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Wednesday, March 23, 2011

Achilles Tendon Rupture and Body Pump Classes

Here is an email received on 3/21/11

Anonymous has left a new comment on your post "B.R.I.S.S. Principle of Tendinitis Treatment":


I am a aerobic instructor (body pump, rpm and bodystep) and I have just had achilles tendon surgery (achilles tendon stretched over heel bone). It has been five weeks since my surgery, and I am now in a walking cast. I would like to know when it would be reasonable to go back to teaching. I realise I have months of physical theraphy ahead of me. Would it be possible to get back into teaching bodypump around 5 months post op?

Thank you very much for any advice.

For any of my readers unfamiliar with body pump, here is a short you tube video which is good to watch before reading my response.

     Thank you so very much for your email. Even though I do not do this surgery, I have rehabed patients successfully back from the surgery for many years. This answer can get more refined as I learn from your physical therapist the state of your tendon's flexibility and strength (this can be emailed). I will assume you were very strong before surgery in your calves, so we must use the noninjured side as our comparison. In the 1970s you assumed the injured side would only get to 90% of the normal side in strength, but in 2011, with all the improvements of therapy, 110% is common in an athlete like you. Yes, you will get the injured side to 110% in strength since you want this never to happen again.

     First of all, strength gains can not be obtained with Bad Pain. So, please become an expert on Good Pain vs Bad Pain and live in the Good Pain realm. See the link to my post on Good and Bad Pain and memorize it. It is the only way to say reasonably objective, along with your physical therapist's and surgeon's guidance.

     When I watched the video on Body Pump, I realize that your classes may be more intense. As an instructor, it would be hard not to demonstrate, but some level of cheating on technique will occur. You must assume with surgery that the calf/achilles have stopped working and you have little to no strength. You are starting all over. With this surgery, regaining strength is key. Tone comes first, then gradually power, and then finally endurance. Power and endurance come slowly unforunately and our key to preventing re-injury. Typically, even in well trained athletes, the endurance strength takes 12 months to get to that 110% level, but you will need only 50-60% strength to start teaching protected. On average following injury, you lose 3-5% of your overall strength daily until you painlessly begin to restrengthen. At 5 weeks post surgery, not injury, if you do the math, we can assume your achilles and calf are like jello. So, you need to begin to strengthen now, and as painlessly as possible. This is not the time for No Pain No Gain.

     As you strengthen the calf/achilles, you will gain tone first, power second, and endurance third. You unfortunately gain much slower than you lost. Tone is gained, as long as you do not push through pain, at 1% per day at best. So, given a good strenghtening program, in 2 monthes you will have 60 % of you tone back. That will give you some protection for your achilles, probably along with a tightly wrapped ASO Ankle Brace, and you can start going back to class. The problem is that tone is gained 1% daily, power at 1/3% daily, and endurance 1/4% daily. These are rough but good generalizations.

    I have found that 80% of normal power is acceptable at achieving initial athletic goals. This will occur 240 days from now, or approximataely  9 monthes from surgery. This is when the average patient after achilles surgery begins a running program (with the range from 6 to 12 monthes). For teaching Body Pump Classes initially you will not need 80%, probably only 50% since most demonstrations can be done with both feet on the ground (like squats and upper extremity strengthening). You should hit 50% at 150 days or 5 monthes after surgery!! See how the math works.

    The real problem is at 5 monthes will be the lunges and any other forced weight bearing exercises on predominately on one leg. When doing a lunge, the back foot is in a heel non weightbearing/ suspended position (thus unstable and prone for too much chance of injury). Please see my previous post on Negative Heel Stretching which you should not do for several years post surgery, and explains the precarious position of the off weighted heel.

     A good physical therapist, and many trainors, will be able to help you improving in tone, power, and endurance over the next year. 5 monthes is the normal time to start back when you are at 50% power for Body Pump, but higher levels will take 80-90% (and this will not be achieved for 8 monthes or 240 days). Endurance just takes time, and is associated with painfree sport specific exercise (for me, I just have to go out and play basketball and build up my strength). For ACL repairs, Tommy John Surgery, Achilles Tendon Repairs, and a few other surgeries, the 2nd year is really the Endurance Year. That is when you feel like your old self again. It takes 4 to 12 monthes working out at a high level to regain your endurance back. The second year normally begins with you just starting or up to 2 monthes into a high level of activity. So, be kind to yourself the second year. Until you get back your endurance, your fatigue level is lower than you want, and pushing through fatigue is when injuries occur.

     Read over my post on types of strengthening exercises (see Question #18) and then you will have better conversations with your PTs/Trainors on tone/power/endurance.

     I want to close with two points.  #1 strengthening above the calve is vital to building good strength back for athletic endeavors--quads, hams, core, esp. There is an indirect but powerful protective mechanism in strengthening above the injury. I believe it really pays huge dividends when you are in the endurance phase. And #2 see the post on the Power of 2 postitional toe raises. Once you are doing 2 sets of 25 one legged toe raises daily with ease you are at 80 % power. 1 set of 25 is around 50% power and when you are ready to start teaching Body Pump. I sure hope this helps.

1 comment:

  1. Hi, it's been almost a year now but I am back teaching cycle, bodypump and bodystep. I started with bodypump and easy cycle within the first six months and graduated to bodystep. Still more time needed to get back to 100% fitness but well on the way.

    Thank you Dr. Blake.


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.