So in this 3rd blog in the series following my Achilles tendon rupture I wanted to share what my experience has been like through my own recovery. This will reflect on what I’ve learnt and experienced working with physios as well as some common hurdles others have experienced who have suffer the same injury that I have spoken to.
This one has taken me a lot longer to get around to write, and this is partly due to life getting back to ‘normal’ after 2 months of being immobile on the sofa but also as I don’t feel I am fully recovered yet so hard to find a definitive point to reflect from. If you have sustained the same injury yourself you will be aware, or maybe not yet, that it’s a process that you have to embrace that has moving goal posts. There is always more work to be done, more strength or more range to recuperate, a better outcome measure to achieve or activity to return to or desire to improve function and feel more like your old uninjured self.
In short once you have a significant injury such as an AT rupture its not the simple case of returning to preinjury, going back to life and function as you use to know it, it’s a life of living with it, managing it and the process of slowly but surely getting stronger, fitter and reducing the risk of it occurring again. Sure you will most likely be able to get back to what you use to do by putting in the hard work in rehab but it won’t be exactly as the uninjured side. Whether this limits your sport or day to day life totally depends, from my experience everyone’s experience is different, whether operation or non op. But don’t be disheartened by this, be positive and see it as a process.
So the key things to be aware of in the heads up in recovery, whether conservative (non op) or invasive (op) approach:
1. Be realistic – unfortunately they will say its 6 months and you will be fixed and back to normal. Yes back to doing normal activities like walking, driving and day to day tasks but don’t be expecting to be back running marathons and playing football. That takes time and could be up to 2 years +/- depending. Be optimistic but be realistic. There are so many factors that effect the speed of recovery and progress in healing. Which leads me into the following point.
2. Everyone is different- and heals differently so try not to compare against the healing frame work that you may be told or read about or compare against others. They are totally different people, lifestyles, expectations, capabilities etc. Just focus on what you can do and not what you cant, and build from there.
3. Get a physio early doors – Push to see the NHS physio asap and if you can afford it then I would strongly advise seeing a private physio. I think from week 6 is around the time suggested but some may be able to work with you earlier. They will be able to support you in your recovery, giving you exercises you can work on, things you can do and hopefully discussing the wider psychosocial aspects affecting recovery and wellbeing.
4. Don’t rush it early –embrace the process, not the outcome. It is likely that if you rush it could take longer if you aggravate it, it flairs up or the unimaginable, its ruptures again. Classic Tortoise and the hare story, slow and steady wins the race. Distract yourself, surround yourself with friends & family, rest, be kind to yourself and focus on what you can do. If you cant express yourself physically then what can you do mentally to keep busy?Learn something new or do those jobs you’ve been meaning to do for years.
5. Come to terms it’s going to take a year/years – it's better to overestimate it rather than underestimate and then go through the disappointment of missing milestones. Speak to others, physios, other people who have had the injury. Get some perspective about it and make sure you highlight the positives from what they are saying. Have goals to work towards, but your own goals based on things that are achievable to you and important to you.
6. Get comfortable being uncomfortable - Load it (when appropriate)– tendons need to be loaded (70-80%) for them to respond so they need to be pissed off a bit to adapt and respond. This is the hardest part, to know how much is enough and when it’s too much. This is where working with a physio is key to help guide you through this process. I have heard some interesting research on the use of blood flow restriction training in AT recovery but this must be guided by health professionals.
7. Celebrate the successes – make a journal and reflect. This is one of the reasons I started this series of blogs, I wanted to know why it happened to me to start with, then how do I rehab it and turned into more of a reflection of what I have learnt, what I have gained from the whole experience and coming to terms with the long term prospect of living with this injury. I now always compare progress to the last 2 – 4 weeks not 2 -4 days, as I have got past the year mark I look at the last 1-2 months instead of the 2-4 weeks. Progress slows down but still needs to be celebrated and to look back on where you have come from. The body is incredible, even if it does it slower than you want it to.
8. Realistic enjoyable goals – give yourself purpose. Give yourself realistic goals to work towards, keeping the short term ones (days/ weeks) more firm and fixed with the mid term goals (weeks to months) and long term (months to years) more flexible and review them based on progress. One feeds into another. Ensure they are fun and enjoyable, e.g. a 3 mile walk whilst on holiday with the family. I’ve had to defer a 45m ultra marathon twice already and still may have to move for a 3rd time as my expectations of my rehab were so way out. Originally it was 4 months post op so that was never doing to happen, I deferred a year as thought 16 months post op was doable. It wasn’t for me so I deferred again. Now I may have to defer again, but I haven’t just binned it as its still something in the background, a long term goal, to work towards. I am certainly not chasing this, I chasing my current short term goals that lead into my mid term and hopefully this race.
9. Its more psycho-social than you realise-After you get past the first 3-6 months progress slows down and its diminishing returns. This is the hardest time to keep sane and focus on what you can do. It's good to talk to others, find other ways to process and reflect, or to have your own time. I used trail running as a way to escape, process things and have 'me time'. I haven’t been able to do that for a 18months. I struggled to find something else to replace this but walking in the woods or similar has helped. I am now getting back to trail running which is a breath of fresh air. Its important to find this enjoyment and mental peace during this process to help with the psycho- social elements of life and rehab.
