Injury Rehab. question

coupe93 · February 26, 2009

Hello everyone,

I'm fairly new to this forum, and I hope this is the correct page to post this question.

I've recently injured myself playing hockey in the off season in an attempt to try and keep myself in shape for the upcoming golf season. Long story short, I ruptured my right achilles tendon and received the operation to attach the tendon just over two weeks ago. I'm in a soft non weight bearing cast at the moment and have been told to expect to be immobilized for up to six weeks following surgery.

Q. Has anyone on this board experienced this type of injury, and what was the recovery time?

Q If yes to the above, how long was it until you could take a full swing and play golf unaffected?

Any feedback would be appreciated, until then I'll just have to bear with the inactivity and hope for a speedy recovery. Thanks all!

P.S. Reading this forum with interest and learning from others on this forum does relieve some of the angst of not being able to swing. Keep up the good work!

**Ben** · February 27, 2009

Uh-Oh. Sorry to head about this. I just went through an injury last year. Oddly enough I was just reading the old thread I made about my accident. ( That thread ). My injury was broken bones though. Dislocated and fracture my right ankle in three spots. Had surgery as well. As you can read in that thread, I thought I'd screwed myself up good. Well I did, but was only out for nine weeks. I have heard that muscle and tendon injuries take a little longer to heal.

Full swing and play golf unaffected. I played my first tournament at that nine week mark.

Get well soon. I found that books and the Nip/Tuck DVD series helped pass that time stuck in bed.

**uttexas** · February 27, 2009

Yes, I have personally had a similar injury and it ended my competitive athletic career. It is a horrible injury that takes forever to recover from. To this day, if I play basketball or sprint full out for 200 yards or so, it will ache a bit. In fact, I picked up golf in highschool due to this injury (golf was the only sport I could play pain free) PS I did not fully rupture my achilles, and did not require surgery.

The best advice would be to follow the orthopedic surgeons instructions. At follow up, ask the surgeon for a physical therapy order. Surgeons tend to have their own preferences on what exactly they want you to do once weight bearing is allowed.

In general, the first step will be to regain range of motion. some of the most basic exercises would be spelling the alphabet with your foot. Your achilles will ache and feel swollen. I spent every morning before school with my foot in the ice whirlpool, then alternating with the warm pool. This therapy is called contrast bath and is good for chronic, slow healing injuries. Then there are other treatments such as medications, iontophoresis, phonophoresis, and ultrasound. You may or may not get instructions to utilize these options depending on your surgeon's preference. Many therepeutic treatments are debatable. Medicine is both a science and art. Do what your surgeon wants you to do. He is the only person that actually visualized the physical state of your tendon and how well it was repaired. Thus, do what he/she says.

**uttexas** · February 27, 2009

....and I absolutely empathize with you. Most professional athletes that suffer this injury are never quite the same again. Even at "full" recovery your top sprinting speed will be one or two percent less than previous maximum speed. Acceleration is also certainly effected.

The good news is that golf does not put terrible strain on the achilles. Jumping and sprinting sports are the worst for achilles injuries. Most golfers don't do much of that (except for the young Sergio)

My general feeling is that you will be able to play golf by summer. You might still have aches and pains.

Best wishes to you. I will try to find some articles or textbook references for you.

**uttexas** · February 27, 2009

Here is some solid info.
http://emedicine.medscape.com/article/85024-overview

coupe93 · February 27, 2009

Ben,

I'm very happy to hear that you returned to competitive golf and your management of the injury was successful enough to accomplish this. I can only hope I will also be able to return in as short of time as possible to again enjoy the sport that I love! Thanks very much for your response and the kind words, I appreciate it!

Uttexas,

Thanks for attaching the link with your reply. Sorry to hear about the injury and loss in your other athletic interests, that must have been a tough one to swallow. Golf is a sport you can remain competitive in for many year, which I intend to do more of in the future post recovery.
I have read the link you've kindly provided along with other reports in it's entirety and certainly intend to follow the Orthopedic surgeons instructions. I'm fortunate enough to have a physiotherapist made available to me through work, and have already contacted him and spoke about rehab and other options.
I've also seen and read lots of reports on a fairly new rehab protocol which employs early mobilization. The test results and positives for early mobilization post Op trials is quite extensive and is very encouraging. Re-ruptures utilizing this protocol is no higher than the standard immobilization rehab protocol, and also the studies indicate the recovery time to be almost half the time with better range of motion and strength results upon recovery. I'm going to inquire about this protocol through my surgeon to see whether this is an option that would be available to me.

