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Exercise

exercise-posters.jpg

The discussion about exercise has come up a number of times on achillesblog over the last several weeks. So, I thought I would take a minute to reflect on some of the things that I was able to do during the first 10 weeks of my recovery. Keep in mind that this is only my experience, and you should consult with your doctor and/or therapist about what exercises are appropriate for you.

I had been in very good physical condition prior to my injury. About 4 years ago I started to get into long distance running and since then I’ve completed a couple of marathons and numerous half-marathons. I also do a fair amount of biking to supplement my running. So, my cardio level has been pretty good. Following the rupture I was able to quickly accept the fact that I would lose most of the cardio I had built up for the last several year. I’m okay with this, because I know it will provide motivation once I’m able to start running again.

With that being said, I still wanted to try and keep some level of fitness while I was in casts and the boot. I really didn’t do much the first two weeks following surgery as my focus was on getting back to work and a level of normalcy. My exercising consisted mainly of propelling myself around on crutches. This actually provided a pretty good workout.

At my 2 week post op appointment I transferred from a splint into a cast and briefly spoke with my surgeon about things I could do to stay in shape. I was still non-weightbearing (NWB) at this point, so there wasn’t much I could do that involved the injured leg. My surgeon suggest to keep moving my toes around (up and down) and to do leg lifts. I could also weight lift with other parts of my body, as long as I remained NWB. I’ve never been much of a weightlifter, so I stuck mainly to the leg lifts. I was still getting a pretty good workout from the crutches.

I had another post op visit at week 4 when I was recasted with my foot back in a neutral position. I was also given the okay to start partial weightbearing and my doctor allowed me to start riding an exercise bike, if it felt comfortable. Well, my bike was sitting in a trainer in my basement since winter set in, just waiting to be ridden. So, that night I carefully hopped back into the saddle and went for a ride, albeit relatively short.

I rode my bike about 4 times a week for the next two weeks, slowly increasing my rpm and resistance. I also continued to do some leg lifts during these two weeks. I went back to the doctor at week 6 post op and moved into the boot. My doctor encouraged me to keep riding the bike and told me I could even ride the bike without the boot if I felt comfortable. He also encouraged pool exercises now that the incisions had healed. He said to start in shoulder depth water trying to walk slowly and trying to do heel lifts. Unfortunately, I let my gym membership lapse several months back, so I didn’t have access to a pool. I also wasn’t driving at this point and I didn’t want to be a burden on my family, asking them to take me to the pool. In hindsight, it may have been good to renew my membership and at least make a couple of trips to the pool.

Wearing the boot also allowed me to start some range of motion exercises. These exercises were pretty basic and can be seen on the first page of this exercise guide. I was also given the okay to start full weightbearing while wearing the boot. Just walking around in the boot provided some great exercise. The injury has given me more respect for walking as a good form of exercise.

I’m now beginning week 11 post op and I continue to ride on my bike trainer. I’m almost back to the same resistance and rpm I was at prior to the surgery. Biking works well because it doesn’t put a lot of strain on the tendon. I’ve done some work with therabands as well over the last few weeks to improve range of motion and start the slow process of rebuilding the calf muscle. I’m also in physical therapy now where the focus will be on rebuilding strength and getting back to my pre-injury level of fitness.

I’m sure my level of fitness has dropped quite a bit since the injury occurred, but I still feel pretty good. I’ve lost a lot of strength, but I feel good about my cardio level at this point. I also don’t think I’ve gained any weight, which is good. Most importantly, exercising has helped me mentally. Every little thing that I can do to get back to a level of normalcy allows me to accept that the injury happened and that I can now move on and focus on walking normally again.

40 Responses to “Exercise”

  1. I got shot in my left knee august 24, 2008. The bullit was remove in 5 minute from below the skin. their was no damage. A hard cast was pu on for two months. Third month nwb. I’m now doing therapy. What is your best recommendation for getting back in shape.

  2. Alfredo - Sorry to hear about your accident. My best recommendation is to remain patient. The strength will not return over night and there really are no shortcuts. Good luck.

