Feed on

It has been over 15 months now and it seems only now do I have the time to sit down and add another post. Life gets back to normal much quicker than it would seem in the early stages of this injury. The biggest change since my last post is a marked increase in flexibility. The tendon and surrounding joints do not feel as stiff and I wake up in the morning not thinking about ever having had this injury. My other AT still gets a bit sore from time to time and all I can hope is that I can get my house finished before anything happens to it. It is not something I dwell on as much but I have lessoned the risks for the moment by not running or doing other explosive sports and I keep up some specific exercises. I also have to think of my long suffering partner. This is a lifestyle choice I have made until the house is completed and it would be selfish to risk another injury. I now live in a beautiful and somewhat isolated part of Australia and intend to spend many days exploring the mountains on foot and horseback. I feel I may have at least one more ultra marathon in me but I am no longer driven to do it. In any case, I have the perfect location for training should I decided to go that way. This injury will give you a brief pause to reflect on your life. Take some time to smell the roses and then get back into whatever you choose. What have I been doing in my spare time - Hiking, fly fishing for trout in our own river and simply building a dream.

Snow on the new house

Our view of the mountians

I know that it has been said many times that a healed tendon should not rupture again, at least in the same place, but always in the back of my mind is the question - How strong is it?  Well I answered that yesterday for myself.  I have been buiding my new house of late and climbing up and down ladders, scrambling along trusses, balancing on top plates.  All giving my almost 9 month healed tendon a good workout, but yesterday we had to lift a 200kg steel beam 3 metres.  I must admit I was a bit apprehensive, still unsure if my tendon is competely healed. We are in a remote area so machines are not available.  There is nothing above the beam to set up a block and tackle so the only way to lift it was by hand.  We were able to set up a rope to a wall on either end and my partner would take the slack and lock it off as I took each step up the ladder with the beam on my shoulder.  The first lift put incredible pressure on my injured side and I must admit I was quite concerned but it held and felt very strong.  Lifting the other side of the beam put the same stress on the other tendon (as the weight of the beam was on my other side) and I hoped it would not let go.  It took a series of lifts, one side then the other, until it was in position and my injured side felt strong throughout.  My other side felt a little sore.  This morning it is only my shoulder that feels sore.  I feel so much more confident now and would like to asure others that getting back to the things you did before is very achievable.

From week 12 everything seems to ramp up and measurable gains came rapidly.  I initially thought I would be back to normal by now.  How wrong was that.  I know now that I am looking to another 9 months at least and possibly 2 years in total before I wake up in the morning not thinking about it.  Still, I am mobile and improving and am very happy with that.  I have been through a long rehab before, taking over 12 months to get the use of my left hand back after the median nerve was severed.  Some physios introduce theraband exercises early but I did not start until now.  My doctor and physio urged ‘active’ motion instead of ‘passive’ in the early stages.  Active uses your own muscles and passive is an external aid.  Using the green band I started passive planta flexion and lateral strength exercises.  My dorsiflexion was still not good and I was told not to start jogging until I was plus 10 (i.e. barefoot with my knee against wall and my toe 10cm from it) and could hop on my bad leg 40 times.  I was keen to start running again as it is the only way I can lose weight and the best way for me to get fit.  It is also most likely to be the main reason I am in this boat so why would I want to do more of it.  I guess that is how I am wired.   I was toe against the wall and my knee 4cm away.  Long way to go so be patient. 


Continuing those strength building and balance exercises is so important.  It was around week 14 when the next major change occurred.  10 single leg raises.  It is one of those magical moments.  Some people struggle with it but it is something most will aspire to as an indication of healing.  Taking some of the weight going up at first and concentrating on a slow controlled down.  Ten became 3 x 10 which became 3 x 20, taking all the weight on my bad leg, over a period of 7 weeks and whatever I did with my bad leg I replicated with my good.  My dorsiflexion was improving, sometimes with significant gains but mostly small.  I walked or rode my mountain bike everyday during this time, walking fast up to 5km and riding big hills within a short time but I found that after this exercise my dorsiflexion was reduced.  I put this down to swelling as after so rest, elevation and massage it returned.   Walking put more stress on the tendon than riding so alternating between these exercises gave some balance.  As I progressed with my riding I started doing some trails, not technical just a good change of scenery.  When it was time to do some real XC riding (week 19) I was again fortunate to have a course nearby.  I knew what to expect and there were many exit ports if things got hard.  I had been wearing my spd’s for easy tracks for a few weeks but for this I needed to be able to get my feet down fast.  A week later and I decided to try the spd’s on a trail.  I made sure I could comfortably twist out fast and away I went.  It was better not having my foot bouncing all over the place which I felt would be more of a problem.  The hardest part of this sort of riding is keeping the weight on the tendon as you balance out of the saddle.  I found myself riding a bit slower and sitting down, relying on the comfort of my dual suspension. 


