Ruptured achilles tendon - getting back up

[Tricky Dog]

So here's the news:

While out fighting, I put a foot down to brace myself (perfectly positioned) and felt a Pop!  as my achilles tendon ruptured completely.  I knew what it was despite having never experienced it before.  The first few minutes were spent living the next six months of my life in anticipation, howling in mental anguish the whole time.

I'm past that.  I have had the surgery to re-attach the tendon and I'm in a partial cast with crutches.  I dropped the painkillers within 24 hours and I have been plying myself with
  i) rest, elevation, and more rest
 ii) Vitamin C, B complex, MSM, protein, Omega-3, anti-oxidants (including now alpha lipoic acid, flax seed oil, and salmon oil), and chondroitin/glucosamine sulphates
iii) reduced my caffeine intake (that's hard)
 
I've also been looking into the various rehabilition protocols and trying to find the most reasonable, performance-oriented protocol (translates as "aggressive") I can.

I'm looking for your input.  Supplements to take.  Rehab protocols.  Words of wisdom.  Anything useful.

But no kind words of sympathy, OK?  A downed fighter is a fighter who is getting up....  

For anyone interested in the wheres and whyfores, I was actually fighting SCA (i.e. in armour against sword and shield), not DB/kali, at the time.  I've been steadily training in SCA, starting out with 10 lb shield (or "heater" as its called) and 36" sword, and moving over to double sword (or Florentine).  Why?  'Cause DB doesn't dress up in funny costumes, call each other Laird/m'Lady, and bow/curtsey before hitting each other really hard (otherwise known as "heavy death" fighting).  I kind of like that sort of thing myself - and of course I can bring the kids and wife along and they have fun too 'cause there's lots of stuff going on.  Every weekend is like a cross between a two day country miedeval fair and a drunken brawl.

I'm adapting Krabi Krabong to Florentine - it ain't easy - and don't think kali/KK doesn't have something to learn when there's a shield and armour involved.  Open field, unarmoured fighting may be best done with DB/kali but that ain't the whole picture.  Try this SCA stuff out and you too shall relive the humility of being a newbie.  And despite the armour, THEY HIT REALLY HARD.  And despite the rules, the best fighters try to reduce their armour to the minimum.

So anyways, I had stretched my achilles (which I almost never do since I have a very fine natural stretch) for some reason.  And been warming up and fighting for over an hour.  And I was just going to get a few extra fights in.  I stepped forward (double sword) to engage, drew a shot from a newbie fighting sword/shield and stepped back quickly out of range, intending to load my achilles/calf, and spring back in for a sinawali-like flurry.

Pop!  I thought someone had hit me in the back of the leg because they were too close.  No pain.  Just that feeling of something popping.  Whirling around, I saw no one, realized immediately what it was, and collapsed to the ground.  Still no pain.

I took some time, screamed at my disfavour in the eyes of Destiny, removed my armour, and felt the achilles.  It was still there, for about 5 cm, and then there was a slightly sickening soft spot where it should have been tight.  And then the muscle.  Ruptured.  Completely.  Still no pain.

So I'm happy there was no pain.  And even the operation was relatively low impact.  And I'm on my way back.  And I have a long way to go before I can face down the likes of Lonely Dog.

Crafty has lived this down before (his knee in any case) and come back.  And so I will too.  Your experiences are appreciated.

[Crafty_Dog]

Woof My Friend:

  Most important is that you have your mind right.  There is no more important piece to this challenge.  

  One specific suggestion I would emphasize is to focus on walking with a natural stride as much as and as soon as possible.  This IMHO is VERY important.  Avoid weird gates even if they enable you to go faster.  Walk as slowly as you need to in order to walk with an even stride.    Uneven strides will have fugly consequences for the alignment of your whole body.  

Also this is a very good time to really focus on your core/waist strength-- not only as a way to be productive with this time, but also as a preventive measure against postural alignment problems due to your unavoidably unnatural stride in the near term.  Also a good time to work grip and neck.