  3. Hi there i completely tore my achilles about 7 weeks ago. I had surgery a week after and i started weight bearing (heel only) about 3 weeks after surgery.I was under strict orders from my doc not to WB until 8 weeks,well im a very active person and also a Barber so that requires me to be on my feet.Anyhow i started the gym last week doing regular weights,stationary bike and calf raises with 20% WB on my operated foot. I think i am recovering rather quickly,i am not overdoing it,if i feel pain i stop,i am not tying to be a superhero however i read online that a test was done witha group of ppl that had surgery,they were divided into 2 groups and one group started weight bearing 4 days after the surgery and the other half in a boot for 8 weeks well obviously the weight bearing group recovered much quicker without complications and both groups healed evenly and have good flex and tension on the tendon at 6 mths and no reports of rerupture were reported. So i guess im kind of incorporating the two theories.I feel good but am i wrong for not listening to my doc?

  4. Serge, start a blog and give us the details. You’re certainly not the first ATR patient here to be “bad” and go faster than their Doc said. Many have done well, a few not so well. I’d rather see informed patients take the evidence to their Docs, because most of them don’t have time to read it, or would rather do things the way they’ve always done them. Think of the NEXT 100 patients that open that same door!!

    There are also risks (obviously) to going at your own speed. And not all setbacks come with immediate pain, or even discomfort. There are a few studies linked on the main page here that show the benefits of early WB. Waiting NWB for 8 weeks is Not Good according to the studies.

    But staying in a boot for 8 weeks — FWB for maybe half of that time — is not necessarily too long, especially if you can get a hinged boot, one that lets your ankle (and calf and AT) flex downward, while protecting it from flexing upwards past 90 degrees.

    Most large studies have SOME reruptures, BTW. It is a fact of life for 1 or 2% of ATR patients, most of the time. In a good study, I think most of them are freak accidents like falling down the stairs on crutches, but that’s just my theory.

  5. Serge - I’m not going to tell you whether you’re right or wrong for not listening to your doctor, but I do encourage that you try to have an open dialogue with him/her. Your doctor may just be following a standard protocol he/she is comfortable with, but there could also be a reason he/she wants you to remain NWB for 8 weeks, based on your particular set of circumstances. I would suggest discussing your circumstances with your doctor.

    As for exercising, my only words of caution at this point would be to make sure you’re not dorsiflexing the foot much past neutral as this can lead to the tendon healing long.

  6. Tomtom,

    thanks for progress pictures.

    Would you mind, while you remember post your progress from 4 months? Please.
    What activity you did at 4,5,6 months?
    What exercises?
    Any video would help a lot.

  7. mikek753 - You should be able to read through my blog to get an idea of the activities I’ve done around the 4-6 month mark following both surgeries. Most of the activities I did at that point were standard rehab exercises to improve strength, balance, and range of motion. I also started to jog at around the 5-6 month mark following both surgeries. I haven’t had a chance to update my blog as much after the second surgery, but I’ll try and write up a post in the near future. My progress hasn’t changed significantly since my last post, as I’m still battling a bit of soreness and trying to get back calf strength.

  8. Hi

    I ruptured my achilles tendon on July 1st and did not opt for surgery. My doctor tells me that it has healed and that I am able to place some weight on the leg. I saw an osteopath today and he said there is a gap between the tendon and the calf muscle. However the foot is able to move and up and down. I’m just worried as to whether the tendon has healed or not. I can feel a small gap. Please advise.

  9. Sam, did anybody do the Thompson test on you? It’s pretty diagnostic for AT connection, or not. Many of us could feel various bumps and/or depressions at various times along the way. Some are serious, some Not So Much.

    What kind of protocol did you follow without surgery? E.g., how long in a cast, or boot, how long NWB, when did you start exercise, and PT?

    Also, was your original rupture up high, near the calf muscle?

    (And start a blog of your own!)

  10. I strongly believe exercise is the KEY to recovery….most of us on this site have injured our achilles & the rest of our bodies still work as well as they did prior to our ruptures….yet I read, over & over again, of people who sit around doing nothing, for two weeks, then several weeks more….. If you keep the rest of the body active, as far as possible, without WB, then with partial WB when it’s allowed, you are going to be in a much better state mentally AND physically. Read my blog for encouragement; you can definitely swim in a cast & using just one leg, even when the injured leg is too painful to move, in the early stages. You can also do a lot of stuff in the gym, without WB & without using your achilles at all. The cast, or boot protects you, so stop thinking of these things as enemies & use them to your advantage. You’ll then be in great shape to start your official rehab, when that time comes around & you’ll be a far nicer person to live with too!

