One Year on

Well, I’ve made it past the first anniversary of my ATR. The good news is that everything seems to be going well. Physically my leg is 100% Psychologically I still have some reservations… I haven’t played badminton and I’m afraid to get back on the court. I know that’s daft and there shouldn’t be any issues but there remains this nagging fear. Instead I’m throwing myself into cycling for exercise as it feels much safer.

If you’ve just had your ATR or are feeling down because it seems to be taking forever to heal, don’t despair. It does get better and it will heal, honest!

16 Responses to “One Year on”

  1. 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! :-)

  2. 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??

  3. > 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 increased risk is very very significant, and you’ve got to personally figure out how to manage it. Myself? I will never again do sprints uphill with a weight vest on. I put such an extreme load on my tendon, that I think it will be fairly easy to reduce/eliminate the risk of imparting that kind of load on my “good” side in the future. I also hope to maintain better strength in the tendon by sticking to a weightlifting program for the long haul (I believe part of my risk factor was high level of muscle development without the peak loading required to develop associated connective tissue strength).

    Others have chosen to back away from sports in a big way. You’ve got to decide what’s right for you.

  4. 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.” :-)

  5. 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!

  6. 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

  7. 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.

  8. 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 what % of post-ATR people take it easy, or quit playing high-risk sports and take up golf or cycling or swimming. That would drop the rate of same-leg 2nd ATRs — but it would also drop the rate of “contralateral” ATRs, and there are a LOT of them. . .

    Bottom line, I’ve never seen anything solid to prove that our healed-ATR legs are ATR-proof (or that an ATR cures pre-existent -itis and -osis), but it’s all been repeated so often without contradiction that I’d bet there’s a fair amount of truth to it.

  9. 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 change that - with those words ringing true for me, I decided I may as well carry on aiming for my goals and playing the game I enjoy.

    Nothing wrong with cycling and if you enjoy it, why stop

    Congrats on the reaching that 12month milestone

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

  11. 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.

  12. 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.

  13. 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!

  14. 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

  15. Dear all, thanks for the great information on here. It is comforting to know I’m not alone. I ruptured my left Achilles’ tendon back in February 2012. The diagnosis was missed and resulted in two further ruptures 3months apart when I was just walking. I ended up having an Achilles’ tendon transfer in Feb 2013.

    Frustrated is an understatement, more like suicidle! So now I am extremely anxious re the recovery. I am now aprx 16 weeks post op, been taken out of the walking boot but still on crutches. Problem is my ankle is so stiff, the more I walk on it the more it aches. To make things even worse the bottom of my foot is numb, tender and hurts when I put weight on it. Has anyone experienced this ? I really can’t see myself being able to walk without pain by the 6 month period. Unfortunately for me, pain killers don’t even touch the sides.

  16. Ouch100, lots of us are stiff post-ATR. A lot of that is often due to swelling, and keeping that down — with Rest, Ice, Compression, and Elevation — may help more than you think.

    Weirdness (including pains) in the bottom of the foot is also very common, and fades at different rates for different folks. Rolling your bare foot over a ball (tennis? maybe golf) while seated often helps. I’d avoid NSAID pain-killers (ASA, ibuprofen, etc.), because I’ve heard and read that they’re bad for tendon healing. Tylenol is probably safe for the tendon.

    For me, walking barefoot on a flat floor and accidentally stepping on a little phone cord made me think like I was about to sprain my ankle on the edge of a curb. I wanted to carpet the whole house in squishy foam. Instead I started wearing squishy-foam Crocs, similar effect. Many others here have also gotten relief with Crocs in early 2-shoes.

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