Reading Time: 12 minutes, (but if you follow all the links an hour or so); Skimming highlights, 2-3 minutes.
Before we get into the very serious business of making sure you can heal your ruptured Achilles tendon in the best way possible, I think we can all agree that if that statue is a faithful representation of Achilles, then we can better understand why he was eager to live fast and die young. He certainly wasn’t going to be remembered for his penis size was he?
Secondly, let me add the standard disclaimers: I am not a doctor, the information provided here is for information purposes only, blah, blah, legal crap, blah. Bottom line: You take responsibility for your own outcomes. I present this information here because when my injury happened to me it was very hard to find any good information on how I could go about ensuring I didn’t remain a functional cripple for the rest of my life. The information relating to the recovery of full Achilles tendon ruptures on the net was so wide-ranging it seemed to be the work of a thousand monkeys. Recovery rates and times varied wildly and it was hard to understand why. I personally contacted other people who had this same injury and again, it seemed their recovery rates differed from mine quite drastically, but by speaking to them I could begin to understand why. Their recovery regimes differed from mine in several important ways and it is my personal view that this had a lot to do with it.
Type of injury: The type of injury you actually have will of course affect everything. Mine was a COMPLETE Achilles Tendon Rupture. That is, the tendon was fully snapped. There was about an inch gap of “empty” flesh where the tendon at the back of the leg, just above the heel should be. So these notes are mostly for those type of injuries, which is also the most severe kind. Important: If you have this type of injury it is imperative you receive surgery within 48 hours according to most good medical experts I have discussed this with. On a personal note, I was also strongly suggested by the doctors and nurses on duty at the hospital shortly after my injury, to NOT have surgery. Again, this is just my opinion, but I am sure that had a LOT to do with trying to save money for the NHS and nothing to do with what was best for me. I am a layman, not a doctor, but it is my considered opinion that if you ever want to be able to walk and use your leg normally again, the only way to do that with this type of injury is with surgery. And good surgery at that if you can get it. So don’t let the docs “persuade” you to do the cheaper and easier thing for the government.
Expected prognosis: Assuming you had surgery within 48 hours and assuming your surgeon was not trained in a sausage plant factory, you will generally be told that you should be “back to normal” within 6 to 9 months if you are fit, have no health problems and generally heal well, otherwise they will tell you 9 to 12 months but up to 18 months before you are “fully operational” again. This can all be a bit confusing, so here is my interpretation:
- According to a search done on the rather extensive NHS database for physiotherapists and doctors that my physio did for me, the actual tendon, once ruptured will take on average about 6 months before it has healed to full strength. As with all things biological, this is just a guideline.
- The main issue with proper healing of this injury is to have good blood-flow through the area. Blood pooling is common unless you keep the leg elevated, this is especially important for the first few weeks after surgery, but is a generally important point to keep in mind. Promoting ACTIVE blood-flow through the area and preventing the stagnation of blood in the area after surgery is important and probably the single most important point regarding healing of the actual tendon.
- Even while healing, if you do not take APPROPRIATE action to manipulate, exercise and generally “activate” the area, the healing will not be ideal. The important point here is that you need to do enough to stimulate growth, healing, reacquisition of proprioception and so on, and not so much that you re-injure or impair healing through too much work on the injured area. This is the single most important point and it is really the crux of whether you will heal well or not. My personal experience was that everyone was telling me to take it easy, when instead I felt I had to do more work on the area. As it turns out, I was right, but it IS a fine balance, and it is EASY to make a mistake and re-injure yourself. I was EXTREMELY CAREFUL with all of my own invented little exercises, and I always used my own sensation of my own body as my guide. I cannot teach anyone else how to do this, you have to find your own way, but if you CAN do this, your healing of your injury will outperform most professional expectations. this at least, was my experience.
Actual Recovery Time: I snapped my tendon on the 22nd of June and had surgery on the 24th of June 2010. I am writing this on the 9th of March 2011, so about 8 and a half months after the surgery. My initial aim was to be able to walk properly 5 months after the injury as I was getting married at that time and would be in Brazil and I wanted to be able to swim in the sea, run around, train with Brazilian Ju-jitsu people and so on. I am happy to report that despite the fact I was repeatedly told these were unrealistic expectations, I hit all of my targets. After 9 months I wanted to be back to performing in training to the same level as before the injury. This was also considered wildly optimistic and unrealistic by many professionals I discussed it with. It is not quite 9 months yet, and I am not quite 100% as capable as I was before the injury (and I will give you details on that) but I would say that I am at least 90% of the way there. In some respects I am probably more than 95% of the way there, so I am still on track, and in the next two weeks or so I may well achieve my target or at least be very, very close to it. I also have no doubt that in time (however long) I will be as capable (or more, with further training improving my ability anyway overall) than I was before the injury.