  11. I ruptured my Achilles 35 days ago, I agree with the blog that exercise is the key to recovery, one of the biggest things that hurts is the incision from the surgery. I too have lost a lot of my cardio endurance from this but am will certainly work my way back.

  12. Are you saying your incision still hurts? How long ago was your surgery?

  13. Hi Guys,

    i tore my achilles Sept 2nd 2010, had surgery after 1 week , after 2 weeks on a cast i was required to wear a boot after about 2weeks plus a few days my boot was removed now im walking witha slight limp ( now on my 2nd month ) i have a hard time giong up and down stairs but hopefully in 1 more month i get better at it

  14. hi guys

    Myles from Dublin Ireland, ruptured my achilles playing squash - typical case of male 46yrs good fitness but only started playing squash after 10 years layoff. Anyway I had surgery 16th Nov 2010 and still getting used to crutches and general helpnessness. Im back for full cast Friday 25th so appears sooner than majority of cases i read about. I intend to ask the doc to push forward a little to a least try be out of cast by Christmas. I presume the ski holiday I’ve fully paid for on 2nd Jan is total no for skiing - OR IS IT??

    Love to hear your thoughts and best of luck to all other sufferers
    Myles

  15. Hi all
    ann marie from louth, ruptured my achilles playing football last august 2010. 39 at the time. felt completely crushed as we had got to a final and was only 2 weeks from it. anyway had surgery and had the leg in plaster for 12 weeks. got the plaster off at beginning of Nov on a thursday - fell at home on the sat (2 days later) and reruptured it again. was absolutely unconsolable that weekend. Back into the system in Drogheda, noone really knew what way to go about treating. Anyway long story short transferred to a specialist in Dublin and was put into a boot this time. No surgery allowed (too soon). Boot came off in mid Jan. I am about to go back for my 3 month check up. I have made reasonable progress, doing a little light jogging and hoping to impress him next week with my progress. Still have not come to terms that i am not to play again.
    I have not come across anyone who else who has re-ruptured so soon after or indeed anyone that did it twice. So i still feel completely alone in my rehab.

    My advice to anyone who has recently ruptured achilles tendon be extremely careful when aids come off, my second mishap was so simple to happen but the pain was excruciating and something i hope never to encounter again.

  16. Sorry about your experience, Ann Marie — and I think it deserves a blog of your own!

    You “only” reruptured ONCE, right? If so, you’re in an elite club here, but far from completely alone. You’re also not the only one who’s recently re-ruptured after surgery, then got the re-rupture treated WITHOUT surgery — though (a) I forget the ID of the guy who did that ~4 months ago and (b) it’s more common to go in the opposite direction, especially after super-slow “conservative casting” the first time.

    Your 12 weeks in a cast post-op is long and slow, and may have increased the odds of your re-rupture, though we’re all very vulnerable when we first get into 2 shoes, no matter when.

    When you say “Still have not come to terms that i am not to play again”, do you mean “for now”, or “ever”?? Most ATs heal up as strong as new, or more so, and the main reason to give up football forever would be for fear of rupturing the OTHER side, as several of us here (including me) have done.

    Was your re-rupture much more painful than your initial rupture? The pain of an ATR seems hugely variable, and I have no idea what determines how painful it is, or whether it “means” anything, e.g., for the prospects of healing.

  17. Question -

    I ruptured my achilles on 3/19 and it was a high tear so the surgeon could not operate. I received a PRP injection on 3/25 and was put in a cast w/ crutches for about 11 days.

    Since Tuesday I have been in a boot (with 2 heel raises) and, against the doctor’s advice, have not been using crutches. I try to limit the amount of time I walk around, but crutches are no good for my 3 story apartment in the city.

    I have limited pain in the morning when I get out of bed (without the boot). It goes away, then the only pain I have is from the discomfort of the boot.

