21st Nov 2014 – Running to standstill

So it’s over 7 months since my operation and the surgeon’s prediction that I would be back to normal by now isn’t holding through. Frankly, I’m a long way being back to normal and it’s kind of frustrating as I think I’ve followed all the advice I’ve been given and fairly well struck to the physio exercised I was given.

Anyway, I continued to run throughout September as per the physio’s advice and I gradually built up the distance. I was back into see the physio in the hospital, a new physio again and she identified a weakness at the very start of the lift off. She gave me some exercises to focus on this and also encouraged me to continue running. I was also discharged as I had run my course in the hospital as I was functionally back to normal as far as they were concerned.

So I continued running, 3 times a week and building up on one of the runs to 8km. However, I seemed to be getting slower and slower and more laboured over time. Also, my Achilles seemed stiff all the time. So I persevered for a while but it didn’t feel right at the time and in retrospect nearly everything was wrong. So I went back to my own physio and brought him up to speed on what I had been doing and how it didn’t feel right. He had a good luck at me doing heel raises and jogging on the spot. He immediately gave me a fairly good synopsis of my situation which rang true with me. Basically, I haven’t yet developed enough strength to be able to run properly. The bio-mechanics of correct running require your Achilles to act like a spring so that you exert pressure to a certain point and then it springs back. So I wasn’t doing this at all and when I was running I wasn’t really using my feet or Achilles at all but instead driving from my quad with a flat footed motion.

This all made sense to me and although it was going to take a bit or maybe a lot longer it meant that at least I’d be able to get it right. So I’m not to do any more running. I’m skipping every morning which aims to try and activate the Achilles and get it working like a spring. I’m also using the Tera-band doing toe extensions – something I was doing back in April.

I’m also doing run walks – one minute run and one minute walk. The aim in this is to run with really good form with good spring for a short period and hopefully over time build it up. At the moment, it feels a tiny bit better every time I do a run/walk or skipping – mostly it starts off firmly stiff and then frees up a bit. Then about once a week it feels really good and much better. I’ve been doing it first thing in the morning and it never feels good at that time.  

Everything else is going well – my swimming feels fairly good and I’m getting 2 swims a week in. I’m getting out for one long cycle a week and one indoor session.

I feel reasonably fit but it’s very hard to get really fit without running.

I got an email about Ironman 70.3 in Dublin in August saying that I can register on Monday. Would love to do it but no guarantee that I’m going to be able to at this stage but something to aim for (as long as it doesn’t sell out).    

12th Sept 2014 - 24 Weeks Post Op and I’m still not close

Its 5 or 6 weeks since my last post and that’s mainly down to other stuff that’s been happening (changing job and holiday) and an absence of any step progress in my recovery. Just after my last post, I did a 110km sportive (Tour de Kilkenny) which was a good test of my cycling. It was a lashing rain all through and it was fairly hilly but I did it in a little over 4 hours so I was fairly happy enough with that. I was then on holiday for a week and did a good bit of walking and had a good bit of time on the sand so plenty of opportunity to balance on one foot on the soft sand.

I’m kind of sick of physio at this stage but I’m still doing it. However, the single leg heel raises don’t seem to be improving no matter what I do. My balancing is reasonably good and everything else seems fine – so its just lacking strength.

So I was back to the physio about 3 weeks ago and he had a good look at it and my heel raises and balancing. He got me walking on my tip toes (which was hard) and on my heels (which was easy). He then got me up on the treadmill and started me jogging. It felt sore when running but the gait felt ok and it didn’t feel like I was dropping a lot on my bad foot. He told me to continue to jog and to build up the time slowly i.e. 1 min extra each session.

I have been doing this and it always hurts starting out and feels really awkward and then over time it starts to feel better and smoother. I tried to run first thing in the morning a few weeks back and I just couldn’t – I ended up running 20m then walking then running another 20m then walking again and then just giving up as it was too sore. So it needs to get limbered up before I can run and this takes time. If I cycle before I run then it feels much better.

The weekend before last there was a mini triathlon to celebrate my clubs 10^th anniversary (Go Trilogy). I was running 10min the week running up to it and the run was only 3km so I decided to go for it. Had a good swim and bike and I was able to run fairly solidly albeit slowly for the full 3km. I felt fine afterward but the ankle was swollen. Racing this year was something I hadn't expected to be doing so was delighted to get back into it and really enjoyed the cycle part where I was able to race properly (albeit slower than normal).