Thank you for responding and providing your testimonial and taking the time to provide this very informative link. I appreciate it very much!

**denver_nuggs_15** · February 27, 2009

My dad ruptured his achilles while doing karate. He needed surgury and had to be in a non-weight bearing cast for about 6 weeks. He says it's still really tight. He also said that doctors have told him that it will never be 100% healthy again (mainly because he's an old guy). If you are younger, you can probably overcome it and make it better again.

It really didn't affect his golf game at all. He was afraid to walk a couple courses at first, but that's not the case anymore. His calf also got really small from not using it for weeks. You'll probably need to work out your calf and leg for a while to get back to where you were before.

He did physical therapy for a while until he felt that he didn't need it anymore. If you stretch the calf, your achilles should get looser. Also, you could stretch your ham strings.

Best of luck and let us know how it all turns out.

coupe93 · February 28, 2009

denver_nuggs_15

Thanks for the information/reply. Glad to hear your dads golf game didn't suffer over the long haul. I've been told the same, in regards to 6 weeks in a non-weight bearing cast, however I see the surgeon in a few days and my intension is to request some sort of early mobility protocol in the form of a removable walking cast and physio.

Being 45 years old my recovery probably won't be as responsive or as quick as if I were in my 20s or 30s, but I've alway tried to maintain a good level of physical fitness, with this I'm hoping it will pay off in the end with better rehab results.

I'll absolutely info this post with any further developments or info. I don't wish for anyone to have to go through this type of injury, however the sharing of any info could be useful in the future to anyone suffering any type of injury. Thanks for the reply and info.

**Jeepthrills** · March 1, 2009

I worked in the fitness and physical therapy field for the past 15 years and I now teach Sports Medicine. Although your injury is one of the more severe ones in sports, a full recovery is very possible. I agree 100% with the people that said follow your doctors instructions to the letter. If you were a football or basketball player, you would be looking at up to 1 year, but with golf you should be fine by late Spring. One mistake a lot of people make is they stop their rehab when they are feeling "pretty" good. Stick with it to the end. I would suggest looking into a workout that will help strengthen the lower legs and ankles as well. Make sure you include stretching. One of the side effects of an achillies tear is the build up of scar tissue in the area. This can reduce range of motion. Believe it or not, but a complete tear can actually be better than a severe partial tear. With a complete tear they can reatach it to allow for the best recovery. Good luck. Keep us updated with your progress.

coupe93 · March 2, 2009

Thanks for the reply, I certainly appreciate your professional advice. I do absolutely intent on following my surgeons instructions and plan on completing any physio implemented to assist in the recovery. I guess I'm fortunate in a sense that my injury was a complete rupture of the tendon and did require the tendon to be sutured back together. I see the surgeon tomorrow for the first time post Op (almost three weeks post surgery) and hope to gain a bit of mobility perhaps in the form of a walking cast if I'm lucky. The leg feels better as every day passes and doesn't require being elevated as often as earlier. I really can't wait to get rid of these crutches, my house has three separate flights of stairs and the simplest tasks are not so simple any more (I thank the heavens I have a loving wife who assists me greatly). I suppose another positive is the really good daily upper body workout I'm receiving climbing these stairs 3-4 times daily haha.

Again, thanks for your professional advice and I will certainly post updates as I progress.

coupe93 · March 4, 2009

Went to see the surgeon yesterday for the first time in almost three weeks since the operation. I'm now in a walking air cast but have also been instructed NOT to do any weight bearing what so ever! His instructions and rehad schedule are as follows;

week 06- some weight bearing (partial w/ walking cast) start physio but only light manipulation only.

week 09- weight bearing, continue physio to include some light resistance training.
week 12- full weight bearing, physio w/ strength training.

