What should physiotherapy consist of?
9 03 2015I originally ruptured my achilles tendon fully on 22 Nov and followed a conservative approach. I reruptured the tendon in a different place on 21 Dec so had to start the recover process all over again. I had an airboot which came off Weds 4 Feb but did not start Physio/physical therapy until 24 Feb. I have had two appointments which have jst consisted of the physio showing me exercises to do at home. I now have developed an extremely sore heel and foot which the physio said is plantar fasciitas. The pain takes my breath away when i stand on it and does ease with my exercises. Can anyone tell me a bit more about the physio they have at this stage and what I should be expecting? I have so far had no kind of massage or really anyone work specifically on my leg and foot. Is this something that happens further down the line? I am now down to one crutch which I limit using apart from on stairs and longer walks. Any advice would be amazing!!!
Sounds right in that you’d start with ROM exercises at home and basic walking without the boot. PT massage for scar tissue management started around 10 weeks for me as well as 8 ultrasound treatments. You can watch YouTubes on correct ATR massage & do it yourself. PT has me doing daily massage on myself for 10 mins each evening. Standing up at PT and doing simple lunges, squats at 10 weeks and progressed in difficulty by 12 weeks. Also did squats and calf raises with both legs on a machine using half my body weight started at 8 weeks and I’m still doing them but with close to my total body weight at 17 weeks now. Most things started at 8 weeks in simple forms and got harder between 12 - 16 weeks. Everything is about balance, strength, and flexibility. It’s not just the calf you strengthen but the quads, hamstrings, glutes, hips also. Hope that helps.
Hi Tess, I am sorry to read about the re-rupture and the pain you are in. I have never had plantar fasciitis but have read that rolling your foot on a tennis ball or frozen water bottle helps as well as wearing soft shoes like Croc’s. There is a website- Athletes Treating Athletes that has loads of info on this.
As far as PT goes- I had almost no massage on my non-surgical leg, but on my surgical side the massage started immediately and deep and painful. The scaring process is very different for each, so are some aspects of recovery. Are you working on heel raises and maybe gentle squats? Walking may be tough but you could try walking in a pool?
I am not a big fan of stretching the AT early on if you are a non-op, in fact I have really haven’t stretched it at all and have a good ROM.
Hope some of this is helpful- all the best!
Please think hard before you take on any self massage Tess. Stuart recently posted an excellent reply that detailed the way the tendon lays down collagen. Without surgery the body does a brilliant job of repairing the tendon so the scar tissue is usually minimal. At 10 weeks I still had a small divot or thinning in the tendon, any massage would have interfered with the ongoing building. At 5 months I had a fully formed tendon and at 7 months it is hard to feel the rupture point- all without any massage!
Hi everyone. Thank you for the information. My foot ROM seems to be good and the physio was happy with that. My injured leg is very stiff with the stiffest being just above the ankle where it appears there is quite a bit of scar tissue as it is much bigger than it used to be. The physio said there is a definite step in my leg still and so she does not think it has full healed yet.
I have exercises to do at home which mostly consist of softly and slowly stretching my calf muscle. I will have a go at the ball or water bottle under my foot as the pain puts me off walking and doing my exercises but i know I need to push through it otherwise I won’t get anywhere.
I won’t be attempting any massage myself - bit scared I may do more damage than good. I have become so careful after rerupturing and want to do things right. I keep thinking I can do more especially walking and just need to remember this is a long process and I am getting somewhere compared to a month ago. I just wanted to know what others experienced. I have another physio appointment in a week so will ask about massage then.
Just to help with the plantar fasciitas - I suffered from it many years ago while distance running. The problem could be caused by a few things. Firstly the type of shoe you use - is it supportive? Does it stop your foot from rolling inward on it’s arch? Does your arch roll in naturally as you walk? Have you considered wearing orthotics? I also strapped my foot (your physio should know how to do this) until it was better and have never suffered again although I was more careful about my shoes and always wore orthotics. As far as supportive runners go then you should be looking at the higher end ASIC or Brooks. If you have Nike then the best place for them is in the bin. Try this on your current shoes. Hold the heel in one hand and the toe in the other. Bend the shoe along it’s sole. It should bend near the ball of your foot and not the arch. Now try to twist the shoe still holding it the same. It should not twist easy or at all. You could also try radial shock wave therapy if you can find someone who knows how to do it. Some say it doesn’t work but it did for my other AT but you may need to be pain tolerant. It didn’t hurt me but I was told some people find it painful.
I advise others using this site to always take what’s helpful and leave the rest…and it stands to reason to get your heath care providers input before starting anything new. I haven’t had any problem managing scar tissue with massage. PT started it at 10 weeks - 12 weeks. As I said I do it on my own now . Of course you shouldn’t do anything on your own you are not comfortable with and I’d agree many probably don’t use massage to manage scar tissue, although it is a common practice. I don’t know about it interfering with tendon healing…it didn’t in my case anyway, though I couldn’t say it wouldn’t. Not my area of expertise. I also agree that early stretching before 12 - 16 weeks as well as excessive stretching after are not helpful.
Thanks for sharing this information guide with us.