    I can put weight on my foot without the boot and it doesn’t hurt, it’s just tender.

    Will my achilles recover if I continue to use the boot for 2 more months (as recommended), but skip the crutches, which were recommended for month 1?

  18. Hi Woody from Australia. Great to be able to read everyone’s blogs, I am almost 2 wks post op and was totally ignorant to what was ahead of me before reading your stories.
    I am in my early 40s and very active, it’s just coming into summer here and I am worried that I am going to spend it on crutches and in a boot.
    Are you able to advise me (on average) how long can I expect to wait until I can at least walk normally.
    Also how long before you can mentally get over the fear that you might re re - rupture?
    Sorry, one last question, I live near the beach in Sydney and like to spend a of time surfing, I feel like I will be too scared to walk in the sand let alone surf on my board for a long time, any surfers out there that can give m some guidance. Thanks

  19. Woody, the crutches should only last around 4 weeks, and the boot maybe 8. At least if you follow my fave schedule — online at bit.ly/UWOProtocol , taken from a very successful Canadian study published last year. Lots of doctors get their patients moving more slowly to be “conservative”, but the studies suggest that slower rehab INcreases risks, not the other way around.
    Walking normally, without any hint of a “dip” at the end of the stride over your injured ankle, is actually a pretty tough test of calf and AT strength, and it takes most of us around 3 or 4 months, give or take. First you’ll start walking fast on the crutches, then you’ll ditch the crutches and slow down then gradually get going fast in the boot. Then you’ll ditch the boot and slow down again, then gradually get going fast in two shoes.

    Each step is a milestone and gets you closer to full recovery and should be celebrated, though none of them is the end of the journey.

    The vast majority of re-ruptures happen in the first 12 or 13 weeks into treatment (post-op or post-immobilization if you skipped the surgery), and the risks of re-rupture drop to very tiny a month or two after that. In fact, once your AT and calf heal up, your risk of re-rupturing THAT tendon are essentially zero. (Unfortunately, your risk of tearing the OTHER one are much higher than your neighbors’ or your teammates — sorry ’bout that!)

    Walking on sand is a relatively AT-friendly activity, and you should be able to do that (and walking barefoot around the house) roughly when you ditch the boot, maybe 8 weeks post-op if you follow the UWO protocol above. Surfing isn’t my “bag”, but I’d expect it to wait for close to full recovery, probably 6 months or longer post-op. I got back to downhill skiing just 17 weeks post-non-op, but that’s in a big stiff boot. I waited ’til 10-11 months post-op (after my first of two ATRs) before getting back to competitive volleyball, which may not be any scarier than surfing — though I’m just guessing from the wind-surfing I’ve done.

    In short, once you heal up, there isn’t much reason to be scared. (Before that, it’s GOOD to be scared, because it might keep you from doing something dumb.) Some people change their lives, or their sports, from fear of rupturing the other AT, but most of us go back to the activities we love and take our chances. I lost that bet myself (tore the other one 8 years later) but I wouldn’t change a thing.

  20. > In fact, once your AT and calf heal up, your risk of re-rupturing THAT tendon are essentially zero.

    Norm: this topic has come up a few times lately. Do you have a pointer to any studies/stats that would confirm this? Is a fully healed rupture really less prone to tear than - say - an uninjured tendon? Folks on the blog are definitely getting conflicting advice from their docs/therapists.

    It would be good to see some hard data on the topic-

  21. Ryan, I don’t think I have an answer that’s quite as good as your question is, but I’m still convinced the statement is true. My understanding is partly based on statements by “my elders” here, including doug53 (himself a prominent MD, though not in this field), and partly based on a couple of studies on the risk of rupturing the OTHER AT (including one that’s listed in the “Studies” page on the Main Page here), and partly based on comments in studies on various op and non-op protocols I’ve read (or skimmed the abstracts of!).

    Doug once mentioned that even most people who suffered from pre-ATR Achilles problems (tendinosis, tendonitis. . .) tend to be “cured” of them after their ATR fully heals. I’m not sure of his source for that.