Things I did that I think made the most difference
Immediately after surgery and for the next 3-4 weeks: Kept my leg elevated almost constantly. Did some self-hypnosis to improve circulation, if I lowered the leg, for a brief time it would feel “full” of blood at the bottom, so I would then also lift it again to ensure blood did not pool there. I spent most of my time with my leg elevated and not an inconsiderable time with it higher than chest level. This can (and did) cause me problems in the hip area later, but I am not sure how you could minimise this. I also slept with several pillows under the leg to try and keep it elevated during sleep. Getting good sleep made a LOT of difference and I would advise you to try to ensure you have good, deep sleep of long enough duration. I did not take many painkillers, but I did so for the first few days to ensure I slept as deeply as possible. In particular, a drug which helped me in this regard was the dihydrocodeine tablets (30mg), which I took only before sleep (1 tablet) and not even every day, but for the first 2-3 days after surgery I did. I also used a lot of self-hypnosis just before sleep and at various times throughout the recovery period to improve healing, relaxation and blood circulation.
After removal of the solid cast and use of the Air-boot: I was kind of lucky/unlucky with my casts, depending on your approach to things. My first cast was very heavy and solid and this caused me hip problems. I didn’t know when they put me in this cast that they had done so because they got the weird idea that being a sportsman I was a “dumb jock” and would probably try to run around my block or something, so they used plaster of paris and a heavy cast to help “immobilise” me. The result was an inflamed hip and knee joint due to the unrelenting weight which became pretty uncomfortable. I only found this out on my return to the hospital when the nurse on duty told me, as she was busy replacing my cast with the new, lighter (and colourful) fibreglass version. This was a godsent in terms of weight, but as it turned out, it had been put on a bit too tight and it blocked circulation a bit, causing me pretty impressive pain after about a week or so. So I had to go in before time and have it removed. At this point, though it was in contravention of what the doctors originally all told me, for some reason, they issued me with an air-boot. I suspect this was due
to the fact that in their version of events it should have been solid cast, then fibreglass cast, then when that comes off air-boot, and that is what they did, but without checking the timeline. This was actually a GOOD thing from my point of view, because it allowed me access to the wound for the first time, and so I could also very gently begin some massage to help circulation as well as proprioception and healing. I had spent a total time of only 3 weeks in rigid casts as opposed to the minimum of 6 weeks I had been told would be mandatory. The down side of this is that at this point, your tendon is VERY fragile and if you screw up just once by falling, being careless, or somehow putting too much weight or pressure on it you have a very real risk of popping your tendon again. SO…if you ARE a “dumb jock” it’s safer to keep you in a rigid cast for another 3 weeks, but if instead you are more of a Batman, supercool, and supersmart jock, then this is the best way forward. You can even let your leg get a little sunshine (if you live in a country with sunshine) and let the leg “breathe” without any cast when you rest it carefully on pillows while you watch daytime TV and feel your brain cells dying even as your leg cells heal.
Important: If you live with animals, small children or careless adults, this is a dangerous option to take. A simple mistake of someone bumping your injured leg when it’s out of the cast can have some bad results. I was lucky in that I had Redhead Girl looking after me like only she can. Everyone should have a girlfriend as dedicated to nursing duties as she is!
In summary then, if you can get an air-cast sooner rather than later, do so as long as you can be careful. During this period, some exercises I think helped quite a bit, generally try to move your foot, do gentle resistance work and so on, always being careful to feel your limits and never push even just to these, but always hold a bit back.
The most important things I did here were:
1. Using the BEMER System. In fact I would advise you to use this immediately after surgery if you can. If I could do things again, I would use a BEMER mat right from the start for the first 4-6 weeks I think.
2. Swimming. You have to wait until your scar is healed to make sure there is no chance of any kind of infection, but swimming and walking in a pool was the single most useful exercise for the leg overall. After each session i could feel an improvement in proprioception and even range of movement, dorsiflextion etc. Sometimes when you have exercised the leg a bit too much, movement range decreases for a bit, but a couple of days later it suddenly makes a jump forward again.