Going back a bit, Week 16 had me on a mini tramp doing some jogging and balance.  I had always thought mini tramps were a waste of time but I have changed my mind.  What a great and inexpensive way to move you forward while actually not going anywhere.  Jog 3 steps then balance on one leg and another 3 steps then balance on the other.  Do that for 5 minutes and you actually start sweating.  This phase of physio prepares you for the dynamic activity we used to do.  Four weeks later and I was  +7 and could do the 40 hops.  My walks were now in the bush and on uneven ground.  Big step from here.  After 5 minutes straight jogging on the mini tramp the physio declared I was cleared to start jogging (so much for +10 but I think that may have been to hold be back a bit for my own good) so of course what did you think I did that day, day 137.  Nothing stupid though.  A walk for a warm up then a run for about 1km and more walking then more running and so on for 6km.  Within a week I was up to 4km of running but still doing a walk warm up and alternating the run/walk.  Now my other knee is getter sore, most likely inflammation from the increase in stressful activity but this injury has a way of changing your perspective.  My dream for the moment is to build a house and a new life 9 hours away in a remote area, not to run another marathon.  Cut back on the running for now.


Take the time to review how others define you and how you define yourself then ask if all that matters.  If all this drive to return to your pre-injury activity so that others can see how much you have achieved then you need a perspective check.  I heard an NFL player comment after his ATR that without football he was nothing.  I feel that is a sad inditement on his life.  It was time  not to be selfish and to think of my partner’s dreams as well.  This injury has affected her as well.  Make sure you look after your other half if you are fortunate to have one.  Time to try something old but new, indoor rock climbing. 


The time was coming when I would have to climb ladders and I thought it would be a good lead up.  Indoor climbing is graded 1-6 with 6 being the hardest.  I used to climb grade 4 and warm up on 2’s and 3’s.  This time it was warm up on the 1’s and do mostly 2’s with an attempt at a 3.  Still it is worth it and I was surprised how strong my tendon had become.  My physio added jumping into the equation.  Firstly on the tramp and then on the ground.  I was actually starting to feel fit and could see my calf muscle returning.  Looking at it you could not see any difference.  A few more climbs in the coming weeks had me convinced I could build a house.  The first part was to build a shed, which would become the temporary dwelling during construction. 


After 13 physio appointments I was discharged and the next week away to my farm.  Five weeks of living in a tent, up and down ladders, carrying full wheelbarrows of concrete, walking on a roof and I managed quite well.  I would not go as far to say I was 100%.  My tendon is still stiff and there is a bit of swelling and soreness from time to time.  Roofing was the hardest because of the constant angle and pressure.  At times I would have to defer the ladder work to my partner so I did not overdo it but on the whole I would say I was at 80%.  Just being sensible.  All the training I had done certainly made the difference, not just for the injury, as it gave me the stamina to go back to active and heavy work.  I also managed to lose 5kg without having to run. 


Life for the most part is normal, as normal as I need it to be for the moment.  We have a tremendous propensity to adapt to our surrounding and situation.  The only thing that really holds us back is our state of mind. I still get stiff in the mornings and after a hard days work or driving long distances (thank goodness for cruise control) but life is going on and forward and there is definitely hope for more improvement. Maybe in the distant future, another marathon, but that is no longer as important in my mind.




Home for 5 weeks while building the shed

The shed that will be home until the house is finished

Home until the house is finished

By week 6 I was walking without crutches outside and had started some ambulation exercises at physio.  These exercises are aimed at your glute and core muscles to improve your gate.  The 6 week mark is one of those milestones in this journey.  The tendon should be knitted together with its own tissue but that tissue is still very weak and disorganised.  The next 6 weeks is when the work really starts on remodelling the collagen tissue and regaining some flexion.


