I am shocked the doctor has given me the okay to ditch the boot. I have been reading on the internet about many people’s experiences with this injury and they all appear to have different recovery times. Some orthopedic surgeons are conservative and some, like mine, are very aggressive. Every time I visit with my doctor I ask him, “When can I play basketball again?” Every time he gives me the same answer, “six months.”
Some people (who posted on http://www.achillestendonblog.com/) stated that they have reported not losing the boot until week 14 post operation! I am not using my boot at week 8 post operation. It appears every surgeon does things differently based upon their experiences. Every day my leg is getting stronger. The atrophy of my calf was bad, but I have noticed it is improving. When I first started walking without the boot, I walked with a severe limp. Now in just the past few days it has improved greatly. Although, the tendon still feels stiff. When I am walking I can feel the tightness of the tendon, almost like I haven’t stretched it in months (in which case I haven’t). I know I could not stand on my toes or walk up stairs if I wanted. As my limp dissipates, I cannot wait to see what I can do in a month from now.
Monday, February 4, 2008
Monday, January 14, 2008
Pop quiz, hotshot. What do you do?
Here is a general crash course of what you’re in for.
General Considerations:
- Time frames mentioned in this protocol should be considered approximate with actual progression based upon clinical presentation. Physician appointments as well as continued assessment by the treating practitioner should dictate progress.
- Avoid forceful active and passive range of motion of the Achilles for 10 - 12 weeks.
- Carefully monitor the tendon and incisions for mobility and signs of scar tissue formation. Regular soft tissue treatments (i.e. scar mobilization and friction massage) to decrease fibrosis.
- All exercises should be carefully observed for any signs of compensation or guarding.
- No running, jumping, or ballistic activities for 6 months.
- Aerobic and general conditioning throughout the rehabilitation process.
- M.D. appointments at Day 1, Day 8-10, 1 month, 2 months, 4 months, 6 months, and 1 year post-op.
0 - 3 weeks:
- Adjustable boot locked out at 30 of plantar flexion.
- Non-weightbearing for 3 weeks--no push off or toe-touch walking.
- Pain and edema control (i.e. cryotherapy, electric stim, soft tissue treatments).
- Toe curls, toe spreads, gentle foot movement in boot, straight leg raises, knee flexion/extension.
- Well-leg cycling, weight training, and swimming for cardiovascular conditioning.
3 - 8 weeks:
- Gradually increase weight bearing from toe-touchdown to partial as tolerated. After 6 weeks, okay to progress to full weightbearing.
- Walking orthosis adjusted 5 degrees a week until 10 degrees of plantar flexion. After 8 weeks, okay to wear shoes with a heel (i.e. cowboy boots, 1/4 " heel lift in shoes).
- Isometrics of uninvolved muscles, light active dorsiflexion of the ankle until gentle stretch of Achilles. Slowly increase the intensity and ranges of isometrics of Achilles within the range of the boot.
- Slowly increase passive range of motion and stretch on the Achilles after 6 weeks.
- Proprioception exercises, intrinsic muscle strengthening, PNF patterns (not to Achilles)
- At 6 weeks, okay to add stationary cycling with heel push only. Deep water workouts.
- Soft tissue treatments daily.
8 - 12 weeks:
- Full weightbearing with heel lift as tolerated, gait training.
- Wean into a regular shoe over a 2-4 week period.
- Begin and gradually increase active / resistive exercises of the Achilles (i.e. submaximal isometrics, cautious isotonics, Theraband)
- Manual full passive range of motion of the Achilles--nothing forceful.
- Progress to cycling in shoe, swimming.
3 - 6 months:
- Wean off heel lifts (if not already).
- Closed chain exercises: controlled squats, lunges, bilateral calf raise (progress to unilateral), toe raises, controlled slow eccentrics vs. body weight.
- Cycling, VersaClimber, rowing machine, Nordic Track (gradually).
- Unless excessive fibrosis present, should be discharged into a home program.
6 months - 9 months:
- Progress training jogging / running, jumping and eccentric loading exercises, noncompetitive sporting activities, sports-simulated exercises.
- Return to physically demanding sport and/or work.
General Considerations:
- Time frames mentioned in this protocol should be considered approximate with actual progression based upon clinical presentation. Physician appointments as well as continued assessment by the treating practitioner should dictate progress.
