Achilles Hell: tips for rehab.

Regular readers of this blog (my wife) will know that a couple of years ago I ruptured my Achilles heel in a typically below average five-a-side football match in east London. Over the past few months I have returned to running and am slowly regaining the fitness of yester year. For anyone going through the rehab process it can be a pretty nasty ordeal, testing your patience to breaking point. I often think back to my own rehab (which is still on-going) and think what I would/should have done differently and have come up with a few tips for those of you about to start the slog.

Achilles-rehab-tendon-injury-treatment-forefoot-running-runforefoot-bretta-riches

1. To operate or not to operate.
The first key decision of your rehab and one of which I have no clear advice (great blog this, eh…) is whether to have operative or non-operative treatment. In my defence, this is because the medical world seems split. Rupturing my Achilles in east London meant I ended up at The Royal London Hospital in Whitechapel. The orthopaedic unit there advised against surgery on the basis that there is no clear evidence that surgery is better than non-operative treatment. Those of you who are Arsenal fans will know about Santi Cazorla’s terrible and gruesome Achilles woes which are due to infection as a result from surgery – something I was warned about. When I look back on my decision to have non-operative treatment I do question why all professional sports men and women (research them, it’s quite an impressive list) have surgery if there is no clear evidence and wonder if I did make the right decision.

2. Choosing the right physio.
This is the most important decision you will make in your rehab. A friend recommended her physio as she had been successful in treating my friend’s back injuries from ballet. In my naïve mind I thought, “a physio is a physio, right?” How wrong I was. In hindsight the exercises that she asked me to do were too much too soon which I think contributed to my partial re-rupture when walking “normally” down steps (something I should never have been doing so soon). When I returned to The Royal London after this my doctor was at a loss about what to do so asked his boss – an orthopaedic consultant called Nima Heidari who at once asked who my physio was. He advised that I see Adam Goode at Pure Sports Medicine which undoubtedly turned out to be the best decision of my rehab. Adam is a specialist in sports injuries and has extensive experience working with ruptured Achilles. His programme of exercises and crucially guidance on when to start doing more challenging exercises, when to start running and for how and at what pace, are the reason I am running today. It may cost a bit more but the right physio is money worth spending.

3. Having access to a running machine.
I’ve never been a fan of running machines. For me there is no reason to use one when you can simply, and for free, run outside. A lot of this is down to a PE lesson at school where a classmate who went by the name of “Mower,” was happily jogging along on a running machine. Mr Knight, our PE teacher, thought it would be funny to up the speed on Mower’s machine to the point where the poor lad’s initial smile turned to fear as his legs started rotating like Fred Flinstone’s. Young Mower couldn’t keep up and flew off the back of the machine like a cork out of bottle, skinning his back. I’ve never looked a running machine the same way since. I doubt Mower has either. Having said that, when it comes to rehabbing an Achilles rupture, they are a must when you first start running again. It is crucial to be able to control the pace and gradient of your runs, something that you cannot do outside. Also, the potential for slips and trips outside is a risk not worth taking, particularly in the more dark and wet autumn and winter months. You can systematically increase your pace and distance in those crucial first few weeks and stay in control when the urge to sprint off is strong. Just make sure Mr Knight isn’t around.

4. Choose your outdoor run routes carefully.
Those first runs outside post rupture are a thing of beauty. You’ve spent months in a boot, months being able to do nothing but heel lifts and then a few more months spent trying to not to fall asleep on the dreaded running machine. Finally, you feel normal again, shivering in the cold air and inhaling the friendly fumes of London. The key to this final part of your rehab is choosing a route that is Achilles friendly. By this I mean flat. The flatter the better. The only times (touch all the wood) that I have had Achilles pain is when taking on a punchy incline or a steep set of steps. Steps are a no go. Don’t even think of running down them. Stay away. They stretch and torture your tendon. You want a tarmacked route, that is lit and you know well. Did I mention it needs to be flat?

 

Ultimately the right physio and patience are key in rehabbing your tendon the right way. As I have alluded to earlier, the process can be beyond grim, particularly if you’re a regular runner. Choosing the right physio to guide and encourage you through this makes the difference and is worth every penny. In time your Achilles will get better and you will run again. Just don’t rush it.

 

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