Achilles Tendon – PRP – Post-Op Update #2

My last post on my progress was @ 8 weeks. I am now a full 22 weeks post-op. (See my last post.)

My last doctor appointment at 12 weeks went well. He released me on my own recognizance. He reiterated that no real training should take place until I can to the one-leg toe raise. I could do a shortened toe raise but only lift my heel barely an inch off the ground. The calf was too weak. It was not pain from surgery or the tendon that prevented me from doing so.

My physical therapy ended on 12/8. Due to the holidays and some travel I did not pursue running on the Alter-G treadmill. [Spooner Physical Therapy offers a monthly “membership” fee to come in and use it.] I also will admit I have not been as diligent at my exercises on my own. I have continued some strength work.

The key however is that I have begun running – real running. Ok, jogging – real jogging. My first run was on 12/7 – 3 full months post-op. It was a 1 mile jog on the track. My goal was to run on ground by the end of the year. Success! Here is how my running log looked for December.

I felt as though I was favoring my right leg (the surgery side). There is no doubt is was weaker. The achilles tendon is still very thick compared to the other side. But, other than a slight twinge in one tiny area I have no pain or discomfort at all. It’s just weak. I cannot push off.

I experimented with paces. The bottom line is that after 26 months of non-training, I am simply very out of shape and my legs are weak. I need time off after a run due to other aches pains and my left calf cramping badly. No doubt much of this is from compensation. I can do a toe raise but not well, not repeated, and not powerfully.

January I ran a total of just over 40 miles total. I am still struggling with other aches and pains. No change in the achilles tendon.

One notable difficult thing is how this has worn on me emotionally. It is very difficult fighting back. I have to practice a good “mental game” and stay in the moment and focused on the current task at hand. My mind tends to wander back to how “I used to be” and if I will ever run well again. The doc says the surgery will not prohibit that. But, it most certainly is taking longer than I thought.

I have put off all thoughts of racing until the Fall. There will be no way I can regain my strength to even think about racing until then.

In the meantime, I enjoy being able to run at least some.

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About Dean Hebert

I’m a mental game coach, author and speaker. I work with individual athletes, parents, coaches, and teams on sports performance enhancement. Beyond my academic post-graduate work in sports psychology - the psychology behind athlete performance – I am a certified Mental Games Coaching Professional (MGCP) and certified hypnotherapist. I’ve authored several books and hundreds of articles. “Coach, I didn’t run because…” (2008) is a seriously light-hearted look at making excuses not to workout and how to overcome them. “Focus for Fitness” (2009) and “Screw the Goals Give me the Donut” (2010) are two of my eBooks on mental game approaches for the everyday athlete. I wrote these because I believe that everyone can benefit from the powerful mental techniques that the world’s best athletes use. I have been cited in Runners World, Best Health magazine (CN), SWEAT Magazine, and the Washington Examiner amongst many other publications. I have been a featured mental games coach in Runner’s World and for the internationally acclaimed trail running resource - trailrunningclub.com. I also regularly appear on sports and fitness talk shows such as LTKFitness, Runnersroundtable and for more than three years I have co-hosted a weekly video series with Coach Joe English for Running-Advice.com. I specialize in mental toughness training. My clients include tennis, synchronized swimming, golf, race-kart, soccer, motocross, volleyball, MMA, cycling (road, off-road, time-trialist), running, duathlon and triathlon, basketball, football and baseball athletes. I have coached world-class athletes and athletes internationally. I have a passion for working with youth athletes and helping them apply mental game skills and techniques to all areas of life. Most importantly, my aim is to have people enjoy sports and life to their fullest through peak performances.
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13 Responses to Achilles Tendon – PRP – Post-Op Update #2

  1. Jimmy says:

    Go, Dean! It is a blessing to be able to run at all. I hope to also run again someday. Thank you for continuing to help the rest of us even while you could not do the activity yourself. It seems that you are gaining ever deeper insights into the psychological side of things through this “time trial” of another kind. You can relate to people who face very tough mental challenges – insight into breakthrough living even when this broken world can never be the same. As for me, it pares life down to the core and my single remaining hope, the reason to make chicken soup out of chicken parts, is the αγάπη of יהוה

    …and “chicken soup is good for the…”

  2. David Shumate says:

    Keep rocking Dean! As you are know, I am in the same boat as you. I plan on taking my first “run” in the next week.