I had a sports massage last Friday (Hi Claire!) just on my Achilles and calf trying to break down the remaining scar tissue. I felt great the next day and I went for a run the following evening and it felt super.

I’m not back to the physio for another 3 weeks and I’m not sure how much more he’s going to give me. I’m going to get a sports massage every couple of weeks to try to get it back to normal and continue to run every second night to try to build up strength. Still a good bit to go!

Back in action with a slow jog

Slowly getting back to Normal

Thurs 31 August
Its about 4 weeks since my last blog and time for a next installment.
I have continued to do my physio exercises - single heel raises - I can do ten of these with one hand on a table or chair in front of me. I have been trying to reduce the weight on my hand and just use my foot to lift and lower all my weight. This has not been easy and 4 weeks on I'm still only seeing very small incremental increases in strength and I still cannot do a heel raise without using my hand for support. Double heel raises - I'm able to do 50 or 60 of these without problem. Stretches are going fine and I've good range of movement. Doing a few balancing exercises now to try and strengthen the side mussels. These involve standing on bad leg with eyes clothes, standing on cushion, standing on uneven surface etc.
I have also been massaging the tendon which is starting to resemble a normal shape again. Before it was a rounded shape and it hurt when you pushed it, now its more like the other tendon. There is one really sore spot in the middle. I do have a problem with walking as I still have a slight limp. Basically as I raise my hell and roll onto my toes I feel a very slight pinch on the tendon which I think equates to the tender spot in the centre. I think this is causing the limp. I have broken into a jog a couple of times (running for Luas/train) and it felt OK. Not super by any stretch but not really painful either.
I have been swimming fairly consistently and feel some fitness and form coming back. I also have been cycling three times a week which is a lot for me. I feel some stamina coming back but I'm still a long way off on strength and I really struggle on any kind of decent hill.
I was back in at the physio this morning and he wants me to continue with the exercises and to do more balance work. He wants to give me another two weeks before coming back to try running on the treadmill. 

Week 13 - Back in action

30^th June 2014 – 13 weeks post-surgery

Over a month since my last post and the good weather coupled with my increasing activity being the main cause for the gap. After I saw the physio at the end of May. I had a big event (TriAthy) which I was pretty involved in (I was chief marshal) which meant I was on my feet for a long day and had to do a lot of walking. The ankle got increasingly swelled through the day and by the end of the day it was pretty swollen and sore. The next day it was still swollen and sore and it was only 3 or 4 days later that it was back to normal and I could start back on the physio properly. Lesson learned was that just walking and standing for a long day put a lot of strain on it.

Anyway, after I recovered, I was able to crack on with the physio double heal raises and single heal raises supported. I was also doing step ups and step downs. I was back in to see the physio on the 11^th of June and she was happy with progress. She continued to get into the calf and try and get the knots out of the muscles and also break down the scar tissue on the wound itself. Only one new exercise – balance on the bad leg.

We then had a week in France on a family holiday which was fine. Went down the water slide a few times with the kids which I don’t think was great for the injury. However, had plenty of time to do the physio exercises and I was on my feet much more than I would have been than if I had been working. Overall, it felt good all week and it didn't swell or feel sore despite the increased activity. We arrived back from holidays on Saturday and I went for a decent cycle on Sunday (1 hr 40).  

Last week was a busy week. Physio on Mon and Consultant on Thurs. However, when I headed off to work on Monday morning I felt a lot stiffer and sore. I think this was partly due to be being back in work shoes after being in cross trainers all week on holidays and partly due to a busy Sunday including the cycle. Anyway the physio picked up on this and wasn't happy. She did notice that after massaging the calf and wound site that it freed up a god bit and she thinks I’m tensing the tendon too much when I’m not using it. Anyway, I was given the same exercises and we would see what the consultant would say on Thursday.

In to see the consultant on Thursday morning, he was really happy with my progress. He said that normally you wouldn't be doing single heal raises until 16 weeks so I was 3 or 4 weeks ahead of where I should be. He stressed though that it wasn't a race and I still needed time for the strength to come back. He gave me the green light to cycle away as much as I can and said that I could start to jog in 6 to 8 weeks’ time but said that I wouldn't be able to go fast or change pace until about 3 months. He also said I didn't need to see him again until I get called for day surgery to have the plate and screws removed from the previous break which will probably be later this year.