This period is generally characterised by the transition to 2 shoes and then learning to walk again, building strength and being careful.


A boot or cast provides a great deal of protection, mentally and physically but there comes a time when we have to let it go.  Walking in a boot without crutches poses other problems with your body because of its weight and size.  It is difficult to match up the height of the boot with the other shoe and therefore you tend to walk with your toe pointed out putting pressure on your knee and hip.  Getting rid of it too soon means you have a longer period where you need to be careful not to trip or misstep.  Finding a balance is an individual thing and the associated risks must be accepted.   Going into 2 shoes does not mean you are ahead in your recovery but it does mean that your lifestyle will change.  The first thing you notice is how much slower you get around.


Transition is what it is and it is mostly done over a period of days or weeks.  I started with 2 shoes, with the heel wedges from my boot under the orthotics, around the house, using crutches at first then when confident ditching one and then two.  My shoes were ASIC Gel Evolution and the type of shoes are very important.  My physio advised me to select a shoe with good motion control.  Bend it from toe to heel and it should only bend at the ball of the foot, not under the arch.  Then twist it holding the toe and heel.  The shoe should again twist under the ball of the foot.  Modern runners have a heel higher than the toe so are ideal for the transition to shoes.  The next very important part of this transition is to walk in a controlled slow manner without limping.  Limping is very bad for you and if you have to limp to walk faster then you are walking too fast or taking too long a stride.


A little over a week and I was ready to give the 2 shoes a go outside the house again using one crutch for support and to give others around me an idea why I was not getting out of their way.  Planned small journeys followed by rest, elevation and ice.  Swelling and soreness will be a problem for some time to come. 


Although some do not advocate heel wedges in shoes, I cannot speak more highly of them.  My physio attended a tendon seminar with a world renowned therapist and was confirmed in her thinking.  Pressure is taken off the tendon and your gate/stride improves quickly.  When you are able to walk at a normal pace and cadence without limping then it is time to take a wedge out.


The next thing to try was driving.  Being my right foot I needed to be sure I could push on the brake if needed.  It is ridiculous to try and drive before you are ready.  The risks to other road users because of a selfish desire for independence could be considered criminal if you were to cause a collision and injury someone.  Get a clearance from your doctor.  If you cannot operate the controls of the vehicle properly then you should not be driving.  Modern cars do not need a lot of pressure on the pedal to stop but to be certain then you should always keep a generous distance between you and the car in front.  Of course if it had been my left foot then it would have been much longer before I would be driving unless I bought an automatic.  Again, short planned trips until I was confident.


I hate treadmills more than stationary bike but a treadmill is a good aid when it comes to forcing you to walk at an even speed.  Week 9 had me 10 minutes on the treadmill and I was surprised how well I did although by the end I was getting quite sore and tired.  The strength build up is slow and deliberate.  It is not something to be rushed and trying to jump ahead will only set you back.  Walking barefoot around the house is very tempting but again you have to go slow and walk without a limp.  Because of the lack of dorsiflexion this will be difficult.  It is very tempting to try and stretch the hell out of the tendon early in an attempt to regain dorsiflexion.  It is something I was advised to avoid.  It will come in time as you return to more normal activity.  A functional rehabilitation focuses on the things that are important to get you moving properly again.  Severe stretches too early could be a cause of elongated healing.


It was almost week 10 when my physio had me doing two leg heel raises.  Going up on my good leg and coming down slowly on my bad.  The going down is more important.  Taking it slow and building up strength.  3 x 10 until that is easy then adding weight in a backpack when it is easy and put more weight on the bad leg while going up.  Still have to keep up the butt and thigh exercises.  Every week there is a new exercise to do and as you have become more mobile and independent, it seems you are getting too busy to do them all but you have to make time.  Massage, rest, ice, exercise, mobility – no time to be depressed now and plenty of distractions.

