This the story of how I ruptured my achilles and followed a conservative rather than surgical approach to manage it that resulted in hiking the mountains of China 5 months later.
The path was pretty clear. Two weeks in plaster and on crutches followed by 12 weeks in a moon-boot. And then a progressive strengthening program.
It’s pretty incredible to think through.
When the injury occurred there was 3-4 cm gap between the two ends of the achilles tendon.
The goal for the first 2 weeks of immobility was to allow scar tissue to form in the gap.
This scar tissue would partly draw the two ends back together but also over the next 12 weeks be transformed into the new achilles tendon.
But those two weeks were long.
Every night I would go to bed pretty early after a long and exhausting day of watching netflix. In the morning I would wake up with my sexy plaster on.
I’d roll over and slowly sit up with my legs dangling over the bed. And then I’d wait.
I’d learnt an important lesson the first morning after the injury. One that no one had thought to inform me of.
That first morning, I’d woken up, rolled over, grabbed the crutches, hauled myself up and clumsily started to make for the bathroom.
As I was standing over the bowl (trying to figure out how I was going to undo my pants, balance on my crutches and negotiate a flow of urine that wouldn’t result in me on my hands and knees wiping the floor) it hit me.
A deep pain emanating from my leg through to the pit of my stomach came roaring into my awareness. It caused blotches on my vision and nausea to flutter like a epileptic butterfly in my stomach.
Sweating profusely I sat down on the floor, then lay horizontal and considered my fate between groans. My bathroom looked like a very nice place to spend the rest of my life.
When we lie horizontally the heart and blood vessels don’t have to work very hard to get blood to all of our bits.
When we stand up all the blood drops downwards due to the effect of gravity and the heart and blood vessels get to work to stop the blood from all pooling in our legs.
But, if you have a huge amount of newly form scar tissue that is highly sensitive a flood of blood into the space slowly but surely increases the amount of pressure on the newly forming scar tissue.
This triggers receptors that send messages to the spine and then the brain that set off a warning system
The warning system is pain. And boatloads of it.
And so time progressed.
I got back to work earlier than I probably should have and learnt that swivelly chairs make great lower leg scooters and are far easier to negotiate a room with than crutches.
Some children thought this was the funniest thing they had seen and labelled me the Pirate Osteopath. This made no sense to me.
Once the plaster came off there was the very slow and gradual re introduction to walking, initially with crutches taking some of the weight and then less and less.
The main purpose of the rehabilitation was to put stress on the healing tendon to force it to get used to taking load again.
When I was at work I spent a lot of time clenching my calf. So much so that my calf got pretty buff. The point of it was to pull on the achilles tendon to load it up and make the scar tissue stronger.
And between patients I would read. I’d read journal articles and blog pieces discussing the specificity of achilles rupture rehabilitation as well as the broader concept of tendon rehabilitation.
The Science of Tendon Rehabilitation
As we have discussed above and in previous pieces it is really important to place load on tendons. This makes them heal stronger as well as prepares the tendon to absorb load in the variety of ways that life will throw at it.
For me in the early stages this meant a lot of calf clenching. In the later stages of the 12 weeks of moon booting it meant doing two legged calf raises. Over and over and over and over.
It meant varying the way I was doing the calf raises. Sometimes with my knees bent, sometimes with my knees straight and then later it meant doing it as if I were holding a squat position.
But the disconnect was that a lot of the research indicated the need to make rehabilitation as task specific as possible.
That is, that the exercises performed should mimic actions in life. Thereby preparing the tendon and my body for the things I am going to be doing.
Now personally I have done some weird semi-squat calf raises at weddings and on dance floors after midnight and pretty much never else.
And so after a while I started to think more and more about my rehabilitation and how I could more easily integrate the concept of task specific rehabilitation with tendon specific rehabilitation principles.
I am a walker and a cyclist and a very low level footballer.
And so, with great trepidation, I removed the moonboot and walked to work. And then I walked home. And then I walked around the block.
When walking I was essentially doing a calf raise, over and over and over. And I liked it. It was way better than doing 30 calf raises per day.
With time it got easier. So I walked further.
And then that got easy, my achilles stopped aching so much afterwards and I need to progress myself.
This is where the official stuff started talking about eccentric loading, lowering my heels very slowly off steps.
But I was well and truly bored of this stuff by now. And so I started thinking on how I could incorporate this heel lowering into my walks
You should have seen me walking that day. It would have been one of the weirdest sights to see.
I ‘popped’ my way home from work.
I’d essentially walk on my toes and as my back leg went backwards I would stay on my tip toes until the last bit and then slowly lower my heel, basically bobbing up and down as I walked.
Although to be honest I lasted less than 200m doing it that first day before my legs were fried.
This became the way that I would walk to and from work for the next month. Bobbing and popping at a slow pace through down town North Melbourne.
By December (injury in August) I was walking 15-20km every Monday. The popping I would do at times within the walk but not the whole time as I just couldn’t do it for that long.
But the real test came in January when my partner and I went to China to hike the Tiger Leaping Gorge.
A cliff edge path between a 6400m mountain and 5600m mountain. For 3 days we hiked.
The views were amazing although they were probably a bit ruined by my panting and sweating. The achilles was fine. I ached all over but my achilles was fine.
It is now early February. I bowled in the nets last night for an hour. On Sunday just gone I trained at football training for the first time since the injury.
I was slow, but then I was never fast. I was still too afraid to really jump for the ball.
But I think I’m going to play again. Partly out of pride as I don’t like the idea that my last kick in my last game of football would be the winning point for the opposition. And partly because it is fun.
Moral of the Story?
The body is remarkable. It can recover from a lot of things that you wouldn’t think possible.
The key is to find ways to get yourself to do the stuff that is required. The protocols that exist are great but if they don’t suit you find someone that can help you adapt them to things you like.
Errol St Osteo: Has Massively Nerded Out On This Experience But We Are Looking Forward To Living Normally Once Again