- Avoid forceful active and passive range of motion of the Achilles for 10 - 12 weeks.
- Carefully monitor the tendon and incisions for mobility and signs of scar tissue formation. Regular soft tissue treatments (i.e. scar mobilization and friction massage) to decrease fibrosis.
- All exercises should be carefully observed for any signs of compensation or guarding.
- No running, jumping, or ballistic activities for 6 months.
- Aerobic and general conditioning throughout the rehabilitation process.
- M.D. appointments at Day 1, Day 8-10, 1 month, 2 months, 4 months, 6 months, and 1 year post-op.
0 - 3 weeks:
- Adjustable boot locked out at 30 of plantar flexion.
- Non-weightbearing for 3 weeks--no push off or toe-touch walking.
- Pain and edema control (i.e. cryotherapy, electric stim, soft tissue treatments).
- Toe curls, toe spreads, gentle foot movement in boot, straight leg raises, knee flexion/extension.
- Well-leg cycling, weight training, and swimming for cardiovascular conditioning.
3 - 8 weeks:
- Gradually increase weight bearing from toe-touchdown to partial as tolerated. After 6 weeks, okay to progress to full weightbearing.
- Walking orthosis adjusted 5 degrees a week until 10 degrees of plantar flexion. After 8 weeks, okay to wear shoes with a heel (i.e. cowboy boots, 1/4 " heel lift in shoes).
- Isometrics of uninvolved muscles, light active dorsiflexion of the ankle until gentle stretch of Achilles. Slowly increase the intensity and ranges of isometrics of Achilles within the range of the boot.
- Slowly increase passive range of motion and stretch on the Achilles after 6 weeks.
- Proprioception exercises, intrinsic muscle strengthening, PNF patterns (not to Achilles)
- At 6 weeks, okay to add stationary cycling with heel push only. Deep water workouts.
- Soft tissue treatments daily.
8 - 12 weeks:
- Full weightbearing with heel lift as tolerated, gait training.
- Wean into a regular shoe over a 2-4 week period.
- Begin and gradually increase active / resistive exercises of the Achilles (i.e. submaximal isometrics, cautious isotonics, Theraband)
- Manual full passive range of motion of the Achilles--nothing forceful.
- Progress to cycling in shoe, swimming.
3 - 6 months:
- Wean off heel lifts (if not already).
- Closed chain exercises: controlled squats, lunges, bilateral calf raise (progress to unilateral), toe raises, controlled slow eccentrics vs. body weight.
- Cycling, VersaClimber, rowing machine, Nordic Track (gradually).
- Unless excessive fibrosis present, should be discharged into a home program.
6 months - 9 months:
- Progress training jogging / running, jumping and eccentric loading exercises, noncompetitive sporting activities, sports-simulated exercises.
- Return to physically demanding sport and/or work.
Monday, January 7, 2008
Something caused all this. But what caused...that cause?
Causes of Achilles tendon rupture
Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you move your foot. Injuries to your Achilles tendon result from repeated stress on the tendon, which may be caused or aggravated by:
-Overuse
-Running on hills and hard surfaces
-Poor stretching habits
-Tight calf muscles
-Weak calf muscles
-Worn out or poor fitting shoes
-Flatfeet
Injuries to your Achilles tendon can often result from taking part in an activity involving stop-and-start footwork for which you're not conditioned or for which you haven't stretched properly. This might include playing tennis, racquetball or basketball for the first time after a long break.
Sometimes, though, injuries can occur from simply putting too much stress on your Achilles tendon in the course of a simple activity, such as gardening. Occasionally, even highly conditioned athletes may rupture an Achilles tendon.
As you age, the risk of Achilles tendon rupture may increase. If you don't exercise regularly, the Achilles tendon may weaken and become thin, making it more susceptible to injury.
Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you move your foot. Injuries to your Achilles tendon result from repeated stress on the tendon, which may be caused or aggravated by:
-Overuse
-Running on hills and hard surfaces
-Poor stretching habits
-Tight calf muscles
-Weak calf muscles
-Worn out or poor fitting shoes
-Flatfeet
Injuries to your Achilles tendon can often result from taking part in an activity involving stop-and-start footwork for which you're not conditioned or for which you haven't stretched properly. This might include playing tennis, racquetball or basketball for the first time after a long break.
