Week 11 was a wonderful week of recovery with lots of rehab exercises. As I mentioned last week, Week 10 was when I found a great physiotherapist (Amanda Beers from Excel Physiotherapy) to start active rehab for my Achilles tendon rupture. I fully recommend Amanda if you are ever in need of a physiotherapist, she works out of the Port Moody Recreation Complex location. After a full week of doing exercises and stretching at home, I learned that I may be pushing my recovery too hard. Specifically, it was the stretching portion that I may be overdoing. Before I get into this, here is my Week 11 progress of rehab exercises. My injured left calf is still shrinking in size. It’s official, my right calf at the widest circumference is now officially 2 inches smaller than my left calf! It’s the second week I have been seeing a physiotherapist. Calf muscles are firing again!
Exercises and stretching at this stage should not result in pain of any kind. For me, during stretching and exercise movements, there was absolutely no pain, just a lot of tightness in the tendon and muscles surrounding the Achilles. It’s normal for tightness to develop once you start exercising since many of these muscle fibers have not fired in any significant manner for quite a long time. So my eagerness to get out of the boot and begin to walk normally again may have gotten the best of me. After a few days of stretching and exercises, walking with the boot brought on tenderness and some ripping feeling in the Achilles area. I did feel tiny tears a few weeks back during my recovery but after doing exercises at home, I feel much more soreness on the inside of my ankle (tibialis posterior tendon area) along with some tearing in the Achilles. This is happening even when I have my Össur Rebound Air Walker boot on. The harder the heel strike (ie. the faster I walk) the more soreness I feel. Because of this, I decided not to remove my third and last wedge from the boot until I met with my physiotherapist.
The last 2 wedges that have been removed from my boot always resulted in tenderness on the inside part of my ankle and lots of stretching in the Achille area when I put on the boot again. But it would usually settle in about a week and I would progress from there. Good thing I listened to my body and decided not to remove the last wedge on the target date. Amanda concurs and her suggestion was to try and get the soreness and tiny tearing under control first before removing the last wedge. I agree! Even though the third Achilles boot wedge is not out, I am still getting fantastic food from my wife! This egg noodle wide pasta was to die for!
Physiotherapy to Recover from Achilles Rupture
At my second physio session, I learned to differentiate between stretching and mobility exercises. The most tight area for me is the Achilles area; in particular, probably where the Achilles tendon starts to attach to the calf muscle. I am not sure if it’s the actual tendon or muscles that is tight but I can clearly see that piece of my leg kind of flexed and bulging even when I am not exercising. More on this later.
So during the first week of home exercises, I would stretch that area by pulling my foot (using my own muscles and not using any elastic bands) into a dorsiflexion position. Once I reach my limit, I would hold and wait for things to relax and lengthen, then continue to stretch and pull some more. It may be too much stretching at this point and that could be causing the tiny tearing that I am feeling. I would actually stretch about 20 times a day; perhaps, that is also a bit much. So my physiotherapist is suggesting I continue with my exercises 3 times of 30 reps / day but drop the stretching to a max of 3 times a day. It won’t be easy as stretching out the tightness (repeatedly) feels great after being in a boot for 11 weeks!
Because of recently starting physio and exercises, I am going to continue to see Amanda twice a week to start. The first session in Week 11 was spent on:
- learning new exercises
- sit down heel lifts
- sit down toe lifts while sole is on the ground
- physical massage to the calf, injured Achilles and inside ankle area (Amanda is strong! and yes it hurts when she works on the area; but if it helps, I am up for it)
- electrical stimulus of lower calf and Achilles area (below is an image of my injured Achilles and ankle undergoing electrical stimulation)
In addition to my Achilles tendon injury, I am pretty certain that I may have also injured the inside part of my ankle. It’s been swollen since the rupture 11 weeks ago and it still is. The tendon itself does not hurt much if I don’t put pressure on it and most of my soreness comes from the inside part of my ankle, especially on heel strikes. It is possible that this area was injured from overuse as my body is compensating for not having a working Achilles tendon or that it may have been injured or torn at the same time of my Achilles injury. From physiology diagrams, I see there are lateral ankle tendons and a tibial tendon that could be injured there. So the goal now is to get the pain, soreness and tearing under control before removing my third and final wedge from the boot.
Ankle Pain and Bulging Muscle
As the exercising goes on, I am still a little concerned that the pain and soreness on my inside ankle is not going away. The pain is in the same area as when I first ruptured my Achilles. This area has been swollen since Day 1 so I am concerned. I may book an appointment to see my orthopedic surgeon again next week if things don’t settle down and get better. Let’s see how it goes.
As I had mentioned, I am also a little concerned that the muscle just above the Achilles and below the calf muscle is bulging. It may have been wearing tight socks that moulded this shape during the first 10 weeks but let’s see what the surgeon says next week if I do see him. This is the area I feel the most tightness when I do the rehab exercises. The image below shows the bulging muscle; it was actually even more prominent prior to my physio sessions.
After a second physio session this week, the tightness in my calf was much less. My therapist went through a similar treatment as before with some exercises, physical massage, electrical stimuli with a cold pack and then ultrasound of the tendon area. Yes, it hurt even more than previous sessions when my physio worked to loosen up my tight calf muscles, tendon area and ankle. After the physio visit, I felt a little light headed. I remembered my first ever neck massage therapy session from being in a car accident left me feeling this same way. At the time, the massage therapist told me it was normal to feel light headed after a deep tissue massage. It is your body releasing toxins from the injured muscles and feeling light headed was a side effect. If you get this feeling after a therapy session, make sure you drink lots of water afterwards.
Third and Final Wedge Removed!
With more resting, less rehab exercises and remembering to elevate the injured ankle, the micro tearing and ankle pain was more manageable. In addition to the blessing of my physiotherapist, I decided it was time to remove the third and final wedge from my Össur Rebound Air Walker boot near the end of Week 11! After the last wedge removal, I made sure to strap the boot on tightly and elevated the foot for about an hour before attempting to walk on it. After removing previous wedges, it would take a few days for tenderness around the ankle to settle. This time, I am going to take it easy.
Pump That Boot!
I was given specific instructions NOT to use the air pump in the Össur Rebound Air Walker boot as it may cause issues. This was at Week 1 from the surgeon’s office so it may be because the area was severely injured. But at Week 11 now, I tried to pump up the bladder for the first time and it felt ok. The air bladder actually surrounds the Achilles and lifts the tendon itself from coming in contact with the back of the boot. I should have tried this earlier as the pain and discomfort from sleeping with the boot was from the Achilles being irritated and being painful when it was not positioned away from the back of the boot. I have tried pumping up the boot to sleep and it was definitely better! If you are having issues sleeping with the boot on, check with your surgeon to see if it’s safe for your injury to try and get a better night’s sleep. Wish I discovered this earlier! In fact, using the pump also helped with the Achilles discomfort when I wore the boot and had the foot elevated. My foot, while elevated, would sit flush on my heel and I would have to adjust the position just right to prevent discomfort. In fact, the air bladders located on the inside and outside of my ankle may help to decrease swelling as they act like a compression brace would. This is solely my own opinion as it is now Week 11.
Sometimes, it’s just easier to sit at home with my foot elevated. On sunny days, my wife would encourage me to head outside. It always brightens my day and makes me happy when I enjoying time out of the house with my wife and kids. As I have said many times before, I am one lucky dude.