Activity wise I have continued to swim 2 or 3 times a week and have been building up my cycling from 1 hr to 1hr 40. I notice with swimming that I’m quite slow and out of shape and I think that’s as a result of my overall fitness being poor and not doing enough swimming to bring this up (I’d normally do this through running and cycling). I’m also find the cycles really hard with no speed or stamina so I think I just need to stay plugging away. It’s pretty frustrating having to start from such a low base again.

Yesterday, was Ironman Austria – the race I was planning to do and was training for when I did the injury so it was a poignant weekend for me.  However, It was my triathlon Club (Trilogy)’s weekend away in Kilkee for Hell of The West Triathlon. I was planning to go anyway for weekend but a swim relay spot became free during the week and I decided I’d have a go. I really enjoyed the swim, it was calm, sunny and the water crystal clear. I felt tired on the swim because my swimming isn’t up to scratch but arrived back on the beach in 25 mins and was happy with that. 50 people must have run past me as I walked up the beach including a few people I thought would have been much faster than me. Anyway, very happy to be back participating just 13 weeks post-surgery. Thanks to the Kenco Angels for having me in their team and all the trilogy crew for a great weekend. Now to get my swimming and cycling back into shape!

Team Kenco Angels

Saw this in Aldi last week and thought it would have
been prefect for me immediately post surgery when
I had to keep my leg elevated. Please note these are
not my legs!!

Week 9 Post Op - back on the bike

22nd May 2014

Approximately 3 weeks since my last post when the boot came off and I started on physio exercises. I spent a couple of days weaning myself off the boot. One of them involved a day in Dublin watching the Giro D’Italia and so involved a lot of walking and standing so I was glad I wore the boot that day. Since then I’ve been bootless and walking in thick heeled shoes or runners with a heal raise insert on my bad side. The first few days I was walking very delicately and wasn’t really engaging the tendon in my gait. However, I have been doing the 3 physio exercises strictly and can really feel an improvement in strength when doing the exercises. I also found my walking has got more normal however I’m still not walking with a limp and if I don’t concentrate I tend to walk flat footed and not engage the tendon.

I have been able to swim and have swam every 2 or 3 days. It’s a big relief to be able to do some exercise after nearly two months of inactivity. The first swim session I felt really slow and weighed down – it was like I was wearing a big woolly jumpsuit in the water. The second session felt much better at the start but I got tired pretty quickly. The last few sessions I feel like I’m getting back to a normal. I still can’t kick off from the wall.

I’ve also been able to cycle on a static bike. I put my road bike on the turbo trainer and have taken off the cleat pedals and put on a pair of flat pedals. Again, this felt sore at the start but has started to feel a bit better. I have increased the time on this up to 40 mins. I have tried to stand up as if I’m climbing and I can handle the pressure of being on my toes but my ankle does get sore fairly quickly. So based on this I don’t think I can take the bike out of the garage for a few more weeks. This is the hard part especially when the weather is good.

I was back in to see the physio last Week morning and she was pleased with the increase in strength and flexibility (I haven’t been doing any stretching so this was a surprise). She messaged my calf muscle which was very painful at the time but has felt much better since. Also, she massaged a bit of the scar tissue either side of the surgery site. There is a lot more to do here as my tendon is really fat and hard along the scar compared to the narrow tendon on the other side. I have to continue with the band strengthening exercises on a green band now and introduced some shallow squats and increase the pressure on the heal raises. I have to go back in a weeks time.

Overall, at 8 weeks post surgery I’m very happy with progress. From a lifestyle perspective I’ve been able to function normally since about 2 weeks post op and start to exercise at 6 weeks. When I compare my recovery to some of the others I see then my progress does seem good. If you look at this guy who is only getting his cast off at 8 weeks and starting to weight bear now then I’m streets ahead

http://achillesblog.com/hoss/category/8th-week-post-surgery/

Update 29^th May

Things have continued in the same vain. I’m still doing strengthening exercises 3 times a day and I can feel the tendon very slowly getting stronger. I have been doing 35 or 40 mins on the turbo trainer every second night and swimming 2 or 3 times a week. Then last night, it was really sunny and warm so I said I’d try go for a spin on the bike. I did 40mins and it felt fine, well the ankle felt fine but I ran out of puff after about 10 mins. Just shows how quickly your fitness goes. My ankle is a little bit sore this morning so I’ll have to build back up slowly.

Back in with the physio this morning and I’m onto double heal raises and single heal raises whilst supporting myself with my hands on a bench or back of a chair. She has started to massage the Achilles itself trying to break down some of the scar tissue – theres a long way to go and a lot of scar tissue to break down. 

