thenxtgrt1’s AchillesBlog

Congrats on making the one year mark. I am a year behind you, but looking forward to getting there already. I see you made very good progress after surgery, in the first weeks, and I hope to do the same. Thanks for the blogs..

My friends every time tell me, our health is very important. ! Great blog!

Doug…were you doing standing single leg calf raises at about 9 weeks or am I reading above statement wrong? I can’t wait to do some real calf raises. My calf is atrophied but thankfully it’s not too bad. I expected it to be alot worse.

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The dogma that strength work has to wait for weeks or months after surgery is one of the things I rejected with my homemade rehab. I think it’s a waste to not take advantage of the strength of the surgical repair. It makes more sense to me to start contracting that calf muscle as early as possible, to minimize the atrophy and shorten the recovery. Maybe someday that approach will get properly tested, (or maybe surgery will all but disappear in the coming years, who knows).

Having said that, you are doing well if you are doing sitting calf raises at six weeks. I was at that point at about five weeks, and I started doing single leg calf raises about four weeks later.

I hope your recovery keeps going well,

Doug

Therabands are like giant rubber bands except they come on rolls and can be cut to various lengths. They come in different colors which designates how elastic they are. Yellow is very elastic, blue is less elastic and dark gray is pretty tough. There may be other colors but those are the ones I’ve been given by physical therapists. I would be kind of surprised if you don’t get one at your first PT appointment.

I’ll have to check out the theraband. I’m unfamiliar with it. I’m calling tomorrow to set up physical therapy for next week. Maybe they will suggest it there.

I was given a yellow Theraband and some exercises to do with it at my first PT appointment which was right at 2 weeks post-op.

Many of us started on gentle strength work (like stretching relatively lightweight Therabands) WAY before the 3 or 4 months you’re expected to wait. Find “my” protocol, linked from my blog page, if you can (or ask for directions) and check it out. (I remember it says you can start “sports-specific exercises” including plyometrics at “>12 weeks”, so I’m sure it says the therabands are way earlier than that.)

That protocol produced excellent results with and without surgery in a good-sized study, so I don’t think there’s any good reason to go any slower.

With a neglected and “not sexy” injury like an ATR, it’s apparently up to us to educate our health professionals, rather than the other way around!

OK, the first paragraph is clear now.

Bearing partial weight while keeping the crutches is what we usually call PWB, partial WB. My protocol called it “protected WB” but I think it means about the same thing. Gradually re-introduce your foot to the job (and joys) of carrying weight, and re-introduce your leg and body to the rhythm and “swing” of walking on two feet.

The thickness of the heel lifts matters, as does the size/length of your foot, since what probably matters most is the angle of your ankle. But nobody knows what the right angle is, or for how long, so this part is all TLAR (That Looks About Right), aka “the Goldilocks Principle”. Your progression Looks About Right to this experienced non-professional!

My computer had switched some things around on original post. It has now been corrected.

The only thing I’ve been told is to eat a high protein diet after surgery to promote healing of the incision. I’ve heard that from the last two surgeons. I don’t know if they have any scientific evidence that it helps, but it doesn’t do any harm to increase protein for a couple of weeks. Unless there’s solid scientific evidence that something works it falls into the category of “snake oil.” I have never bought into the “maybe it works and even if it doesn’t work it doesn’t hurt.” Lots of people consume all sorts of crap under the delusion that it’s good for them when there is no real scientific evidence to support it.

I haven’t heard much about nutrient supplements duting ATR healing.
Personally, I have increased my doses of Vitamin C, Glucosamine with chondritin, Vitamin D and have started taking a Zinc supplement as these, I think, help in connective tissue regeneration.
I am a little concerned about my first PT session as I plan to take my first long drive from Toronto to Memphis -1600 I’m- two days later. I have heard that that there is some discomfort after the session.

Glutamine or glucosamine? A bunch of us have taken various supplements during our rehab, though I don’t think there’s any good evidence to show that any of them actually helps. (I started popping MSM a few months ago. Who knows?)

I didn’t follow your first paragraph, when you jumped straight from removing stitches to “placing the foot at this angle”. If you mean “Why does it help to immobilize an ATR ankle in a toe-down position?” it’s to keep the two torn (and maybe repaired) ends close together, with as little tension as possible pulling them apart. Gradually, as you remove heel lifts, you stretch the tendon (and your poor knotted-up calf muscle!), back toward “normal”.