    I think the studies demonstrating our elevated risks of tearing the other AT (as I did 8 yrs later) either state or imply that virtually nobody tears the same one over again years later. (The study linked here only followed up for ~4 years, and found a ~200X elevated risk of doing the other AT, with no mention of years-delayed RE-ruptures of the same AT.)

    IIRC, the authors of the UWO study were asked at AAOS 2009 (http://bit.ly/UWOStudy) why they “only” followed up their patients for 2 years, and they mentioned how “front-end-loaded” the timing of re-ruptures was. And other expert researchers have made similar (and stronger) statements along those lines.

    If you check the study on the “other-side” risks, I think you’ll be reassured about the “same-side” risks. Click on “ATR Rehab Protocols, Publications, Studies” near the top of the Main Page, and look for “Contralateral (your other) Tendon Rupture study”. If not, I’m remembering wrong.

  22. Norm - you are one of the few people on here who have gone the non-operative route - at least on one of your ATRs. I’m in week 6 after ‘conservative’ treatment and in an Aircast boot now for a week having managed to cut the plaster time down from 6 weeks to five. I find I can walk around without crutches - although I sometimes use one or two crutches - and don’t seem to be getting any adverse reaction. In your experience is this OK to do, or would you think more caution might be advisable. Don’t get any pain when I take boot off to sleep. My worry is I got minimum instruction from my Doctor and in the great British state health system its difficult to get hold of anyone who can give any serious advice. Going on a 2 week holiday in a couple of weeks’ time which could involve a fair amount of trying to get around (prob using crutches as I can move faster with 2 crutches and I guess it makes for less strain). again do you think that would be ok?

  23. Hi Lawwill, one more reason to bring crutches is that people will treat you completely differently. They will walk around you, make sure they don’t bump into you and also you will probably get help boarding the airplane etc. So definitely bring them even if you may not really need them.
    Also remember to elevate extra as your swelling will probably be a bit worse with all the extra effort plus the time in the airplane. I use those compression stockings, even on short flights, or long drives.
    Good luck,
    Wilco

  24. Lawwill, quite a few of us posting have gone non-op, though many don’t mention it all the time. I’ve recently commented TWICE that I wish I’d remembered THAT person (2 of ‘em!) had gone non-op and done very well. . .

    Concerning your protocol and how fast you should go and whether going faster is OK in my opinion. . . it’s your leg, and you’re in the care of the people whose care you’re in, so my opinion is just another patient’s opinion. What I do recommend is that ATR folks look at bit.ly/UWOProtocol and the published protocols from other recent scientific studies that have produced excellent results — in your case, without surgery, though the UWO study produced excellent results with surgery as well.

    Basically, if you’re going much slower than that protocol, I’d speed it up. Don’t “jump” straight from where you are to where that protocol is, but gradually taper into it, so you gradually close the gap. “Plot a converging course”, as a navigator might say. E.g., if you haven’t done any exercises yet at week 4, and UWO started at week 2, then do the week 2 exercises for 4 or 5 days then move on to week 3, etc.

    It may be true of post-op patients that they/we all get to about the same place in a year or two. But for non-op treatment, my reading of the big difference between the second-rate results from the earlier studies and the first-rate results from the post-2007 studies, suggests that faster protocols actually decrease re-rupture rates and produce superior results in strength and ROM. If that’s right, then avoiding the “conservative” delays improves clinical outcomes — as well as decreasing the bloody nuisance of long NWB and long immobilization, etc.

  25. Hi folks

    Great info tks. Would love to hear on how to avoid elongated tendon during healing. Woke up after day two in a borrowed boot that had a rounded base. Found I could walk without assitance and could move good leg a few inches ahead of bad leg in the walk shuffle maneuver I now call walking. I was shocked but also nervous that I had moved to quickly. I am 5.5 weeks post tear with no operation. 5 days post fiberglass cast. Have not pulled out my lifts yet.

  26. If you go off and exercise you run the risk of:

    a) injuring your good leg and now you’re in a wheelchair

    or

    b) falling when you’re crutching around and whacking your head or worse.

    Unless you can do exercises that eliminate these, I’d suggest you just take it easy for a bit.

