Thursday, December 21, 2017

Achillies Tendon Rupture: Post Surgery Week 1-2

On Dec 2 in a Cyclocross race my left achllies tendon ruptured.  On Dec 5th I had surgery to repair it.  I took that week of work off between doctors appointments and surgery and used the guidance of elevatation to help to control swelling.  I went back to work the following Monday and worked a regular schedule with the help of a knee scooter.

The doctor told me it was the worst achillies rupture he had ever repaired.  In his words there must have been a previous tear in there.  Because of the extensive damage he decided to put me in a cast for 12 days instead of the normal 3-5.  Being in a cast wasn't that bad until a week in and the itching started.  Nothing you can do about it.  Those were some sleepless nights.

I got on an air dyne that evening after surgery to help try to get whatever residual anesthesia may be in my system and get some blood flowing.  I used a Marc Pro a minimum of 2-3x a day for 1-2 hours each for the first week.  I continue to do that at least once a day.  Here is a timeline of modalities used and why.

Day 0 surgery.
Introduced air dyne.  10-20 min easy effort.
Marc Pro 3 sets of > 60 minutes
Kept the foot elevated
Wrapped blood flow restriction band (BFR) around upper thigh and did bodyweight leg extensions.
Did Glute ISOmetric holds for time.  Both sides.
Hip Flexion, knee rotation CARS
Side planks with Active Movement

Day 1-3
Pretty much did the exact same protocols.  But did this 3x a day.
I added in bone both with gelatin and 3-5 grams vitamin C in a drink that I slugged down 30-60 min before I rehabbed.  Who knows if this will help, but it can't hurt.
Reverse Hyper without any weight with Slingshot around my knees.  My thought process is that I was getting some type of stimulation into the calf perhaps.
Regular GYM work for what I would do for upper body, lots of extra pulling work.

Day 4-7
Started pushing through the heel of my cast into the air dyne pedals.  This felt good.
Extra seated work at the SkiERG
Light band resisted knee extensions with BFR on upper thigh.
Stopped taking the Ibuprofen they recommended.  I felt like I was controlling inflammation well with exercise and the research seems to say NSAIDS delay tendon healing.
Still taking baby Aspirin morning and night to help prevent any clotting issues.

Day 8-12
Lack of showering under my cast is starting to feel it.  Itching.  Nothing you can do about it.
Kept up all the same work as previous days.
Got the cast off!

My doctor walked in looks at me and states,  "You tore the shit out of it."  But it looks like it's healing well."

I was shocked at how swollen my foot looked.  I thought I had been doing a pretty decent job of elevating and movement when I wasn't working.  Now I'm in whats called a CAM boot now.  Locked in Plantar flexion of 20 degrees for 2 weeks and then 10 degrees for two weeks and then at a month at neutral or 90 degrees.  It just feels awesome to be able to take it off.  I've found that If I put half a deck of cards in my Timberland boots it makes for a secure workout bike riding boot.  I can ride much more aggressively and really drive through the foot with no pain.  Thats big.

Day 14
Holding ISOmetric lunges with the left leg forward for repeated sets of 20-30 seconds.  I can raise up out of it for 2-3 inches with minimal pain.  Going to start doing LOTS of this.

The next few days, I'm going to feel out, band assisted bodyweight box squats, hip thrusts loaded,  Seated calf raises and some alactic/aerobic work like 10/50 work to rest for blocks of time.

There is nothing like skin in the game to start really reading and applying something to your life.  All injuries have reasons.  Do we ever figure them out is another story.  But, I've come to accept that this one is 90 percent my fault and 10 percent shit happens.  This achillies has a history of bothering me.  I would do some eccentric calf
raises for a few months, bring back some jump roping and by fall it would be feeling pretty good again.  Winter comes, I don't do a much of that stuff and I think my tendon, which had a small tear in it apparently already, would get cranky from "spring enthusiasm" and be sore in the summer, start to rehab it, be good by fall.  Cycle starts again.  This year I got more into biking and spent most of my time biking.  After chasing a 1/2 mile time I wanted to beat, it got sore, but instead of rehabbing, I just biked more and avoided it, I believe without the loading, my tendon got weaker.