The next 2 weeks are summed up by more and more of the same.  Building slowly, walking further and waiting for that magical 12 week mark when it is said the risk of re-rupture declines.  It doesn’t suddenly go away but it becomes less likely every day after that.  Of course there will be individual differences but the science says there is no way to make it go faster.  The collagen type 1 is needed to build strong tendons.  It is thin, flexible, organised and much stronger than the collagen type 3 laid down in the first phase of healing and comes with the strength building, walking and massage.  I concentrated on getting stronger, walking further and increasing the resistance on the stationary bike.  I had taken one wedge out of my shoe and put it in the other shoe.  It slowed me down for a few days but then it was back to normal.  Some days I would push too hard or far and when fatigue set in I would limp.  It is hard to gauge how far but I would suggest you plan you walks with an escape route.  Don’t walk anywhere you cannot be picked up and don’t be so brave to push it past the pain.  There is no benefit.  A little often or just a little less.  Getting off the stationary bike was also a big plus at this time.  It was a bit scary but fortunately there is a good cycle track nearby and it is flat.  The first thing remember is not to push off with you bad leg and the next is to practise stopping.  At first I instinctively put my bad leg down, like going down stairs on crutches but due to the lack of flexion I quickly found this to be the wrong way.  Good leg down for the moment.  This would change in the weeks to come when my flexion improved.  To clip in my spd’s or not was the next question.  No real benefit at this stage as it hurts to twist the foot out and the power gain is not required.



The first 2 weeks is an important healing time for wounds and once that was over, I needed to get some motivation and exercise to get out of the mental rut.  I have an exercise bench so while I couldn’t do any work with my injured leg, I could still give my upper body a good work out.  It was great and as I was to discover, it was the best thing for when I was able to start building.  Being a long distance runner I have never really wanted upper body bulk as it tends to be a bit of a draw back carrying weight that is not used.  I usually work on tone and stamina with lower weights.  A week later and I started on the stationary bike every other day for about 15minutes.  Easy gears with the heel of my boot on the pedal.  The exercise endorphins are great for the mental attitude. 


Mobility is a thing most of us take for granted and when we lose it we will try get it back as soon as we can.  The information I read in the journals pointed to early weight bearing and getting rid of the crutches quickly.  At the 3 week mark there were some other significant changes.  I was allowed to take my boot off to do some basic active ROM exercises.  No stretching, just writing the ABC’s with my foot while it was supported.  It was also good to get some ice on the foot to help with the swelling.  My wound was good to get wet from week 2 but now I was able to take the boot off to shower while seated.  I changed to forearm crutches with moulded handles which are far more comfortable and found I could partially weight bear on my foot, still with the boot on.  Within a few days I was down to one crutch around the house.  Something in my brain had changed.  I was beginning to concede to the injury and find a new routine.  The pain had gone and the anxiety no longer a problem.  The boot, exercise and increased mobility all a contributing factor.  It can take a while to get into a new routine and by this time I was feeling more settled.


The next step was to shop for a physio.  I didn’t like the first one and I wanted to find one who would work with me.  Physio was not due to start until week 6 but one physio wanted to have a look at me at week 4.  She was horrified at how the boot had been set up and immediately put 2 heel wedges in, giving me a 1.6cm rise.  We started with some massage and weekly visits, not much really but it was good to develop the relationship.


Week 4 also saw me ditch the crutches around home and keep one handy outside.  People don’t really look much and having a crutch gives you extra support for tricky situations and a visual aid for others.  Funny how the boot is not always enough. 

Another week and I was able to stand in the shower on my heel but without much dorsiflexion it was necessary to have my bad leg forward and bend the knee of my good leg.  Crutches in the bathroom on wet floors are dangerous and I had a few slips that put a shock through me.  I had been careful up the this stage to put my boot on before I left the bathroom but for good or bad I decided to take a chance and walk to the bedroom without a boot.  It is a risk walking anywhere without that protection but I was able to walk on my heel with one crutch and it was only 10 steps.  I like being independent but know that is very difficult with this injury.  Every piece of independence you reclaim is something to be celebrated.  I was also reviewed by the surgeon this week and to my amazement he said I didn’t need to come back unless there was a problem.  He left the rehab to the physio with basic instructions and was happy to see me partially weight bearing.

The beginning of my story

I have had a lot of comment on this site but I have not had a page of my own until now.  I have my reasons and now I feel it is time to put it all down for posterity.  My name is Stuart, I am 52 living near Sydney, Australia.  For most of my life I have been a distance runner but I have enjoyed many other active sports and outdoor activities.  Like most here, I am not a sedentary person and have enjoyed a full and active life.  There are a few changes to it now but no reason to stop living a full life.  I am just over 6 months through this ordeal and things are going well.  There are many different methods employed to treat this injury and I don’t say my way is the best or the one others should follow.  It worked for me so this is my story.  I hope it helps someone.