3. Getting the right mental attitude. more than the swimming and the BEMER machines, has been my general attitude that I would do whatever it took to get back to 100% capability of use. Often that attitude resulted in me having to RELAX and take things easy and NOT stress instead of me being aggressively pro-active. Sometimes, the best thing I did was…nothing. just sat on my ass and read a book and took things easy. Also, the pretty constant self-hypnosis helped more than even would ever have guessed. Sometimes a dream or a self-induced trance allowed me to literally increase the movement range by almost an inch in a day without any effort or pain, just a shift of internal proprioception and muscular tension. This may sound like Voodoo, but it’s actually got a name: Psycho-cybernetics. Your mental attitude and self-identity really affects your body a LOT more than anyone believes.
4. Get a big shoe to match the height of your air-boot, so when you walk (assisted by crutches) you have the same height for your hips. this all goes to avoiding hip/knee inflammations which were the biggest problem for me. Besides, wearing platform/really thick flip-flops/stripper shoes for men is so much fun.
After the Air-boot:
1. Use your toes — do exercises to use your foot and move your ankle as much as you can. “Grab” the carpet with your feet, and “walk” your leg forward (from a sitting position) position by using your toes.
2. Do little “push-ups” with your foot. I found the best way to do this is to “stand on tip-toes” with my injured leg, BUT only from a sitting position at first. So at first I was only lifting the weight of my own lower leg, later I added weights on top of my knee (a box, a child, the girlfriend) as I got progressively stronger. I found that being in a rush to be able to stand on tiptoes or “spring” on your injured leg is NOT a good idea, instead focus more on getting full proprioception of your leg, that is, learn to use the whole foot again as much as possible. Play with it. Use a ball to increase its ability to “manipulate” (“pedipulate”?) objects and so on. this is key in my opinion for good recovery.
3. Massage. The way this was explained to me by a doctor is: Liquid accumulated in the injured area and other joints and eventually hardens and solidifies making movement difficult. By massaging the “liquid” up into the main body of the leg you promote better circulation and reduce swelling mechanically, which all helps your foot, ankle, and leg in general to stay “alive” and not get atrophied not just muscularly (which will happen anyway) but proprioceptively (proprioception is your ability to perceive, be aware of and use in fine detail, a specific part of your body)
4. Focus on proprioception more than strength. Don’t worry if you can support your body-weight well on the injured leg for a while, concentrate instead on making sure your MOVEMENT of the foot is correct. As soon as you begin to walk without an air-boot concentrate on ensuring the motions your foot goes through are correct. practice in a pool if you need to. I began to be able to do this about 7 weeks after surgery, which again was WAY ahead of schedule, (I should still have been in a solid cast according to them) but I must re-iterate, this new found mobility is probably THE MOST DANGEROUS TIME, and you should really take extra care. This is a critical period. A simple thing like a wrong step, tripping, or stepping inadvertently off a curb or onto some obstacle will break your tendon again, so TAKE CARE!)
5. Use a pool. Seriously, even if it means you have to get your crippled ass on a bus and then to a gym with a pool, do it. The use of water to be able to walk with a much lowered weight so you can make sure the foot is moving correctly when you walk in slow motion is very important. A LOT of problems are avoided by ensuring your motion and proprioception are correct. Exercising in the pool also lowers the “fear threshold” your injured leg will have. It is important you make your leg do the right movements, but you need to do so WITHOUT ANY WEIGHT at first. In fact, you can begin by manipulating your own foot with your hands, very gently before you begin trying to get your leg to do it by itself. Concentrate on getting the movements to be smooth and natural instead of jerky and sporadic. The smoother and more natural the movement, the easier you will be able to use your leg again when it has strength. Strength, of both the tendon and the surrounding muscle tissue, is easily increased once the tendon is FULLY healed, but recall this takes AT LEAST 6 months. So you need to make sure all your movements are correct and working well BEFORE you have the strength to do the movements with your full body weight. This point, the understanding of how important it is to make your leg move in the way it should move when it is healed or when it was normal before the injury, while at the same time understanding that your physical strength and structural strength to do so will not be available until MONTHS later, is probably the single most important point for correct healing of this type of injury.