Sometimes, though, injuries can occur from simply putting too much stress on your Achilles tendon in the course of a simple activity, such as gardening. Occasionally, even highly conditioned athletes may rupture an Achilles tendon.
As you age, the risk of Achilles tendon rupture may increase. If you don't exercise regularly, the Achilles tendon may weaken and become thin, making it more susceptible to injury.
An Incident!
This is how I ruptured my Achilles tendon. Feel free to share your stories. I was playing a pickup game of basketball at my local Lifetime Fitness. I had already played one game earlier and was starting my second game. I was on the left baseline of the court when my teammate gave me a give and go pass. Only when started to go it felt like Bruce Lee gave me a kick to the back of my left heel. I knew right away something was right. I have sprained my ankles plenty of times. This was not an ankle sprain. It was a bizarre feeling at first. My foot literally did not work. I would try to walk and my foot would not respond. Everyone told me there heard a loud pop, but I didn’t hear anything. After icing for about ten minutes I grabbed my stuff and limped home. It really did not hurt that much, and I can see why some people do not see their doctor as soon as possible. The next day I saw my primary physician, and he recommended me to an orthopedic surgeon. The surgeon game me the Thompson Test and stated I have ruptured my left Achilles tendon. I thought I would be given an MRI or something. Nope. Just a date for the surgery I was having next week.
I am 27 years old. I have been playing basketball for at least twice a week since high school. Thinking back upon it, I had a pain in my left calf in the earlier game. I have always had aches and pains playing basketball, but I should have stopped right then and there. Coulda, Woulda, Shoulda. At least it was not my right Achilles tendon. I feel sorry for the person that can’t drive around.
Another surgery. I recently had an emergency appendectomy earlier this year. Acute appendicitis is no fun. The difference with the Achilles tendon surgery is you have time to think about all the horrible things that can go wrong. The appendicitis happened so fast and I was in so much pain I wanted that bugger outta there.
I can into the out-patient surgery wing of the hospital at 7:15 A.M. My Surgery was schedule for 8:45 A.M. I was checked into a small room and changed into the gown they gave me. The nurse put in an I.V. The anesthesiologist came in to talk to me about the procedure. He asked a couple of questions about my prior surgery and how I did with the general anesthesia. I was asking him I bunch of questions but I could not understand him, I believe he was from Croatia. His accent was heavy. I told him I felt no ill effects before. He asked me if I wanted general anesthesia or a spinal shot. I elected to have general anesthesia. I didn’t have to wear a catheter. Hurray, No Catheter!
They rolled me into the pre-op room where I met with another nurse the Croatian anesthesiologist and another anesthesiologist and the surgeon. They told me they made a last minute decision to give me a nerve block. They inject a numbing agent into the nerve of my leg. It is done to help the patient with post op. pain. I rolled onto my stomach and could hear the Croatian explaining to the other anesthesiologist where to inject the needle into my nerve. And then…..Darkness.
Awake…I was in the post op. room on my back with a cast on my leg and a bag of ice underneath. The nurse said the operation only lasted 45 minutes. If this is going to your first time going under it is a trip. I couldn’t feel a thing in my left leg. I went to the bathroom, put on my clothes and went home.
Fast forward roughly 24 hours later when the nerve block wore off. Holy Christ was I in Pain. The pain hit in a matter of minutes. It was painful. It eventually wore off, and I was only on painkillers for a couple of days.
Just a side note they give you a lot of antibiotics to take after the surgery. The biggest problem post operation is an infection of the wound. At the time of writing this I am four weeks post op. and have had not problems.
I am 27 years old. I have been playing basketball for at least twice a week since high school. Thinking back upon it, I had a pain in my left calf in the earlier game. I have always had aches and pains playing basketball, but I should have stopped right then and there. Coulda, Woulda, Shoulda. At least it was not my right Achilles tendon. I feel sorry for the person that can’t drive around.
Another surgery. I recently had an emergency appendectomy earlier this year. Acute appendicitis is no fun. The difference with the Achilles tendon surgery is you have time to think about all the horrible things that can go wrong. The appendicitis happened so fast and I was in so much pain I wanted that bugger outta there.