Also, walk barefoot on soft earth and/or sand when given clearance by your doctor.

Woof,
Crafty Dog

[Anonymous]

at this time, you should be doing a million and one calf raises to get back the lost semetry.

then start bunny hopping around.  but, most of all stretch, stretch, stretch those tendons!!!

[William Woofter.]

Useful forum an Achilles tendon ruptures-

http://www.marfell.me.uk/forum/viewtopic.php?t=53

[trickydog]

Well - as if the first time wasn't enough.....

January 31st (2010) and I popped the left Achilles.  Pretty much the same move - this time without armor on.  Knife sparring and moving very fast against an agile opponent (speedy Edwin Tam who likes his knives just fine).  And that just after having lectured my students on safety.

Nothing I would have changed - just leaping back out of the way.  And POP!

I had done this before so I knew what it was all over again.  And this time, I was really unhappy about it.  I had so many things lined up for the coming months - fire sword performances at the Winter Olympics, the Spring Tribal Gathering, into the second week of an 8 week mini-course on Harimau pencak silat.... I was seriously unhappy.

But - thanks to the benefits of a robust public health system (this is Canada we're talking about here), I was examined and in a hospital bed within 2 hours.  And I would have had surgery that afternoon if I hadn't stopped to each lunch before going to Emergency.  So I went in the next day - same reconstructive surgery (different surgeon though).  Back home.  Leg elevated, off painkillers in 24 hours again (this time they threw Oxycodone at me - what?!?!).  And back up that same damned mountain.

Here it is mid-May and I'm just out of the air cast again.  I made a point of training hard all through this period - I even finished the Harimau mini-course after delaying it for 3 weeks.  Kept my tone and now I've got another 6 months of stretching, strengthening, and getting back to where I was again.

So - what did I learn this time?

Well a few new things came up on this go'round - something some of you might want to consider:

First - "platelet rich plasma" treatments - too late for me to consider - but apparently there is a new treatment for tendon ruptures and the like which is being used by professional athletes.  Basically (pardon me if I don't get this exactly right), your own blood is drawn and then using a centrifuge the platelets are extracted along with the plasma.  Then the "platelet rich plasma" (PRP) is injected directly into the damaged site.

The results is analogically like using stem cells - recovery is accelerated dramatically by the presence of the necessary components and the benefits continue for some time after the initial injection.  The benefits are felt almost immediately (within 24 hours) and only one or two injections are needed.  Typical cost is around $500-700 per injection.  And no invasive surgery is required.

Sounds almost too good to be true - well, it certainly isn't available in Canada yet.  And it wouldn't have helped me probably with a full rupture.  But something to consider if you are faced with something similar - ask your doctor.

Second - after regularly I bombarding my surgeon with questions about using various regeneration techniques like pulsed electromagnetic stimulation (apparently not particularly effective), he gave me some thing to think about.  Not a recover but rather a possible explanation for why Achilles tend to rupture - and often affecting the other tendon within 2 years of the initial rupture in a significant percentage of cases.

He pointed at speculation that the calf muscle may be "late firing" under certain conditions.  That is, when stepping back, the calf muscle decelerates the body through the leg by applying force along the Achilles tendon as the ball of the foot makes contact and the heel starts to descend.  This deceleration normally takes place over the distance of about 3-4 inches in a fraction of a second.

Consider what would happen if the calf muscle was not activated early enough - the heel and body would be in free-fall until the muscle finally began its contraction (assuming the heel hasn't hit the ground yet).  Then, the muscle has to decelerate the body over a much shorter distance to bring the body to a halt.  Suddenly the forces required can be double, treble or quadruple normal - the stress upon the Achilles which anchors the calf spikes dramatically.  And if certain things happen to be true (such the presence of irritation due to tendonitis, or poorly designed shoes, or an unexpected unevenness in the terrain), a late firing can result in a rupture.

