Settling into a new routine weeks 2-6
November 25, 2011 by xplora
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.
I am just finishing my first week post ATR and now in a cast. I go back next week and looking forward to maybe a boot. But this post has given me a boost. Thanks
Hi Stuart, I am at the 2 week mark and re-reading your post. I am in a cast and back at work with many limitations of course. The cast is very unconfortable /painful and the crutches tiring. I have been given three different measurements for ‘proper’ crutch length…I feel the pain from the swelling/incision much worse than before, probably because I can’t elevate well during the day. I have now a tentative dr’s appmt for hopefully moving to the boot (still nwb) on 12/8. An earlier appmt to at least open the cast would be great, but it is highly unlikely. Please kindly let me know if you have any thoughts and/or suggestions. Once again, thank you for your sharing and good luck,
Gabe - I hated the cast as you may have gathered and managed and early appointment for the doc. He was very sympathic with me going into boot but not all are the same. If your mental health is suffering then I would suggest you get an appointment as soon as you can and plead you case. You may have to be strong in your dialog. Getting the right crutches can’t be that hard but still they can muck it up. As long as there is a gap and they are not pushing on your armpits as you take the weight and your elbow has a slight bend then you should be OK. I swithced to forearm crutches around 3 weeks when I started PWB and they were so much better. You are back to work quite soon so you will have to sort out a way to take some weight off the leg. It will get sore and swollen. At least if you had a boot, you could take it off at the end of the day to ice. Follow the rules and they are good but try to get around with it before you should and there could be trouble. Keep up some pain meds as needed. 2 Panadol every 6 hours is not harmful and very effective. They are most effective if you take them every 6 hours instead of when you feel the pain. The pain will ease over the next week but if not, see your doc.
Gabe, I echo Stuart’s advice about the crutches (actually all of his advice on this blog is worth heeding) and just would add that about a 1.5 inch gap under my armpits was right for me. You don’t want too much because of the tendency to hunch over but if there is not enough than the motion is awkward and uncomfortable.
After about a week on crutches it will get a lot easier, not to mention the fabulous triceps workout. However if for any reason you feel your overall upper body strength is not up to it, than take it slow. For perspective, I adapted easily to the crutches but by late evening I was wobbly getting up stairs. Had more than my share of near disasters because I was too stubborn to go up on my butt.
I’m 9 weeks post surgery, FWB in a boot although still use one crutch outside the house.
About the hard cast, I hated it as most of us do. Only things good about it were some cool colors and it is easier to get pants over them versus a boot. My second hard cast (I was in hard casts for a total of 7 weeks) was very snug, even painful in the evening before I would collapse into the den barco-lounger. I asked my surgeon about recasting but he strongly preferred a snug cast. He said it keeps the repaired tendon immobile allowing a stronger long term bond between the attached tendon bits.
Admittedly he’s more conservative than most docs attending to us on this blog. My injury was very high up on the leg, involved a lot of the calf muscle (was told I shredded much of it, yuck) so maybe that informs his perspective. And as someone has commented before, surgeons hate it when their work is compromised!
I’m 57 and have the point of view that this is a 12 month recovery. I’m impatient as anyone but my goal is being able to play tennis with abandon again by September 2012, we’ll see.
Many (I’d say most) of the people you see who are using crutches permanently, use elbow/Canadian crutches. There’s a good reason for that. They are more maneuverable, don’t beat up your underarms, are much better on stairs, etc. They do take a little more getting used to, but if you are having troubles getting comfortable with standard crutches, I recommend looking into them. I did a lot of PWB walking, and there’s no way I could have tolerated as much on standard crutches. I requested some through my surgeon, who wrote a prescription for them, so my out of pocket cost was minimal.
Thank you all for your support and suggestions. I still need to improve the ergonomics at work to elevate better and more often. I have ordered the boot and once here I will look into an earlier appointment. My father-in-law had left here canadian crutches and I actually used them the first days after injury. My doc , however, changed me to regular crutches on my first visit…I will give them canadians a new try. Day by day is the mantra. Best,
So you started exercising after 2 weeks? That is very reassuring. I was wondering about the elliptical and will ask when I see the doc. Nice blog.
Superjewgrl - Excercising the unaffected muscles could start at any time but I was keen to spend the first 2 weeks after surgery resting with my foot elevated. I started on the stationary bike a couple of weeks later with the heel of my boot on the pedal. Easy gears at first and only for a short time. It didn’t take long to build the time and speed. The most important thing was that it gave my head a better place to be.