Aug 03 2012

My Achilles Tendon Injury Story

Published by uscgdiver

I have been a competitive athlete since High School with lacrosse being my sport of passion. I have played at almost every level of competition: bench, Junior College, Div. I, travel, club and beer leagues. In 26 years of playing anywhere from 3 to 10 months a year I have suffered a broken collarbone, a few broken fingers and the usual bumps and bruises that are associated with a full-contact sport with sticks!! Other than that, I have remained speedy and retained a great endurance level on the field often surpassing those 20 years younger than me.

In the past 2 years while having to sit out of summer league from a shattered finger from playing indoors, I began distance running to keep in shape and stay competitive. After only a year of training, I began to take home first in age group awards as well as winning the Masters division. All the while, I was still staying competitive on the lacrosse field. After my running season ended and I was in my active rest phase (Nov-Jan), I started graduate school and I figured what better way to keep active than to play lacrosse with the college club team. My active rest also included rigorous strength and endurance training to enter the USAF special operations field, so I was probably in better shape at 41, than I was when I played Div. I ball at age 21.

In our third week of practice, I arrived well rested on the evening of January 25 2012, having taken a week off from all training. However, I was a bit lacking in taking in my fluids that week, got to practice a little later than normal after class, and did not warm up quite as much as I normally do. After the first hour of drills, we went into scrimmage. After about 5 min, my calves started to cramp, so I called for a sub, got some water, and stretched for about 5 min. I came back on the field and immediately got the ball and started breaking toward the goal. I dodged left to avoid the defense, and then as I cut, back right I heard the pop and I went down!

As I scrambled for the ball on the ground, I thought I was hit in the helmet, except for one thing…everyone around me had stopped moving. A few people stopped and said, “We heard a pop” and asked if I was ok? Therefore, I did a quick self-evaluation (12 years as a lifeguard, Ski School Director, and military Deep Sea Diving Officer had given me some decent medical training), knees good, right ankle good, left ankle…sore! I could move it but only gingerly. I thought, I just rolled my ankle and I was going to be ok in a few weeks. Whoops, wrong diagnosis.

My teammates helped me off the field and called for the trainer. In taking off my hi-top cleat (did I mention we were playing on artificial turf), the trainer palpitated the ankle and as I watched him do the classic sprain evaluation I realized that it was not my ankle that had been injured, but my Achilles tendon. Just how bad I did not know but knew that a trip to the hospital was inevitable.

The ER doc did the Thompson test and explained how it worked to me, and said there was good news and bad news. The good news was a partial tear; the bad news was it is still going to be a 6-12 month recovery! In addition, here I was 5 days away from getting out of the Coast Guard before transitioning to the Air Force for my dream job! Well, life happens and as you all have experienced, it is time to adapt and overcome.

Therefore, the fatal triangle for me in this injury was:
1. Arrived late to practice and did not properly warm-up and stretching.
2. I was slightly dehydrated.
3. The kill shot, I grabbed my grass cleats instead of my turf shoes.
So the combination of not being loose, cramping and the turf grabbing my cleat ended not only my lacrosse season, but also my chance to enter the special operation community. I fully believe that if I had taken any one of those legs off the fatal triangle, the outcome would have been different. However, I do feel that due to my strength and conditioning I was spared the full tear and surgery.

After a week in a splint and ace bandage, I had my appointment with the orthopedic surgeon for my evaluation. After another Thompson test and a little bit of movement, he showed me the injury site. As I was belly down looking over my shoulder the Dr. ran his pinky finger down the back of my tendon, then he said watch, as he hit the injury site his pinky fell into a gap and half disappeared….that was the tear site. He then proceeded to test my pain tolerance and said he wasn’t going to recommend surgery, he grabbed just above the tear site and squeezed hard and told me that the tendon was solid there, then repeated that same below the tear site and said it was solid there too. Oh, the looks I gave him! I requested we not do that test again. 30 min later, I walked out with a cool blue cast on, some crutches, and an appointment in 6 weeks.

With my two appendages and competitive spirit, I began practicing balancing on just my crutches. At first 5 seconds, then 10, then 30, then I could actually raise my legs parallel to the floor. 6 weeks later, I was moving faster on crutches than most humans, and carrying a backpack full of schoolbooks. After my 6 week follow-up
the cast came off and all looked good according to the Dr. I was in shock for the first time as I had no calf muscle and the swelling in the ankle was disturbing, along with the bruising and clots. OMG! I got a slick walking boot and was told 40% partial weight bearing for 2 weeks and to start physical therapy the next week.

I felt better moving with crutches and no weight with trying to calculate 40% of my weight, but when I hit 41%, the pain let me know. My first physical therapy session was difficult as there was no walking; it was all just massage, therapy band exercises and evaluation. I tried explaining to the therapist that I had a high tolerance for pain, explaining that on my 1-10 pain scale that 10 was having my kneecap being severely lacerated through the tendon with a snowboard (another story for another time).