  27. True Tony, for the start when NWB exercise is restricted to upperbody, but once you are PWB using crutches is pretty safe if your carfull, always use the hand rail on stairs and the worst that can happen is you “fall” and twist sideways around your arm on the rail.

    https://www.facebook.com/media/set/?set=a.10100121335579931.2461549.61000734&type=3

    John, 5.5 weeks is quite normal to be FWB in a protective (vacocast/ aircast etc) boot, are you planarfelxed in the boot (is your heal raised) some are doing ROM exercises by then and have had no problems but its a lot faster than others like myself (middle of the road non-op protocol)

    my suggestion would be that its ok to do ROM gently but (from what I have read in studies and here) it takes about 8 weeks for the tendon to knit properly and after that point the risk of lengthening is greatly reduced and its after that you should look at increasing your ROM back to “normal”, but always ask the people looking after you, eveyone is different, and never try to push through pain especially at this early stage.

  28. Hi just reading your blogs with interest. I am 5weeks post op still in my boot for another 3 weeks. I have been very active throughout my life and obviously devastated when this occurred. I live on my own and after the first week and half out of necessity I had to go to the shop. I cycled there found I was able to do it fairly easily and once I had my boot that has been my means of getting around. If I know I have to do a lot of walking after I reduce and tape my crutches to the frame of my bike but in general I can walk short 5min stints with just the boot. I only ever get on and off my bike on my good leg. Allied to this I do a lot of self massage to the whole leg and hydrotherapy. I was slighty concerned with swelling and recently saw a homeopath I was given a drop of arnica under the Tongue and ledum. Arnica was supposed to be for the muscular swelling and the ledum for the ligamentous healing. I cannot say about the ledum yet but the swelling has virtually gone. This has been my experience so far I no it’s not conventional but only time will tell

  29. Hi. I ruptured my tendon early in 2009. Trying to get in shape after my 4th baby and in time for my wedding later that year :(. I made the wedding but no high heels for me I was just weight baring as I hobbled down the aisle, after surgical repair.
    No physio - was never referred.
    I have better movement in my ankle now and have lost some baby weight. I am ready to try again and get myself sorted but I realise I am scared of it happening again.
    I was in a class at the time the injury happened. It wasn’t like I was just doing my own thing…and it went during the warm up?!?!
    I’m like many mum’s I was super fit and slim before having children. Had to slow my daily pace for my kids.
    Now I want my body back!
    Any advice? Thank you.

  30. @Cassie,
    I suggest a combination of resistance training and cardio.
    You can start weight training under the supervision of a qualified trainer who can guide you through movements that are safe for your Achilles. Stationary cycling and spinning are both safe and they will help you maintain a healthy weight if you are consistent and watch your diet.
    Good luck on your progress!

  31. Cassie, if your AT has healed normally or anything close, there should be ~0% chance of rerupturing it. Your other AT is at elevated risk, but there’s very little you can do about that other than hope and pray. Being a couch potato is too bad an option in too many ways. Try to put the AT behind you and get active. I wouldn’t spend a second thinking about “movements that are safe for your Achilles”.
    If $#!7 happens, it happens. I’m not sure if active fit people get more or fewer injuries than couch potatos. We get more sports-medicine injuries, but we probably skip a bunch of others — and live longer and better, too.

  32. Cassie,
    I second what housemusic said about stationary cycling and weight training. Both of these are activities that you can get a great workout with while maintaining a lot of control so you don’t experience rapid, unbalanced movements. I’d also add swimming to the list.

  33. Thank you all for taking the time to post and provide your information. I just ruptured my AT last night, had to cancel our family cruise leaving tomorrow so I can have surgery on Tuesday. I’m in good shape for 48, and hope the surgery isn’t too painful and that I can work to keep my recovery time as short as possible. Has anyone here gone back to distance running post ATR?

  34. Hi there - thanks for such a great blog. I ruptured my Achilles playing indoor soccer 6 weeks, I’m 39. Couldn’t believe the news the next day especially when I understood the recovery time. Had surgery almost 4 weeks ago which went well. I’m being pretty agressive, full weight bearing now and think I could probably ditch the crutches this week. Planning on starting physio at 6 weeks. Worst thing for me is being stuck indooors and not being able to work out, it’s a test of patience. I’m in a Bledsoe boot but trying to get my doc to get me a vacocast.

