Wayne’s Achilles Blog

My ATR recovery is going quite well.  I’m now at a point in my recovery where I visit my physical therapist once a month.  In my last blog I mentioned that my physical therapist started me on a Return to Running Program that is based on a program designed by Steven L. Cole from the College of William and Mary.  The complete program is explained at http://www.step-rite.info./files/Return_to_Running_Program3.htm

I’m currently in Phase 2 of this four phase program.  My therapist has me on a regimen consisting of a three day rotation of exercises:

1- Weight training for the calves (strengthening)

2- Double and single leg heel raises (flexibility/range of motion)

3- Return to Running Program

Here’s a summary of the Return to Running Program.

Phase 1:  Walking Program. Best performed on a treadmill.  This phase consists of walking at roughly 4.2 to 5.2 mph.  You need to be able to walk pain free at this pace before moving onto the next phase.

Phase 2:  Plyometric Routine. This phase consists of  ”controlled” hopping.  The key element of a controlled hop is a proper landing.  Its very important that the ankle, knee, and hip joints work in concert to absorb the shock of landing.  A loud slapping sound while landing indicates poor technique.

In my case, my therapist is having me ease into the hopping exercises by first performing these exercises in a pool with the water line at chest level progressing to waist level.  I subjectively guage my effort level at 50%-75%-100% progressions.  Meaning, that I begin by performing my hopping exercises with the water at chest level at 50% effort, then progress to 75% effort, then progress to 100% effort.  Once I reach 100% effort I’ll move towards the shallow end of the pool and  perform my hopping exercises with the water at waist level, progressing at the same rates.  Once I’ve mastered hopping in a pool I’ll move to performing these exercises on land and start all over again!

The Phase 2 Plyometric hopping exercises consist of:

- Two leg hops in place

- Two leg hops forward/backward

- Two leg hops side-to-side

- One leg hops in place

- One leg hops forward/backward

- One leg hops side-to-side

- One leg broad hop (my therapist didn’t prescribe this exercise for me)

Rest Intervals: 90 secs between sets / 3 mins between exercises

Its anticipated that I’ll be in Phase 2 for approximately 4-6 weeks.

Phase 3:  Walk/Jog Progression. Progress to Phase 3 only after you’ve completed Phases 1 & 2, have no pain with normal daily activities, and the AT no longer hurts when you press on it.  Phase 3 consists of a progression of alternating between walking and jogging.  The ratio between walking and jogging starts with 5 minutes of walking, 1 minute of jogging (repeated 5 times for a total of 30 minutes).  You go through a progression of improving upon the walk/jog ratio ultimately reaching a goal of being able to jog every other day at 30 consecutive minutes.

Phase 4:  Times Running Schedule. This phase marks the final phase of the Return to Running Program.  In this phase you increase the intensity of the jog/run as well as the duration.  Use the 10% rule:  Only increase the weekly mileage by 10% of the previous week.  Eventually you’ll increase the frequency of days you jog/run.

And from here, you’re on your way to full recovery!  Simple enough, right?!

It’s been a while since I’ve posted an update to my blog. My recovery has been moving along and I’m able to almost walk normally (just the slightest gimp at the end of my gait). I’m now going to physical therapy once every two weeks with the goal of returning to running. However I learned a valuable lesson today from my physical therapist who provided me with some good advice about my recovery.

I seem to have recently hit a plateau with my recovery doing exercises consisting primarily of doing several sets of two-legged and single-leg toe raises off of a step (focusing on the downward motion). Not only did I experience a plateau, I just may have pushed myself too hard and compromised my recovery schedule.

Essentially I was doing too much, too soon. I’d go to the gym, workout my upper body, then finish my workout by doing my PT exercises. I noticed that after doing my exercises that my Achilles felt inflamed (swollen, redness, and warm to the touch). The next morning my Achilles would be in so much pain. It took 2-3 days for the pain and swelling to go down before I could resume my PT exercises again. I even iced my AT and took Ibuprofen to bring the swelling down.

When I told my physical therapist about this she just gave me that look, “Hey stupid, slow it down and listen to your body!” She explained to me that with ATR recovery exercises its not a “no pain, no gain” situation. Because the tissue is still healing, I need to balance between too much stress (equals overload and tissue breakdown) and not enough stress (equals tissue atrophy and break down). The right balance of stress equals improved strength and hypertrophy.

According to an article that my physical therapist printed out for me – Return to Running Program by Steven L. Cole, it’s important to use the following principles to gauge whether you are overloading your tissues during PT recovery exercises:

1. Pain
2. Swelling, redness, and/or warmth. Apparently chronic swelling impedes the body’s ability to heal and may actually weaken surrounding tissues.
3. If after performing an activity you find that later your function is limited then you did too much.
4. Pain that occurs earlier on in a program that you performed previously.

My physical therapist refers to exercising to the point of my “tissue’s threshold” without exceeding (overloading) that threshold. Once you hit that threshold then its time to ease back a little and give your tissues a rest for the day.

Today my physical therapist introduced some new exercises involving weights – seated toe raises (two-legged using 45 lbs; single-leg using 25 lbs; 3 sets of 10 reps alternating between two- and single-leg seated toe raises).

For my Return to Running Program, I start with the Phase 1: Walking Program. In Phase 1 I must be able to walk, pain free, aggressively (roughly 4.2 to 5.2 miles per hour), preferably on a treadmill, before beginning the plyometric and walk/job program.