**uttexas** · March 4, 2009

pretty much textbook on that protocol.

**Ben** · March 5, 2009

Yeah, that sounds right along the lines of what I went through. Although mine was a bit faster timeline. I'd never been in crutches before so that took some getting used to. You had any prior experience with them? I remember getting up and down stairs the first few times was a bit odd.

coupe93 · March 6, 2009

Yes this is pretty much text book, the surgeon explained that he's a little conservative in his treatment and rehab for this kind of injury. He also explained that his concern is my size being larger than average along with early weight bearing this soon in the recovery process didn't bode well with him. I can certainly understand this and will have to move around for another three weeks or so with crutches and no weight bearing.

Yes, I've had prior experience with crutches, 12 years ago I injured my left leg and was on crutches for just over one month as well. The stairs are difficult but I am getting somewhat use to them, I'm making my way around the house (stair climbing) fairly well now.

Next appointment 26 Mar 09, possibly assisted (walking cast) weight bearing by then if all goes well.

Thanks all!

coupe93 · March 29, 2009

Update,

I've seen the surgeon again for the week 6 follow-up and the rehab is progressing well beyond what was expected at this stage. I'm now full weight bearing with the air cast and can now start physio.
The physio order is for strength training and ROM of the ankle with a possibility of within two weeks full weight bearing without the assistance of the air cast.
The tendon feels strong and is now virtually pain free. My ROM compared to the good leg is at about 80% in my best estimate, however the strength in the calve is still weak, which is to be expected given the 6 weeks without any usage.
I've been able to move the ankle and exercise the calve muscle within it limits since around week 3 post surgery. This alone IMO has paid great dividends toward the positive progression so far. I feel that full weight bearing without any assistance within 2 weeks should be easily attained.
I'm truly looking forward to strength training and physio, and hopefully the recovery process will continue to progress as well as I feel it has so far!

**Ben** · March 30, 2009

Wow, its been 6 weeks already? I'm sure it's felt like an eternity to you though...

I remember when I first got my cast off, I was SO scared to move my ankle at all, even an inch. It was a really odd feeling. Neat, in a weird way. But like you say, I was moving around on mine probably faster than I should have been, but honestly think it was good for it.

The atrophy in the calve is normal, as you know by now. But, the calve on my injured leg feels even stronger than the calve on my other.

coupe93 · April 4, 2009

Week 7 completed:

Started physio which included ultra sound, massages of the scar and calf muscle, stretching and some light resistance training. I'm now walking in air cast without any pain and my range of motion is just about back to normal in comparison to the good leg, I'd say about 90%.

The physiotherapist and surgeon both agreed to allow full weight bearing without the air cast by mid next week (week 8). I continue to exercise the leg while sitting by performing seated calf extensions while watching TV, as well as standing calf raises in the shower each morning while preparing for work, and 3-4 times throughout the day with assistance from the good leg. The calf is still weak in comparison to the good leg which is to be expected.

On a good note, I golfed my first 18 this past Thursday while wearing the air cast. I've been to the range and chipping and putting green numerous time prior, and was ready to swing the clubs. Driving the ball was awkward while wearing the cast, so I took it nice and easy and utilized my 3 wood often. On this very easy course I managed to shoot 1 over for 18, and was very excited to be able to swing. I can't wait for the weather to settle and to go out without the cast!

coupe93 · April 10, 2009

Week 8

The cast is off and I'm walking without assistance of any kind! I'm extremely excited about the progress, some days are better than others in regards to how much you can push the rehad, but with age I've learned to listen to my body and when it tells me to backing off, I know!

The ankle is still a little weak and I'm still walking with a bit of a limp. The longer I'm on my feet, the more pronounced the limp gets. Progress in rehad is getting harder to attain, earlier in the rehad you could guage progress almost daily but now it's like trying to surpass plateau's.

It's probably a good thing that the weather hasn't cooperated this long-weekend, because I really want to get out and golf. I'll be riding a cart for a little bit yet, and the ankle really isn't strong enough to play without any try of assistance. I will be wearing a brace on the ankle and swinging contained until I feel I can walk and the ankle is strong enough.

To all, enjoy the Easter Weekend, and thanks.

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