I can into the out-patient surgery wing of the hospital at 7:15 A.M. My Surgery was schedule for 8:45 A.M. I was checked into a small room and changed into the gown they gave me. The nurse put in an I.V. The anesthesiologist came in to talk to me about the procedure. He asked a couple of questions about my prior surgery and how I did with the general anesthesia. I was asking him I bunch of questions but I could not understand him, I believe he was from Croatia. His accent was heavy. I told him I felt no ill effects before. He asked me if I wanted general anesthesia or a spinal shot. I elected to have general anesthesia. I didn’t have to wear a catheter. Hurray, No Catheter!
They rolled me into the pre-op room where I met with another nurse the Croatian anesthesiologist and another anesthesiologist and the surgeon. They told me they made a last minute decision to give me a nerve block. They inject a numbing agent into the nerve of my leg. It is done to help the patient with post op. pain. I rolled onto my stomach and could hear the Croatian explaining to the other anesthesiologist where to inject the needle into my nerve. And then…..Darkness.
Awake…I was in the post op. room on my back with a cast on my leg and a bag of ice underneath. The nurse said the operation only lasted 45 minutes. If this is going to your first time going under it is a trip. I couldn’t feel a thing in my left leg. I went to the bathroom, put on my clothes and went home.
Fast forward roughly 24 hours later when the nerve block wore off. Holy Christ was I in Pain. The pain hit in a matter of minutes. It was painful. It eventually wore off, and I was only on painkillers for a couple of days.
Just a side note they give you a lot of antibiotics to take after the surgery. The biggest problem post operation is an infection of the wound. At the time of writing this I am four weeks post op. and have had not problems.
Sunday, January 6, 2008
Take your medicine, son.
Prevention can help you avoid this injury.
To help prevent an Achilles tendon injury, gently stretch your Achilles tendon and calf muscles before taking part in physical activities. Perform stretching exercises slowly,stretching to the point at which you feel a noticeable pull, but not pain. Don't bounce during a stretch.
To further reduce your chance of developing Achilles tendon problems, follow these tips:
-Avoid activities that place excessive stress on your heel cords, such as hill-running and jumping activities (especially if done consistently).
-If you notice pain during exercise, rest.
-If one exercise or activity causes you persistent pain, try another.
-Alternate high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming.
-Maintain a healthy weight.
-Wear well-fitting athletic shoes with proper cushioning in the heels.
Strengthening your calf muscles also can help prevent injury to your Achilles tendon.
To strengthen your calf muscles, practice toe raises:
-Stand flat, then rise up on your toes.
-Hold the elevated position momentarily before slowly dropping back down to a stand. -Emphasizing the slow return to the ground will help improve the force absorbing capability of your calf muscle and Achilles tendon.
-Start with raising just your body weight. Later, you can add hand weights as you do this exercise or raise your body weight on just one foot.
To avoid a recurrence of an Achilles tendon injury, follow these guidelines:
-Use warm-up and cool-down exercises and calf-strengthening exercises.
-Apply ice to your Achilles tendon after exercise.
-Alternate high impact sports with low impact sports, so as not to overwork your Achilles tendons.
To help prevent an Achilles tendon injury, gently stretch your Achilles tendon and calf muscles before taking part in physical activities. Perform stretching exercises slowly,stretching to the point at which you feel a noticeable pull, but not pain. Don't bounce during a stretch.
To further reduce your chance of developing Achilles tendon problems, follow these tips:
-Avoid activities that place excessive stress on your heel cords, such as hill-running and jumping activities (especially if done consistently).
-If you notice pain during exercise, rest.
-If one exercise or activity causes you persistent pain, try another.
-Alternate high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming.
-Maintain a healthy weight.
-Wear well-fitting athletic shoes with proper cushioning in the heels.
Strengthening your calf muscles also can help prevent injury to your Achilles tendon.
To strengthen your calf muscles, practice toe raises:
-Stand flat, then rise up on your toes.
-Hold the elevated position momentarily before slowly dropping back down to a stand. -Emphasizing the slow return to the ground will help improve the force absorbing capability of your calf muscle and Achilles tendon.
-Start with raising just your body weight. Later, you can add hand weights as you do this exercise or raise your body weight on just one foot.
To avoid a recurrence of an Achilles tendon injury, follow these guidelines:
-Use warm-up and cool-down exercises and calf-strengthening exercises.
-Apply ice to your Achilles tendon after exercise.
-Alternate high impact sports with low impact sports, so as not to overwork your Achilles tendons.
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