Basketball Blues…
Posted by terencemc on February 17, 2014
Hi All,
Found this network of blogs and already finding it immensely helpful. Here’s my story’s start…
I recently started expanding my exercise from weights and light cardio at the gym to pickup basketball with other 30 somethings a few days a week. I was a hoops player in high school and still love playing. On Sunday Night Feb 9th, i was about 90 mins in to my pickup games. We’d play 2 games, then sit for 1-2. It was a nice rotation. I was pushing for one more game and I now regret not packing up and leaving sooner. I took a pass on the right wing and just shifted quickly to drive to the hoop. With my right leg leading, I was pushing off my back leg and felt the POP and immediately dropped to the floor. The pain was awful and I couldn’t feel my foot. A buddy helped me to the side where i elevated, iced and tightened my shoe laces. After 15 mins, i knew something bad had happened. I was off to the ER.
XRays came back clear and the doctor made his way in, felt my left leg from my heel to the calf, then immediately stopped and told me he had bad news- the Achilles ruptured. He emphasized he wasn’t an Ortho specialist, but had seen this before plenty of times. Mine was fully ruptured and I’d need surgery. The next day, i was in the Cleveland Clinic nearby and i had two doctors examine me. They were both Orthopedic specialists, one focused on non surgical treatment and the other a surgeon. They both agreed that given my fitness level, my age (37) and my overall health, it was best for my long-term recovery to get surgery and then proceed with PT and the usual process from there.
That doctor appt was 7 days ago. My surgery is in 2 days. I’m getting slightly better on my crutches with my boot. But, still can’t put any weight on the foot. I now own a shower chair, crutches, plenty of surgical socks and a massive boot. Huge change overnight. I went from really down a few days ago about how long a road there is ahead of me to feeling pretty optimistic and goal-oriented today. It’s been a rough week for my wife who now has the responsibility for all 4 kids and 2 dogs in our multi-level home. She’s overwhelmed and afraid. I’m trying to find a way to help share my current optimism, but it’s not working yet. I think once the surgery clears, that’ll be a big weight off her shoulders.
One thing I find myself doing is setting milestone goals for my recovery. Walking without crutches by 3 months, light jogging by 6 months, things like that. My wife and I disagree on the utility of this. I feel like i need to do this to keep myself going. My wife is understandably concerned i’ll push too hard too soon and experience a bad setback.
I’d be interested to hear from you all on what the upside/downside is for goal setting like i am doing. Is this a potential for disappointment or do you think it’ll be an aid in my mental state and physical recovery in the months ahead?
Thanks for reading!
February 18th, 2014 at 12:19 am
To the extent your goals are treatment-related mile-markers in a well-documented and successful rehab protocol — like bit.ly/UWOProtocol from the excellent 2010 UWO study or the Exeter protocol from the UK discussed on Suddsy’s blog here — they are important aids to your recovery. And BTW, your “Walking without crutches by 3 months” is Crazy Slow by their standards. UWO has FWB (= Walking without crutches) at 4 weeks into treatment — with or withOUT surgery — and Exeter is either that fast or a bit faster, also op or non-op.
You could almost surely be more helpful to your wife and household without the surgery (which will turn you into a moaning bed-ridden dependent for ~ a week if your post-op experience is like mine), with clinical results that are much more similar/identical to post-op results (according to the best modern evidence) than your Docs seem to have told you.
If you want to review the op/non-op evidence yourself, and consider cancelling the op, the full text of the UWO study is on this site, at achillesblog.com/files/2008/03/jbjsi01401v1.pdf , and Hillie has linked the published results of the Exeter study several times, including on Suddsy’s blog. A couple of my blogs — most recently “The case for skipping ATR surgery” — discuss the evidence, pros and cons, what we know and what we don’t, etc.
The op/non-op evidence has essentially turned upside-down since 2007 (when the first op/non-op study was published that used a fast aggressive rehab protocol for the non-op patients — which produced way FEWER reruptures and better results than the older slow protocols!). Most of the world’s OSs and PTs and coaches and trainers still haven’t completely internalized “the new reality”, which contradicts everything they learned from their teachers and mentors. In fact, it’s only been less than a year since the first meta-study was published that showed that fast modern non-op treatment produces comparable results to surgery. (All the earlier meta-studies lumped ALL the carefully-written non-op studies together, whether they used old-fashioned high-risk “conservative casting” or the new, fast, low-risk protocols. That kind of bad analysis has just prolonged the old myths.)