10. Accept it maybe different in the long term but don’t accept pain and dysfunction – this is key, if its not right then keep trying, different paths, change things up and get different opinions. It will be a life of calf raises to keep the calf and the tendon strong, to keep good function, that’s a given but don’t accept that it’s a gammy leg. I am 18months post op and still get a feeling to tightness and restriction in the Achilles. Even though function and strength is pretty good it doesn’t feel right and so I had another ultrasound (privately) and its shown adhesions between my tendon and tissues surrounding it. So its back to orthopaedics to see if and what they can do. May be another op to free the tendon from the scar tissue so it slides better. Will they do it, who knows but for me it doesn’t feel right and so I have to continue the rehab I can do and pursue other options whilst I do this.
If you have any questions after reading this blog or would like assistance in your own recovery back to fitness then get in touch.
For those that have had an Achilles rupture and want to know a bit more detail in my own recovery over the weeks into months below is a very vague timeline of how my recovery went from a few notes I made whilst I was recovering:
Weeks 1 – 2 – in plaster cast post op and non-weight bearing at 30 deg plantarflexion (toes pointing). Lots of questions and no answers. Settled on the fact I’m in for the long haul! Sit down and get fat, especially as its December in the lead up to Christmas. Stab yourself with a needle to inject blood thinners and worry about every twitch, pain and soreness constantly catastrophising it’s a DVT or the op hasn’t worked after slipping on crutches and falling. Dreaming of walking / running. Waking up at night with calf twitches screaming in pain (very weird). Losing independence is the hardest. Off meds by day 7 & mentally flat by day 12. Rectified by getting out for hops & getting structure to days.
Weeks 3-4 – Transferred into a boot allowing redistricted movement between full planta flexion and 20 deg & check wound to make sure no infection. Learning to hop very well on one leg around the house or using one crutch for ease! Calf doesn’t feel like mine and just getting the muscle to contract hard. Limited bathing as a faff. Week 4 first stand-up shower!
Weeks 5-6 – Start weight bearing and change of the boot angle to 10 degrees planta flexion. How much is a little, too much, enough weight. Such Poor guidance from NHS. How do you even walk again? Fucking crutches just getting in the way. Bit of a set back with stitches and a strand of my tendon sticking out my wound at week 5. More time off my feet not weight bearing and back into the gym as getting flabby doing what I CAN do.
Week 6 – Tried cycling on a static bike in the boot using the heal first as its all settling down, unsure of what should be doing. Feeling like the foot and toes are very sticky/ don’t move very well. Time to see a private physio as NHS not even on the horizon!
Weeks 7-8 -full weight bearing by this point at 0 degrees in the boot, a little later than planned, which is unnerving but great. Hard to trust leg again and feels so different.
Week 7 – see private physio (would have seen at week 6 if possible but too late booking in)– inversion /eversion exercises, passive and active mobility. The start of reframing my expectations of recovery - its 6 months to day to day functions then maybe think about how to get back to running. Good to understand and a lot of time discussing the psycho-social aspects. Discuss and agreed course of action together.
Week 8- appointment to see consultant for the protocol to get out of the boot and reintroduce walking. Didn’t get to see consultant just a junior doctor who had no answers to my questions, No assessment, signed off and told to ask the physios when you get referred. Totally deflated and went to the pub on the way home. Managed to get back to work a little using 1 crutch or walking badly with no crutches.
Week 9 – Private physio discussing ditching the crutches AND boot to improve walking by using walking sticks to work on dynamic flexibility and balance. Now on to waist supported calf raises and seated calf raises. Realized I can’t walk bare foot as I don’t have the foot stability.
Week 10 – NHS physio 10 ½ weeks post op, told to really focus on normal gait pattern, that it’s a long road to recovery but doing well. To expect it to be 18 months to regain full strength. Told to load differently, balance, marches, Single leg dead lifts. First time driving after 2 ½ months . Now walking bare foot
Week 11 – Private physio saying to build cycling capacity, 50/50 (weight distribution) calf raises, ½-1 mile walk , work top supported side to side walking on tip toes, squats, SLDL, Step ups. Back to work properly. Walking properly off road with poles. Building capacity. Lots of different types of shoes to help get use to stability and comfort.
Week 12 – Swimming as wound fully healed. Now out of high risk re-rupture time frame. First off-road walk 1.75 miles walk with poles. Feels great, to be out, but feels terribly vulnerable still.
Week 13 – Walked 2.3 miles & ok. 1st motor bike ride ok but felt vulnerable. 3 weeks post boot and NHS physio said doing well. However a “fast” walk @3 mph for 1.25 miles pissed it off. 3 mph....and its pissed it off.
Week 15- v frustrated with mobility but I am not dedicated time to it! Depressing seeing others progress faster. HEEL PAIN- why?! Just getting use to being on feet again after long time off. Had 1st massage on the scare and calf. It felt really good after.
Week 16 – first 6 mile cycle, 1st single leg calf raise, walking 3 miles all ok & feels normal to walk.
From here life got busy and everything started to blur as I regained normal walking ability and gradually regained my ability to do normal activities without conscious thought about my Achilles. But the following is a timeline of mile stones. Some of which could have happened sooner if I put more effort in or had more time to put to it. But remember rehab is a balance between what capacity you have in your lifestyle to put to it vs. your motivation to regain function or hit miles stones. This is different for everyone and varies over time for the individual too.
First walk pole assisted out of the boot outside = 4th feb @ 8 weeks
Back to work part time @ 8 weeks
First time back driving = 11th Feb @ 10 weeks
Back to work fully @11 weeks
First off road walk with poles= 26th Feb @12 weeks
First single leg calf raise = 26th march @ 16 weeks
First time back skipping (rope) = 30th June @7 ½ months
First 50 mile cycle = 27th august @8 months
First kick about football (badly) @ 9months
First run = 29th Oct @11months
First 10km – May 2023 @17 months
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