All rehab protocols except the most extremely aggressive ones start in a heel-lifted position (aka plantarflexion, “ballerina position”, or “in equinus”), usually for a few weeks. My study-tested protocol was significantly more aggressive than most, but the heel lifts were maintained for a full 6 weeks. OTOH, I was doing gentle exercises up to the neutral (90-degrees) position starting at TWO weeks.

Thanks for the info Norm.

I was in a cast for 7 weeks, with no weight bearing. I used a wheel about, where you put your knee on a very narrow walker with wheels and go on your way. It was very handy. But most of the time I just sat or laid with my foot propped up.
Just take it easy and do what the nice Dr. tells you to do LOL.

My Doc followed the printed protocol he handed me, “No Surprises” (the slogan of a Motel chain, I now forget which one!). Mine was without surgery, but the same exact protocol was used for post-op patients in the study we were following.

That was 2 wks to PWB (which usually means Partial WB, but was translated to “Protected” WB on this protocol — the same thing, I think), then “WBAT” (as tolerated) at 4 weeks. I think it was around 5 weeks when I realized I’d forgotten where I’d left the cane that replaced the crutches.

After my first ATR (and surgery), I was on crutches for a LONG time, in for most of my time in 3 casts (though the 3rd was a fiberglass “walking” cast). I found my “bad-side” knee was starting to hurt a lot from non-WB and from me spending so much time kneeling on it, like at the bathroom and kitchen sinks. The boot (and an “elevator shoe” on the other foot, to balance the heights) definitely helped the rest of my body.

I’ve been suggesting that people request (or demand) a written protocol, because I found mine to be hugely beneficial and empowering. It eliminates all concerns about “bait and switch” and “

There are two exercise-related issues here. First: Some serious loss of tone in the calf muscle and the many smaller muscles and tendons (and probably ligaments) of the foot and ankle are pretty inevitable from NWB and immobilization. And maybe partly related to the length of NWB and immobilization. (Some protocols allow PWB virtually immediately — “mine” waits 2 weeks — and some including mine allow PT-assisted mobilization and gentle exercise starting at 2 weeks.) This recovery is discussed all over this website.

Second, if (like many or most of us) you are a “couch potato” for most of the time you’re on crutches and even in a cast or a boot, PWB and even FWB — in fact, if you’re just much more sedentary than you USUALLY are, when you’re healthy and sound — then you’ll naturally get out of shape all over. Other muscles, cardiovascular system, everything. Then when you start bicycling, or swimming, or running again, you’ll be huffing and puffing where you used to be smiling and laughing.

For most of us, this second kind of recovery happens pretty quickly and smoothly and pleasantly. Most of us are so happy to be back to

Thanks for the uplfiting comments guys. I’ve been doing pushups and situps, but the volume hasn’t been too much. And I will try putting injured leg on top of good leg.

As far as I know I just had the typical, run-of-the-mill surgery. I will have the report from the doc and more details tomorrow at follow up appt.

I’m still putting recovery plan in place. I will be able to have a better idea once physical therapy begins.

Wednesday (5/28) I make my return to the gym. I will only do safe, low impact movements. Focus will be mainly on pushups/situps/pull ups. And I will use machines since this provides more control and less chance of injury than free weights.

hi,

What kind of surgery did you get?
What kind of recovery protocol will you follow?

Yes, keep your self motivation at high you’ll need it.
Don’t just lay down waiting for a boot, do push ups and poll ups and etc. Just make sure your injured leg is secured and risk free to avoid any accidents of re rapture.

I keep my injured leg on top of normal while doing push ups.
You’ll be surprised how fast your body will loose “edge” - don’t let it happen.
Lay down on your back and exercises with weights.
Keep injured foot elevated as much as you can.

Welcome to the journey. I had to give up hoops at about age 40 due to back problems but still carry a ball around the house so I know what wanting to get back is like. My ATR was in tennis, 13 weeks ago. I’m hoping to get back on the court in a month or so and be at full speed in about 9 months. There is a lot of wisdom on this site about each byte of the recovery process so ask any specific questions you have. We all do. It seems the emerging consensus is that the sooner you can get into a flexible walking boot which can be adjusted to get the foot back to neutral over time the better you are. You also need to become educated about recovery steps and timetables. Norm of the North has the best in class plans on his site.

Stay in touch.