After two weeks of therapy and my second follow-up with the Dr., I was now allowed 60% weight bearing with my crutches. It was during these next 3 weeks before my third follow-up with the Dr. that I took my first unassisted steps in running shoes during physical therapy. This was about week twelve. It was liberating and painful all at the same time. The toughest part mentally was learning to walk again and not fear that the tendon was going to re-rupture. At my final follow-up, the Dr. said I could walk in running shoes around the house, but needed to use the boot for another 3 weeks when I went out for normal day to day activates. My biggest challenge was reciprocating steps waling up and down the stairs. I had a narrow escape and landed straight on the heel once, it hurt, but I was able to catch myself with my arms on the railing and pushed my legs in front of me. See, the crutch gymnastics had a purpose!

Slowly, I would take longer and longer walks to the mailbox (about 25 yards) and built up my mental confidence more than my physical confidence. I had great physical therapists who really listened to what I described and we collaborated on many of the exercises. I was also fortunate enough to have Graston deep tissue massage that really broke up a lot of the scar tissue to allow me to get back most of my ROM. Their goal was to get me to 6 degrees ROM for functionality; I completed my regimen at 16 degrees and getting better.

My worst experience throughout the whole recovery process was the tendonitis I developed in the good leg for over compensating for the injured leg. There were mornings that I woke up and the right leg hurt worse than the injured leg. Walk, stretch, Advil…wash, rinse and repeat. I just kept pushing through and reporting the pain to the therapists and it got better. On July 24th, I completed my last physical therapy session. In the last month of PT going two days a week, it became more of an actual work out as the therapists just let me work out on my own. I was able to run on the treadmill at an 8:30 pace for 2 miles, and began doing basic polymeric exercises on the floor (no boxes), as well as squat jumps and basic lateral agility running drills around cones.

At 6 months and 2 weeks post injury with no surgery, I can run, I began playing ice hockey, and my strength in my left calf is about 90% and getting stronger. I still have days when I get up and I get the stiffness and mild tendonitis, but that usually goes away from getting ready to go to work. It is just a reminder for me that at some point during the day I need to warm-up stretch and continues to do my calf strengthening exercises. Therefore, besides closing the door on the special operations career opportunity, I am slowing getting back into a normal exercise routine to lose the 20 lbs. I gained during my sedentary phase and hope to return to the lacrosse field in Jan to play with the university team as I finish my graduate program next spring. In September after the full 9 months of tissue, healing is complete, I will start upping my running miles slowly, and my first competitive goal is to be able to run in the local 10k race on Halloween. I do not intend to try to win anything, but just to participate and finish pain free, even if that means finishing toward the back of the pack.

In my next post, I will go over some helpful exercises that I thought worked really well for me in building my strength and gaining kinesthetic confidence back.

4 Responses to “My Achilles Tendon Injury Story”

  1. normofthenorthon 09 Aug 2012 at 2:31 pm

    Diver, FWIW, I’m doubtful about two of the legs of your “what caused my ATR” triangle. There are a huge bunch of us here who tore our ATs while fully warmed up — if anything, more at the end of a long play session than at the beginning — and while fully hydrated, that I don’t buy it. I was fully warmed up, loose as a goose, and fully “watered” when I tore EACH of mine!

    Stuff happens, including ATRs. Also, lots of super-fit jocks suffer from complete tears, so I wouldn’t attribute your partial tear to anything special, either. Always nice to get back to ~100% without a scar (etc.), though! (If you’re unlucky enough to do the other side completely like a few or us, check out the latest studies before going under the knife for it.)

  2. uscgdiveron 09 Aug 2012 at 3:38 pm

    Norm,

    Thanks for the feedback. I read you loud and clear! The point I was trying to make is not that it wouldn’t have happened eventually, but that if I hadn’t gone back into play I might have lived to play another day.

    I am doing all I can to strengthen both sides so I don’t do the other side. Once is plenty for me….LOL!

    I hope that clears it up.

  3. normofthenorthon 09 Aug 2012 at 8:15 pm

    For sure, if we’d all skipped the high-stress moment when we tore our ATs, they would have lasted another day, or week, or maybe year. Nobody knows how long.

    I’ve heard of a few things that weaken tendons, but precious few that strengthen them — especially the ones that strengthen MORE than they strengthen the associated muscle(s). By “design”, all our tendons should be stronger than their associated muscle(s). ATRs and such happens when they develop a weak spot that isn’t. Building up your other calf and AT (together) won’t guarantee that AT’s long-term integrity either, unfortunately. Giving up all your high-risk sports and such would probably buy an extra decade or two, but where’s the fun in that?

    Good news is that AFTER they tear and heal, they’re almost guaranteed to last as long as you do. (I think we’ve had ONE poster here who re-teared a healed AT in a different spot, but only after taking a bunch of fluoroquinolone drugs.)

  4. uscgdiveron 09 Aug 2012 at 9:15 pm

    I couldn’t agree more….I just started playing hockey. Less impact to the legs, but more the rest of the body! Just trying to come back bigger, faster stronger, and with some prayer hope that I only had one weak spot!! LOL!

Trackback URI | Comments RSS

Leave a Reply

You must be logged in to post a comment.