After exactly 5 months:
This is how long it took me be able to walk like a normal person. Almost to the day, which was also the day I left for Brazil, it was 5 months before I could physically make my body walk in such a way that a bystander would not notice I had been injured.
There are a few corollaries to this though:
1.) I could make it look like I was normal but I could very well feel it wasn’t quite there yet, and I also had to walk slowly.
2.) The pain in my leg/ankle/foot throughout these 5 months was pretty constant. Every step I took was painful. Every day was painful, and the leg still swelled up if I walked for any length of time or was on my feet for more than an hour or so a day. I often was on my feet longer than this but I also massaged (or rather, my superhot girlfriend massaged) my leg every evening to move the fluid back up the leg. I mention the pain, because it was a constant and some people are afraid of this. Pain has never really troubled me in that I only used it as information. More relevant to me was if I felt the leg was “scared” of certain movements. Pain was a constant throughout. Literally every step I took was painful for the first 6 months at least, probably more like 7 months and a half at least actually, but the fact I was feeling pain was not important to me unless the pain was indicative of a warning. Because of my training and my being able to sense my body to a very refined degree, I could easily make this distinction even before the injury, between RELEVANT pain and just painful pain. If you do not know how to do this, then I suggest you really try to learn it over the course of this injury, because it is important. Pain tends to make us flinch and in a Pavlovian way we then stop using our limb as fully as we should. after months, if you don’t use it, you lose it, resulting in restricted movement that is going to be permanent or at least VERY difficult to fix later. So do not let pain stop you from increasing your proprioception. At the same time, do not ignore a fatigued limb, as this is the surest way to re-injure yourself and making this whole shitty situation a lot worse.
If you can keep these two things in mind, then you CAN walk like a human instead of a retarded zombie after only 5 months, but be careful.
You can now start on these activities:
1.) Walk on sand beaches if you can. Sand, sea and swimming is a great combination. I could do this for a couple of months, so it was great. I was walking normally and much better by month 6, and in fact I even took part in some (careful) wrestling with some great Ju-jitsu guys after about 5 and 1/2 months from surgery.
2.) Gentle jogging. Cycling in a gym, and trying to stand on tip-toes (this is still the hardest exercise for me and I did it with my other leg helping a lot to remove some of my body weight).
3.) Stretching. you should have been doing this pretty much throughout, very, very gently, but now you can begin to start doing so a bit more regularly and specifically.
4.) Re-building some of your calf strength, the best way to do this is by walking and even hiking in gentle hills an hour or so a day. I ended up going on a 6 hour hike in the jungles wearing flip-flops, which is absurdly stupid, so don’t do that, but do exercise your leg a bit, and consciously begin to not rely on the other leg for support as much. Begin to re-distribute weight evenly and make the injured leg carry its own load as much as possible without straining the leg.
After 8 months:
I can now run, jog, and walk normally. I still would be a bit scared of a sprain or sudden badly placed foot on odd or broken ground. Obviously this could cause an injury even on a normal leg, but I would be a lot more worried of that now than I used to be in the past.
Hip and knee problems are still niggling at me, but these are also due to my own previous over-exertions and damage from martial arts training of a decade and more ago, so it may not be as pronounced with you, but my left leg (uninjured) took strain and my knee joint is a little “impacted” as a result…BUT…I also moved home 3 times throughout my period of recovery (Once in September 2010, once in October 2010 and Once in January 2011. The lifting and moving of heavy objects in January certainly didn’t help, nor was it smart of me (it was just necessary, unfortunately), so don’t enter any weight-lifting competitions and you should be fine. I was overcompensating on the left leg and put it under too much strain. Despite this, I am recovering very well and although I can’t do full rolls from a run yet, I can roll to the floor from walking or standing without problems. I can also punch, kick and move around without any problems. Squats and duck-walking are painful on the knee/hip and will have to be entered into gradually, but I am not a million miles away from my pre-injured status in terms of ability on the gym floor at training. Once I am completely comfortable again with going to the ground as a result of wrestling, attacks, breakfalls etc. I will then be back to my old self, and I expect this will not take much longer. I also have had to cut back on training for reasons unrelated to the injury, so this obviously had an impact.
For a more detailed and blow-by blow account of the earlier periods with lots of detailed notes on the BEMER systems etc, see the ONLINE DIARY HERE