This is the bad leg - you can still see the
scars from the bike crash but the operation
scare has almost disappeared

This is the good leg obviously but is a
good contrast because you can see the
width that the Achilles should be and the
rest on the bad leg is scar tissue.

Week 6 Post Op

9^th May 2015

So it’s been nearly three weeks since my last post. There was not much happening for the first two weeks. I became increasingly mobile and could walk further and further on the boot. Generally, swelling has stopped and I don’t need to elevate my leg anymore. If I went on a long walk or was doing a good bit of gardening then my leg would get sore but this was more in the sole of my foot and I would need to rest for 10 or 15 mins after this.

There was very little that I could not do in terms of day to day activity, I could cook, pick up and walk with the kids, get around nearly everywhere on foot, etc. I even tried driving a few times with the boot on but decided it was a bit too clunky to take the car out on the road. I have been doing the resistant band weights every other day which has kept me some way active outside of the walking.

Then the last week has been a bit different. The consultant had told me to take off my boot occasionally when I’m sitting at my desk and do some exercises with my foot. These involved pushing my foot up with my toe to start very gently activating the tendon. So I did this for two weeks and then in the last week I progressed this further to putting on a runner and walking up and back really slowly in the office. I knew that they were going to let me take the boot of this week anyway so I didn’t see the harm in taking it off early and starting to walk.

I was back in at the clinic yesterday and the consultant seemed happy enough with progress. The wound has nearly healed up completely so I no longer need to dress it. I can take the boot off and walk in runners with a good heal and a heal raise inserted. The best news is that I can drive, swim (provided I can get into and out of the pool safely) and I can cycle on a static bike with flat pedals. All of which is great and better than I was expecting this early.

The real danger now is the risk of re-rupture – most people re-rupture between 6 and 12 weeks. The tendon has approx. 25% of its strength at the moment (although it feels much more to me) and this will build to 50% by 12 weeks. So I need to be really careful on stairs and uneven ground and to make sure that the tendon is not accidentally extended or I will be back to square one. The consultant also advised me to take the screw and plate from the break two years ago out – he said they don’t serve any purpose and so they booked me in to get those removed in Oct/Nov.

I saw a physio briefly yesterday at the clinic but I had to go back and see her earlier today in the physio department. She measure the degree of dorsi-flex (when I pull my toe towards me). Its 90 degrees on my bad foot and 84 degrees on my good foot. The initial aim is not to stretch the tendon any more as it needs to strengthen first. We will work on evening the stretch after the 12 week stage. She gave me 3 strengthening exercises; rubber band dorsi-flex; rubber band plantar-flex and then a supported heal raise). She also showed me how to massage my calf and try to loosen up the tension in that.

My aim over the next couple of weeks is to try do the physio exercises 3 or 4 times a day and also to focus on my walking gait and try to get walking without a limp. 

Calves at 5 weeks - I was expecting my right calf
to be much smaller 

Week 3 Post Op

Week 3 Post Op 21/04/14

I have now pretty much dispensed with the crutches as I’m able to walk around in the boot without any hassle. The screws in my ankle didn't give me any other bother and I seem to be recovering fairly well. I did catch the worse dose of flu I think I've ever had so spent 3 days or so in bed with that and still kind of suffering a bit. I went back to work last Monday, mainly working from home for the next few weeks and the leg held up fairly well. It didn't swell up too much but I was still pretty tired at the end of the day – I am able to elevate it especially when I’m on conference calls so I’m sure that helped.

On Thursday, I went back into the hospital. They took off the Unna boot dressing and put on a new simple rectangle dressing. The wound looks really good and has basically healed - see picture below. I can now shower and get the wound wet without any problems. I have another three week with the boot on and then I’ll be moved into shoes with heal raises in them – that’s at the 6 weeks stage. From 6 until 12 weeks is when most people re-rupture (usually from doing something relatively stupid according to my consultant) so I will need to take care then.

He said I can do most things with the boot on so I have been able to do practical things around the house like cooking, clearing up, putting the kids to  bed etc. so that’s not bad at 3 weeks. I've

even made a start on the garden and have been able to do manage some digging and mowing.

I’m still doing the weights with the resistant bands but hope to be able to make it to the gym next week and do some proper weights. Its another 3 weeks before I go back into the hospital so I don’t expect much to change in that time and getting the boot off then will be the next big milestone.