I didn't do the work.  Tendons need load, not rest.  Things I knew, but didn't apply.

"Knowledge without application is simply knowledge.  Applying knowledge to ones life is wisdom, and that is the ultimate virtue."  Kasi Kaye

Tuesday, December 5, 2017

Achilles Tendon Rupture: Pre Surgery Day 1-3

When it comes to injuries, hindsight is 20/20.  It's easy to look back in time and create the why.  It's also easy to chalk up injuries to bad luck.   As a Strength coach and Chiropractor/therapist I want to know the why's.  I don't believe in bad luck.  There are reasons.  I don't know all of them, but we do our best to learn and move on.  We also have to be careful to not just create reasons because it fits with our need to have answers.

Sunday morning I had a complete rupture of my left achillies tendon.  I somehow saved my bike from a slide out, I must have used my leg as a kickstand and I felt someone run into or kick my calf.  I looked behind me to see who was there, and in that matrix like moment, time slowed, I saw no one, dropped an f bomb and knew.  I knew instantly when I didn't see anyone behind me.  In the seconds that processed through my brain I thought, here comes the next year of my life.

I've had on and off pain in this achillies tendon for over 10 years.  So chances are there are some decent amount of degeneration in the fibers before the rupture.  From a mechanics stand put, this ankle has lacked as much dorsiflexion in it since a pretty bad ankle sprain that limited life for about 6 months as a freshman in college, jumping over a wall and landing on a parking berm.

Take Care of Your Joints.

It would come and go the inflammation around the achillies.  One thing I've neglected is dynamic loading when I was feeling good.  We know you need to use the qualities you want to keep.  Healthy tendons need load, eccentric strength and must go through stretch shortening cycle.  This had started to fade over the years.

Variable Loads Are Needed.

I normally take my HRV every morning, but I had just finished getting over a weird cold that seemed to last 18 days and had gotten out of the habit.  It had left me with good power in terms of strength, but anything over 160 heart rate I was wiped out.  Part of me thinks I was still fighting something, had extra inflammation in my system when this all when caput.

When I got home from the ER, that Sunday reached out to a bunch of friends and got some surgeons names that were recommended.  I was able to see my Doc Monday morning and he stated it was a bit higher then normal.  I said, great more blood flow!  He said yes, but less tendon to work with.  (here's hoping I'm right)

A good friend sent me to the website of Dr. Amol Saxena, one of the leading foot/calf guys in the world.  He performs lots of achillies surgeries on athletes who's livelihood depends on it.  He lays out a great rehab protocol.  Week by week.  Post Op Rehab Achillies

Nutritionally I'm going to do a very high protein, high fat, low carb diet for at least a month.  Essentially eat no junk and try to limit inflammation.  Bought a bunch of high quality bone broth to drink multiple times a day to see if I can maximize connective tissue health.

Have a Plan

ALTIS just posted a nice recap of their Coaching program and one thing that stuck out was this from Matt Jordan.  1.  Know what matters.  2.  Measure what matters.  3.  Change what matters.  Dr. Saxena has seen hundreds through to the return to running and 3 things matter.  1.  Perform 5x25 single leg raises with 15 seconds rest between sets.  2.  Have a post operative limb within 5mm of the good leg.  This is tricky as mine was already 1.5-2 cm smaller from when I had a back injury to the left.  My goal will be to get as close to the size pre surgery.  3.  Have ankle dorsiflexion and plantarflexion of 5 degrees of the good limb.  If access to an AlterG run 85% bodyweight for 10 minutes.

Be Abel to Measure Your Plan

Surgery is in the morning.  Then the fight begins.  It's been humbling to feel and hear all kinds of support from family and friends.  My wife has been amazing.  Funny, after my first thought of oh shit I tore my achillies, my 2nd thought was, Kelly is going to kill me!  lol

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