The op went well and I had quite a good chat with Mr McDermott while he worked on stitching me back together. I opted for the spinal block over the general anesthetic due to the promise that I'd feel less ill during recovery (if only I'd known). I was kept in over night, and almost suffered another night in a hot hospital. It took a lot of begging to be allowed out last night and I had to promise them that I felt fine (I felt rough but just wanted to be home). My usual ravenous appetite was a distant memory and I could barely focus on a plate never mind actually stomach eating anything. As a kid my mum always gave me Indian Brandy (not actually alcohol) if I complained of nausea. She always knew when I was sick because I'd ask for this foul tasting concoction. Jen managed to find some last night and it worked its magic and rid me of the dizziness and nausea.
The Achilles tendon runs from the calf muscles (gastrocnemius and soleus) at the back of the lower leg and inserts in at the back of the heel. So my lower leg is completely immobilized. Even tensing my upper body to use my crutches hurts my wound (great evidence of fascia planes in the body). A few people have been surprised that I chose the operation route given my usual stance on allowing the body to heal on its own. Without the operation I would have a 12 month period before I could use it competitively again, even then it may not hold so it really did need doing.
Its now time to start rehabilitating myself. Remember you should always follow the guidance of your specialist that is treating you.
- The aim of my rehabilitation is to allow the tendon to heal by reducing pain and inflammation.
- Restore the flexibility and strength of the tendon and muscles in the surrounding area (I had lot considerable flexibility in the weeks prior to the injury and had been frantically attempting to work on keeping it flexible).
- To be able to return to normal activity and competition levels.
- Remaining positive - Everybody is expecting me to be down after such an injury. I must admit I'm absolutely gutted. Initially I think my knowledge was a bad thing because from the very second it happened I knew how much time it would take. Compared to most people though I'm incredibly lucky, not only have I studied anatomy and physiology in depth and at a higher level than most (remember I argued about it with a professor at Notts University), but I'm well aware of what my body is feeling and doing. I also have great friends that are also fellow health practitioners. A few days ago this network paid of when Tina reminded me that CHEK faculty Robert Yang was recovering for a detached Achilles when I studied CHEK exercise coach in Manhattan with him. A quick message to Robert and I was able to use the previous experience of a very talented practitioner. Robert backed up my own ideas such as increasing my protein consumption post surgery (I will also be making use of my Gelatin supplement) to increase the amino acids available to repair the damage. He also suggested taking high doses of glutamine due to the trauma of surgery, and zinc (will be doing a zinc challenge test to determine the required amount), and that boswellia, curcumin and enzymes will help the inflammation.
- More importantly I'm aiming to get working on the scar as soon as I can get to it. Robert backed me up on this one and suggested that being able to remove the boot (need one fitting asap) and use light touch will greatly aide recovery. I intend to use cranio-sacral techniques on the scar tissue and any other techniques which Jen's dad may do for me.
Week 8 onwards
Increasing ROM (range of motion) and flexibility.
- No strengthening will take place until full ROM is achieved (hugely important).
- Sports massage (and neuromuscular work) will help the the fibres form in the new tendon growth.
- Stretching (active) such as pulling the foot upwards to stretch the tendon. Be very careful and take things slowly.
- Passive stretching can only happen once active stretching produces no pain (do not risk it by pushing this phase).
- Strengthening can begin lightly (bands etc) once full ROM is regained.
- Propreceptive and balance training should be used in order to allow the tendon to regain its ability to react to the subtle positional changes it needs to make whilst walking on unstable, uneven surfaces (could do with a little more time walking on the beach in Oahu).
Strengthen the achilles tendon.
- Be careful when beginning the strengthening phase as its easy to re-rupture the tendon. The best indicator of ability is pain. A little pain is ok but you should not suffer and put up with a great deal of pain. Work up to the point at which you start to feel resistance and no further.
- Do not increase the intensity until you can complete your current level pain free (both during the exercise and after). This is not the time to get macho about exercise progression.
- Most protocols recommend at least a month post surgery before commencing any rehab program, although some professionals are now switching to 10 days. Follow the advice your given directly. Even with my knowledge, if my specialist wants me fully immobilized for 8 weeks I'll do it. He fixed it and I don't want to incur his wrath by being back for a second go.
As with any strengthening exercises, warm the muscles up. Gentle mobilization or even heat applied directly to the tendon with a hot water bottle will help. Avoid over training (as I always recommend) and make sure you work on flexibility. Never give up on your flexibility, you messed up once, do not slip up again.