Amid the boredom of this quarantine, many friends are experimenting with various kinds ofvsports virtually, includiing WOD at home challenges, 30km a day cycle, 31 days of Yoga, and of course (my favorite) ….. don’t do anything for 1 month without feeling guilty. Everything is acceptable because this quarantine is not a time for productivity testing. But of course kudos for those who succeed!
Here comes Achilles, a triathlete who has three lungs. Suddenly the energy he had had no limit since the second week of quarantine. He accomplished all the virtual challenges. In his mind there is only one goal, the sub-8 hour Ironman. Unfortunately, his dream was held back because he had a tendon tear.
Background
Three months ago he cycled around Jakarta for 120km. After that, run 5 km in Sudirman, after that take a shower and yoga. The next morning he did a 5-minute jump-ropes (without streching as usual), and there was a loud pop from the calf. He fell and was in pain. Rushing to the hospital, he immediately underwent surgery. He experienced Grade 3 Achilles Tendon Tear, with a healing expectation of 3-6 months. He underwent physiotherapy in various places for months. Unfortunately, it has not yet reaped the results so that the glass of patience has begun to full.
His rehabilitation was not satisfactory, so the mobility was far from perfect. At our first meeting, he came with disappointment and expectations. I can only nod and say, “All is well” like Rancho in the 3 idiots movie. But what actually happened?
Analysis
He came with arm crutches, moon boot, and mixed emotions. The scars had healed completely. However, he could not walk perfectly – stiffness around the ankle and knee increasingly disturbed him; There was swelling around the stitches that had developed 3 days ago as a result of cycling again. I could sense his panic, of course, but he was careful not to frown ro express too much of it.
My other observations included him Initiative to wear boots to increase the flexibility of dorsiflexinya (lift the foot up). Additionally his strength in the calf for plantarflection (tiptoe) was still around 50%. Sensitivity at the suture location was still high when pressed.
Hypothesis
Delayed healing process is a very common thing with post rehabilitationn. One cannot poin point to a single factor that results in this delay – for example, judging that delay is all due to the frequency of activity (factor A), or body’s ability to heal (P factor), or even yesterday’s turn of events (factor V) — would produce inaccurate assumptions. All factors together, be it in a small way, may play a part in influencing the healing process.
Something to take note: Achilles did not stop exercising during calf rehabilitation. He claimed to spend 1 hour for his rehab every day. Apart from that, he still forced himself to continue cycling and rowing 45 minutes every day. But is this wise? Did he forget to factor in the sufficient rest or recovery hours his body needed? Oh yes, and he has been off boot since 4 weeks post-operatively. A little too fast, but he felt that the boot was annoying. Plantarflexion passive motion test only reached 20 ‘and dorsiflexion at 5’. Calf muscle atrophy was increasingly visible.
Another important aspect to keep in mind : There is a lot of compensation in the daily movements during injury, where the shift function was taken over by his left foot. He also admitted that his body tilted to the left. Even though he focuses a lot on using the right side, his understanding is still not enough, hence making his healing journey imperfect.
Treatment Plan
To begin, I immediately invited him to realize his bodily dysfunction. Simply starting wtih his sitting position, then stamding and walking. From there we continued to weight bearing. He was quic to undertand and accept. My goal in starting with a weight shift is to get patients to self realize their imbalance, as they interact with their own bodies. You are your own teacher.
Then, I went to manual therapy to increase the flexibility of each tendon. Dry needling method for gastrocnemius and soleus muscles was performed, activation of the anterior tibial muscle and extensor digitorum longus-brevis, not forgetting the flexor digitorum and posterior tibial muscles were also invited to dance. He was a little confused because he was less deft. Our long-term goal is to restore calf performance to the way it was without pain.
Therapy was to last for 2 months or 10 meetings. After that the performance was to be reviewed.
Closing
It should be noted that each person’s character is different. This goes for one’s ability and mental strength as well. Achilles has a strong character, looks arrogant but he knows that to reach sub-8 hour he must have Mamba Mentality like the late Kobe Bryant.
But we must not forget, we are always inferior. This delayed healing moment is our patience and mindset tested. To do self-introspection and self-reflection is indeed a bit cumbersome. Not easy, but the self realization and acceptance that comes with it results in dedication and commitment – much needed to improve body function and prevent injuries from happening again in the future.