This late firing may be a product of age or nutrition or other aspect of health.  And it may be a rare but inevitable consequence of how the body's neurological system is constructed and operates - I'm not doctor myself so I can hardly comment.  But the prospects are a bit scary - if true (and that's a big IF), then it is ticking time bomb for a lot of us.  It only takes a tendency to late firing to conjunct with the right circumstances and POP! - you're living unhappiness like me.

More importantly, the big question is:  What does cause "late firing"?  And are there any ways to mitigate the possibility of injury?  Shoe design?  Nutrition?  Behavioral changes? 

It at least explains how someone stepping off a curb (as opposed to sparring or playing racquetball) can just as easily rupture the Achilles.  But it doesn't make me feel any better.


And now I start to wonder - even though I have now ruptured both tendons, and they seem thicker and more substantial than before the injuries (although my calf muscle is probably 70% of original strength), am I in any danger of re-rupturing either?  And is there anything I might want to avoid or consider?

..... well that's just one of life's mysteries, I suppose.  I hope I'm quite done with all this.  And there will be nothing more to add to this thread.

And if you are reading this because you have ruptured yours - you have my complete understanding - of all athletic injuries, it is certainly one of the most annoying.  Not life threatening.  Just irritating.  But it sure doesn't go away very quickly.  Keep working at it.

[Kaju Dog]

That sucks...  

Your Achillies sound like my ACL's    

Run this by your Dr 1st, but I do know of some research one of the Therapists I worked with was having good results with E-stem.  

The findings was that the high intensity *(not just e-stem but PAINFUL TORTUROUS E-STEM) causes faster healing.

Tricky Dog,

Would you mind if I copied your post and emailed it to my old Boss "Physical Therapist" to see if I can drum up any help for you?

To your health and speedy recovery,
Dean "Kaju Dog/Doc"  


PS
Make sure you show your other half how to do the MFR.   Every chance you get, you need to work the scar tissue.  *(ONLY ONCE YOUR DR OK'S MFR)
http://www.myofascial-release.com/patientwhat.html

[5RingsFitness]

Well - as if the first time wasn't enough.....

January 31st (2010) and I popped the left Achilles.  Pretty much the same move - this time without armor on.  Knife sparring and moving very fast against an agile opponent (speedy Edwin Tam who likes his knives just fine).  And that just after having lectured my students on safety.

Nothing I would have changed - just leaping back out of the way.  And POP!

I had done this before so I knew what it was all over again.  And this time, I was really unhappy about it.  I had so many things lined up for the coming months - fire sword performances at the Winter Olympics, the Spring Tribal Gathering, into the second week of an 8 week mini-course on Harimau pencak silat.... I was seriously unhappy.

But - thanks to the benefits of a robust public health system (this is Canada we're talking about here), I was examined and in a hospital bed within 2 hours.  And I would have had surgery that afternoon if I hadn't stopped to each lunch before going to Emergency.  So I went in the next day - same reconstructive surgery (different surgeon though).  Back home.  Leg elevated, off painkillers in 24 hours again (this time they threw Oxycodone at me - what?!?!).  And back up that same damned mountain.

Here it is mid-May and I'm just out of the air cast again.  I made a point of training hard all through this period - I even finished the Harimau mini-course after delaying it for 3 weeks.  Kept my tone and now I've got another 6 months of stretching, strengthening, and getting back to where I was again.

So - what did I learn this time?

Well a few new things came up on this go'round - something some of you might want to consider:

First - "platelet rich plasma" treatments - too late for me to consider - but apparently there is a new treatment for tendon ruptures and the like which is being used by professional athletes.  Basically (pardon me if I don't get this exactly right), your own blood is drawn and then using a centrifuge the platelets are extracted along with the plasma.  Then the "platelet rich plasma" (PRP) is injected directly into the damaged site.