  3. Ashleigh says:

    Dean,
    I’ve been battling chronic AT problems for 2 yrs now. I was officially diagnosed with tendinosis in May 2009. I took 4 months off and did pool running and some stationary biking. Then I returned to running, but only about 10 MPW (I was 5 months pregnant at the time. After the baby was born in Jan 2010, I again returned to running 10-20MPW. I didn’t have pain while running (never did) or pinching the tendon. But I always knew it wasn’t the same as the other side. I could always find a sore spot when using the foam roller.
    Finally in November of this year, I found a great PT to try to get to the bottom of my recurrent problems. I had 8 ASTYM treatments and he found several imbalances, etc up the chain. I thought I had finally found my answers, but I just cannot overcome my fear. It does not look and feel right to me and I never know when to stop or press forward. I am only running 15 min at a time every other day, but I am paranoid about every sensation.
    I’ve spent a fortune and I still don’t know if my tendon is ever going to be the same. Maybe I shouldn’t even expect that? It’s gotten to the point that this issue is so mentally stressful that I’ve begun to consider giving up running indefinitely…which is like giving up one of my arms. But I just don’t know what else to do. This has been going on so long I don’t know what normal feels like anymore.

    • Dean Hebert says:

      Well, as you can surmise, my heart goes out to you. I understand. So, unlike perhaps anyone else who will make comments to you…. I really do know what you are going through.

      ASTYM was the preferred treatment.. good for you. You do have at this point what would be considered chronic (not acute) tendonitis or tendonosis. If you have not had a cortisone injection you should consider it. It is possible that your tendon will never return to its former self. HOWEVER, that does not mean you will not be able to run again! I ran 20+ years (at what most people would consider a pretty high level) with it before I had to have surgery. Yes there were some ups and downs.. but it is very manageable.

      You mention a critical factor that I have gone back and forth over the years with… the mental aspect. To push through or not to push through? Am I just being a wimp or am I really being careful and prudent? You have to read your body and back off before it really hurts… of course. But, I also have seen that by running and working out I have LESS discomforts than taking time off between workouts. I find consistency – even if easy – has yielded better results for me.

      Begin to deal with what “is”. It may not feel the same as the other leg… but that may be your new “normal”. It may be thicker than the other leg… it may be your new “look”. You may need to use ice after harder or longer workouts and you may need to get on antiinflammatories from time to time to regain control of it. So be it. If running is as much a part of you as it appears… don’t let it go. The alternative is something I tell all my runners… you COULD never get injured again… just sit on the couch. So, yes, there is some risk. I choose to be prudent.. but I’ll take that over the guarantee of not being injured and sitting on the couch.

      Stay in touch.. share your journey. I would like to support you in your way back. (BTW if you have a blog I’d love to follow you – send it to me.)

  4. Ashleigh says:

    Thank you, Dean. My husband and I made a difficult decision last night. We decided that I should take a “mental health break” from running for an unspecified length of time. Maybe a month, maybe a year…however long it takes to regain some emotional balance, if that is even possible. It has gotten so bad for me that I can barely eat and have lost weight that I cannot really afford to lose. I have 3 small kids and I need to be functional for them.

    The things that you said about accepting the new normal make sense to me and echo statements made by my PT. But this thing has gotten in really deep into my bloodstream, and I’ve just lost the ability to think clearly about it anymore. It is not my body stopping me from running, but my mind.

    My plan is to set running aside for a bit, continue my PT exercises plus stationary biking, swimming, and weights. My hope is that I can settle down emotionally, get some perspective on this, and return to some level of running (though I have accepted that to train for another marathon would be ill advised for me).

    I’ll continue to follow your progress and will let you know if things turn around for me.

