 41yrs old, 6′2″ and around 115kg in weight I guess we share similar ages, type/position of tear and non surgical healing. Not sure if I am a bit heavier than you though?

I am quite adept at 3 weeks at using the dado and hand rail for hopping downstairs (safely and securely mind) but still scooch upstairs on my backside, I tried using just the crutches, but kept bashing my toes on the good foot.

I too have ‘office’ hands, lifitng myself around is good for the rest of my body for sure I can feel the muscle working - also I dont mind toughening up the hands, it’s just one extra thing to be thankful for when I get rid of the crutches.

So many similarities here I’ll be using your blog as my guide.

So sorry to hear of the unfortunate accident - sounds as though things are ok(ish) though.

It’s probably a good lesson to us all that we can never be too careful - the hinged boot on uneven surfaces seems like really good advice for the future (I am 3 weeks in recovery myself soa while to go).

I hope everything okay and wish you contimued successful recovery.

I’m so sorry to hear about the set back. It does help to remind me that I must be ultra careful. I do hope you quickly recover from this minor speed bump.

Sorry to hear the news. I guess its a story for all of us to be wary of. I was thinking at 4 months i will be flying around but this is a real eye opener.

Fingers crossed not to much damage done and hope your recovery gets back on track

Sorry this happened, SMD.

When I had a setback after ATR#1, I got back into my hinged boot until the pain went away and I could walk normally again. Learning to hobble now is NOT progress!

Stalledminidriver,
Based on what I’ve seen, having a lot of mini’s in one place is can be dangerous. Of course that’s based on the road races I’ve been to where they were all trying to crowd into the first turn at the same time.

I’m at 16 weeks also and although I’ve been walking around in 2 shoes for a while, I still put on my boot if I am walking around on unpaved surfaces. Good to hear it wasn’t more serious and hope you recover quickly.

I never get that kind of respect in my beloved 2008 Hyundai Elantra. But when I bicycle at night downtown with all 3 ultra-bright LED lights flashing (1 front, one rear, 1 helmet), I’m almost embarrassed by the way people jump — even cabbies and truck drivers!

stalledminidriver,
I used to go to a lot of sports car races in my late teens/early 20’s and there was a class just devoted to mini’s. It was a lot of fun watching about 20 or 30 of them all trying to squeeze through the first turn going around it on 2 wheels.

ryanb:
Your black Charger does look bad ass. At first I was leaning to black but I saw a red one on the street over the weekend and really liked it too. Now seeing yours, I’m leaning back to black. BTW No need to hate showing me that picture. Here is a picture of my current everyday car next to my other car: http://www.cyber-com-inc.com/vetteprix.jpg And as you may notice, I am a huge Chicago White Sox fan.