And to the extent that your goals are farther out, like returning to jogging or full-on sports, they may or may not turn out to be helpful or realistic. My opinion is that most patients would be better off if they paid more attention to the early landmarks from the most successful published studies, and less attention to arbitrary landmarks (and more attention to their bodies) later on.
Finally, if you check out RyanB’s site here, including his unusual (and somewhat athletic) technique for stair-walking with crutches, you may find the multi-level house less of a challenge in the first few weeks.
Good luck, and keep posting!
February 18th, 2014 at 12:34 am
Terence, your story has me scratching my head about something else, way less relevant to your immediate future:
Many ATR patients naturally blame themselves for their ATRs, and those who ruptured early in a sports session always wonder if they should have stretched and/or warmed up longer than they did. OTOH, MANY of us — including you and me — ruptured late in a long sports session (me TWICE, once on each side!), which long ago convinced me that neither of those “warmups” had much to do with the risk of an ATR. (And recent studies have shown that warming up doesn’t lower injury risk much, and pre-sports stretching seems to INcrease it!?!)
But like your ATR basketball session, my two ATR evenings of competitive volleyball also included games when we were sitting on the bench. And when we came back on the court, we were immediately playing competitive matches that counted, going full-bore, with very little time for warmup.
I don’t actually recall whether each of my ATRs happened very soon after my team rotated back onto the court or not (they were in late 2001 and 2009), but they may well have, and it sounds like yours did for sure. So that’s got me wondering if that common pattern of play — play hard for a few games then sit still and chill for one or two, then “rinse and repeat”. . . — is unusually likely to cause an ATR. It wouldn’t be trivial to gather the data to find out, but it might be possible. . .
February 18th, 2014 at 8:25 am
Thanks Norm for the helpful recovery timeline info here. it’s nice to see that i can hope for something more aggressive (also comparing it to the average recovery timeline for members on here.) I checked out RyanB’s site and wasn’t successful finding the post you reference. if you happen to know where it is, i’d appreciate the link.
Yeh, I did pre comprehensive stretching before playing the night of my injury. I usually do a couple minutes of basic stretching. This was more intensive. And yeh, i’ve wondered if my rotation was part of the issue too. not really sure though obviously. The doctors couldn’t really say and were hesitant to validate that had any part of the cause here.
re: surgery, I am reading your contributions in part in here. I appreciate your passion on the topic here, but i’m extremely comfortable with the path my doctors have recommended. Aside from the ER doctor, I felt like i was presented a balanced case of surgery vs. non-surgery. I trust the care I am under and have a ton of confidence in my upcoming recovery as a result. I think that matters.
Thanks again for the comments and for reading…
February 18th, 2014 at 11:43 am
Terence, good luck with the surgery! I had mine right after the accident and don’t mind the experience. Modern anesthetic is really a trip. They cut half an hour out of your life, switching the brains off an on like a light bulb. I have never had any issues, pains or whatever after the surgery. The mind is probably very important here. With all the information available on non-op vs. op it is hard to decide and both options currently look very equivalent. Therefore it is important to be at ease with the option you chose in order to prevent a later nagging “If only…”.
Enjoy the trip!
February 18th, 2014 at 1:36 pm
Thanks for taking the advice in the spirit I intended, Terence, and best of luck with the surgery. Both approaches work well for sure, and neither comes with a guarantee, which makes it especially important for us to be comfortable with the choice.
I’ll try to find Ryan’s stairs video. Basically he grabbed the handles from the INSIDE, with the top pads outside his shoulders, and muscled his way up and down the stairs at high speed. Quite remarkable to watch. Never tried it myself. Seems to work best on wide staircases, IIRC, because he swung the crutches out to the side. Not sure that’s the only way.. .
February 18th, 2014 at 1:46 pm
achillesblog.com/ryanb/2012/06/19/stairs-and-crutches.
February 18th, 2014 at 4:17 pm
Thanks Neon. Totally with you on avoiding the “if only…” scenario. Norm- appreciate the link!