  35. Hi Out there, ruptured my AT 29th June and hopefully healing well in a VACOped, after three weeks in pot. I’m interested in observations regarding cycling. Pre my ATR, I suffered 6 months of Tendonopathy which pushed me to have my old ‘racing bike’ refurbished and started cycling. I found that my left leg (the problem
    achilles, the one that ruptured) would not take even small hills and was cycling almost one legged. Surely pushing up hills etc does put strain on a healing Achilles ? Comments please.

    rogerg

  36. Rogerg: Cycling obviously puts a strain on the Achilles- but, relative to most activities, I beleive it to be quite safe, and beneficial.

    It’s sort of like the difference between heat and temperature. A spark has a very high temperature, but does not contain a lot of energy (heat). On the other hand, warming up a swimming pool 2 degrees takes an enormous amount of energy (heat), but it’s not a very high temperature. Cycling puts a lot work (akin to heat) through your Achilles. But, the peak loads (”temperature”) are relatively small. I scanned through our database of ATR’s, and could not find any that were the result of turning the pedals (crashing on a bike doesn’t count).

    I actually believe cycling is so easy on the tendon, that - over the long run - it creates a risk factor. Muscles (your calf) respond to work volume (that heat thing again). Cyclists develop powerful calves. However, my days in the weight room have taught me that connective tissue requries maximum forces to stimulate development - they’re very slow to build, but conversely very slow to atrophy too. Anyways- I don’t think cycling puts the kind of stresses into the tendon (peak forces) required to stimulate its growth. So you end up wiht this big powerful calf, attached to a relatively weak Achilles. When the system is somehow taken to the breaking point, it’s the tendon that goes (ATR). A lot of ATR folks here were/are pretty avid cyclists… but we all broke our tendon doing something else.

    I think careful cycling is a great post ATR rehab activity. It stimulates the domant calf, has low peak forces, gets the ankle moving, etc. - all good things. Start off in low gears (spin!). Be very careful pushing off to start: there has been at least one re-rupture from that. And, don’t crash! Some liked to start out without clipless pedals - personally, I used them from the get go- I liked that they positioned my foot on the pedal securely and predictably.

  37. How long did it take you to get your calf back to nomral size that had surgery on it. I’m struggling big time to gain the size back that i once had on it

  38. I am very interested in finding out what other people have done to begin to exercise again. I am 4 weeks post op and in a boot and beginning basic leg strenthening exercises and due to go to my doctor for a 6 week check up in two week. I was told to stay NWB for 6 weeks. I can see that many others start with heal weight in the boot before that. I am typically very active and going stir crazy. I ruptured it playing basketball, which I have done twice a week for many years. I also golf a lot and bike, run races, paddle a kayak, play tennis and hike a lot. I am glad to hear stationary bike is okay. That gives me hope for biking. What about an elyptical machine? Is that okay? I am putting and chipping on one leg in the back yard, lifting weights and returning tennis balls on one leg right now but nothing too active and still not weight bearing. Actually my biggest issue is that I haven’t driven yet because it is my right leg. I hope to be able to do that soon. How soon have others with a right leg started to drive? Thanks in advance for any input. What a great website for all of us!

  39. destorey, here are some thoughts (from right about the 4 week mark) related to your question:

    achillesblog.com/ryanb/2011/09/27/73/

    Later in my blog, I talk quite a bit about the progressions of exercises/activites I was able to do as I continued to heal and rehab.

  40. Destorey, 6 wkS NWB is nuts. Check out bit.ly/UWOProtocol and hit your Doc with a printout. UWO got excellent results your Doc doesn’t dream of getting…
    The good news is that a dumb slow old-fashioned rehab doesn’t do much clinical harm post-op (they’re TOXIC post-NON-op!), but you’re still being driven mad for no benefit — and maybe even some harm.

    If you decide to rebel, be smart and incremental. Don’t jump ahead to UWO’s schedule, but taper or phase a gradual transition to catch up. Each rehab step builds on the previous ones, so the calendar’s only part of the story.

    Good luck!

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