  5. greg yatko says:

    Hi Dean, I feel your pain. Every time I look at this large permanent lump on the inside rear of my right achillies, it constantly reminds me that I can’t run very much any more. Anterior Achillies Bursitis, that no amount of rest can cure. My doc says cutting the tendon and operating may only make it worse. Well, I can still ride….

  6. Eileen says:

    Just had the surgery. They use my big toe tendon to reinforce Achilles after the debridement. Am four weeks into recovery and becoming very frustrated. I alternate between training in a pool and bands, but now worry I have been to vigorous in my training. I question everything I do at this point because there seems to be much conflicting information out. I will not be weight bearing for two more weeks and then only 20 percent. Am 52 and am worried about losing strength in my entire leg. Did you do any sort of weight training? Thank you for your information.

    • Dean Hebert says:

      Eileen,
      My first word to you – PATIENCE!!! I did lose strength in my calves – both of them but the surgical side that was in the boot more of course. My big mistake was that I did NOT do alternative training – weights or otherwise. I was not allowed to do any aqua running at all until after the boot came off anyway. But I shoulda and coulda been doing strength work that would have sped up my recovery and return to running. Do it! Just leave that achilles alone!!!

  7. Eileen says:

    Thank you so much for your reply. I am a little panicked because I still have to have the same surgery on my left leg when the rehab is done on the right. I just want to not mess this up. I had gotten to where I couldn’t even run a short distance without icing my ankles for hours then still limped dramatically. You have given me some hope.

  8. pauldmorgan says:

    Hi Dean

    wondering how you’re getting along now….

    My history is one successful marathon where I trained minimally through the pain followed by four aborted attempts to go quicker as the training load proved too much for my achilles. Two years of eccentric loading and three high volume saline injections didn’t help so I had the same surgery (minus he PRP) as you the day before yesterday under local anaesthetic (which was… interesting). I’m sat here now with my leg up in a traditional cast in a little discomfort wondering if I did the right thing! I find the pictures of swollen ankles quite dispiriting.

    As well as being a runner I’m also a cyclist and riding my bike rarely caused any irritation to my tendon – wondering if you tried cycling to build up calf strength post-op? I’m really hoping I can get back to riding my bike within six months. I am also investigating access to an Alter-G TM and wondering if you or others would recommend this (it’s costly) over cycling or an elliptical trainer?

    cheers, Paul

    • Dean Hebert says:

      Paul,
      Thanks for checking in. Look, those pics I still look back on and shudder! Fact is I can run today. And you will be running too!
      So, a few comments to your questions:
      I am much more in favor of removable casts. Hard casts yield more atrophy in muscles.
      YOu should be cycling WAY before running. Out of boot in 5 weeks; on the alter-g running in 9 weeks; and I was running within 3 months. Cycling would be very close to Alter-G in my books as to amount of pressure/stress on the Achilles.
      Cycling may not be exactly as good as the Alter-G (the rule of neuromuscular specificity). BUT, if you do hard intervals on the bike that has shown good transfer to running and runners.
      It’s hard to handle the uncertainty – I get it. Here’s my advice as coach and mental game coach:
      1. Set goals for next years’ racing… NOW.
      2. Get a calendar. Now, project your return based on mine plus what your doc has told you; and “x” the first day you get out of cast, the first of PT, the first of cycling, the first for running (at any level). I was 55 getting the surgery.. it takes me longer to recover than a younger guy.. so…that is probably good news for you.
      3. Do everything possible to maintain your weight it will expedite your return (I learned the hard way.)
      4. Do every kind of exercise you possibly can to stay strong, core, legs, power, range of motion… just do it! Stay focused on it one day at a time.
      5. If you have access to a pool- aqua running is #1 in rehab for runners. I can send you workouts if you can do this. First chance out of that freakin cast – get in the pool… HUGE boost to comeback.
      6. If you create your own training schedules, now is the time to draft your comeback. I’ll email you part of my Excel spreadsheet just to show you the progression if you like.
      Hang in and stay in touch.

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