The results is analogically like using stem cells - recovery is accelerated dramatically by the presence of the necessary components and the benefits continue for some time after the initial injection.  The benefits are felt almost immediately (within 24 hours) and only one or two injections are needed.  Typical cost is around $500-700 per injection.  And no invasive surgery is required.

Sounds almost too good to be true - well, it certainly isn't available in Canada yet.  And it wouldn't have helped me probably with a full rupture.  But something to consider if you are faced with something similar - ask your doctor.

Second - after regularly I bombarding my surgeon with questions about using various regeneration techniques like pulsed electromagnetic stimulation (apparently not particularly effective), he gave me some thing to think about.  Not a recover but rather a possible explanation for why Achilles tend to rupture - and often affecting the other tendon within 2 years of the initial rupture in a significant percentage of cases.

He pointed at speculation that the calf muscle may be "late firing" under certain conditions.  That is, when stepping back, the calf muscle decelerates the body through the leg by applying force along the Achilles tendon as the ball of the foot makes contact and the heel starts to descend.  This deceleration normally takes place over the distance of about 3-4 inches in a fraction of a second.

Consider what would happen if the calf muscle was not activated early enough - the heel and body would be in free-fall until the muscle finally began its contraction (assuming the heel hasn't hit the ground yet).  Then, the muscle has to decelerate the body over a much shorter distance to bring the body to a halt.  Suddenly the forces required can be double, treble or quadruple normal - the stress upon the Achilles which anchors the calf spikes dramatically.  And if certain things happen to be true (such the presence of irritation due to tendonitis, or poorly designed shoes, or an unexpected unevenness in the terrain), a late firing can result in a rupture.

This late firing may be a product of age or nutrition or other aspect of health.  And it may be a rare but inevitable consequence of how the body's neurological system is constructed and operates - I'm not doctor myself so I can hardly comment.  But the prospects are a bit scary - if true (and that's a big IF), then it is ticking time bomb for a lot of us.  It only takes a tendency to late firing to conjunct with the right circumstances and POP! - you're living unhappiness like me.

More importantly, the big question is:  What does cause "late firing"?  And are there any ways to mitigate the possibility of injury?  Shoe design?  Nutrition?  Behavioral changes? 

It at least explains how someone stepping off a curb (as opposed to sparring or playing racquetball) can just as easily rupture the Achilles.  But it doesn't make me feel any better.


And now I start to wonder - even though I have now ruptured both tendons, and they seem thicker and more substantial than before the injuries (although my calf muscle is probably 70% of original strength), am I in any danger of re-rupturing either?  And is there anything I might want to avoid or consider?

..... well that's just one of life's mysteries, I suppose.  I hope I'm quite done with all this.  And there will be nothing more to add to this thread.

And if you are reading this because you have ruptured yours - you have my complete understanding - of all athletic injuries, it is certainly one of the most annoying.  Not life threatening.  Just irritating.  But it sure doesn't go away very quickly.  Keep working at it.

a couple things

first
I am not a doctor nor do I play one on the internet

second

Guru Crafty is on target

I would also add that what ever is causing it, obviously did not get sorted out or it would not happen again

the #1 pre indicator for chances of injury is prior injury

compensations from injuries or odd postural/gait habits can cause all kinds of groovy things

check out the http://www.functionalmovement.com/SITE/functionalmovementscreen/whatisfms.php FMS
I am a certified practitioner, if you are interested I think it may well help you out, if you can not find one in your area pm me or email me, I can do a screen online via skype, donations accepted, but I will screen you for free, it is part of my initial session with any new client anyway and the information from screens just makes me a better practitioner

I do know some folks in Canada that are practitioners and have other skills that would feed in

there is a pattern in your movement that is causing the issue, find that, and you will be a much happier dog

[stilljames]

I know I am coming at this one late, but I have a question. 

If you can remember, what were your hips and thighs doing at the time of the rupture?  And knees, as well, if you can?