The first 2 weeks


It seems surreal.  I keep thinking back to that moment of stupidity and blame myself when in fact the injury was most likely inevitable.  A week ago I did 5 canyons in 3 days. Jumping, climbing and all that hard stuff.  Today, at a family BBQ I lunged forward to catch something falling although having absolutely no chance of catching it.  Timing could not have been worse.  We were due to head south to our property in the Victorian High Country to start the building process.  We have a small farm (126ac) with river frontage to one of the best trout streams in the Victoria.  The mountain trails are at our gate and in winter you can be backcountry skiing in ½ an hour.  Our journey had been delayed due to the death of a close friend and as it was Easter the funeral was put off due to public holidays. 


There was no need for scans or even a doctors examination, as I knew instantly what had happened and how long it would take to get back on my feet.  I was thinking 12 weeks to get my life back but really had no idea that it would in fact be much longer.  I was driven to the hospital and hobbled into the emergency room on my heel.  I wasn’t offered a great deal of medical advice.  Mostly standard textbook.  Surgery was advised as it had a lower re-rupture rate.  Here I am thinking that this thing could go again in the years to come.  I know different now.  Seeing only that I needed to be at the funeral of my long time friend, I opted for surgery in the public hospital as for me to go private would have put surgery on the day of the funeral.  I waited 3 days in a hospital bed, being bumped back for more urgent surgery.  Finally I was in and later that day discharged with a half cast with my foot pointing down, crutches and told no weight bearing for 6-8 weeks.


While resting, the pain was virtually zero however whenever I moved on crutches the pain quickly rose to severe in my calf.  The funeral was the next day and it took its toll.  To get to the burial site I had to walk on crutches for 400m and then there were no chairs.  By the end of the day I was in severe pain.  Pain medication is important but the morphine based drugs made me sick.  I found straight paracetamol every 6 hours to be the best and after 2 weeks I needed much less.


All was going well but then 3 days after surgery I woke up in the middle of the night in a sweat.  I was hot then cold and felt nauseous.  The next day I suffered from hot flushes and felt agitated and restless.  Fearing an infection I went to the hospital.  My blood pressure was through the roof and after waiting many hours, my cast was taken off and the wound checked.  All was fine.  As the new cast went on I began to feel hot again.  I started to suspect another cause for my symptoms.   A trip to my local doctor the next day and by the end of that week, a week of little sleep or food and it was confirmed.  A simple case of cast claustrophobia and anxiety.  The nights are the worst when everything is quiet and your mind won’t stop so I would take a small pill and usually have a good night sleep.


Coming to terms with this injury can take some.  Reading blogs and scientific journals helped to some degree and I quickly decided that I needed to get out of the cast and into a boot.  I rang a few physios and found one that had a good range of motion boot then I made an appointment to see my surgeon to get the OK.  He was surprisingly sympathetic so it was fitted the next day.  My wound was checked and redressed and I was sent home with a 7.5 degree planta flexion.  This, I was to discover, could have caused serious long term healing issues.  I also learned the crutches fitted at the hospital were the wrong size and would have caused other issues in my elbows if I were to use them for the projected 6 weeks.


While sitting around there is too much time to think and surf the net.  Reading many of the blogs on this site and others started to get to me.  It may have been the frame of mind I was in at the time but many had this competitive air about them and I found myself searching for those who had returned to normal activity as fast as possible to find out any way I could do the same.  I also found blogs that bragged about doing the most ridiculous things at a very early stage.  I learned a great deal about this injury from medical journals and fortunately my early science background had some medical input and I was able to understand most of it.  I realised that reading the blogs only increased my level on anxiety, so I stopped.  


Rest, elevation and the occasional trip to a coffee shop for a change of surrounds.  Finding distractions to take your mind off your circumstance but as I said, the nights are the worst.  My life had changed again and I knew it would affect my partner as well.  Our dreams will have to be put back and she will have to bear the load for a while.  Guilt, blame, frustration and anger all need to be controlled to keep a good relationship going.  Patience in ever increasing measures needs to be learned.  My other AT was starting to get sore and then I began to worry about when it was going to let go. Not unusual as it is now taking all the load of your body.  It is still comes to my mind at times, usually when it is sore,  but I have come to terms it now.  Prepare for the worst and hope for the best is how I have lived my life so that is what I will do.