This week I am happy to announce I have a major breakthrough with my rehab. Co-incidentally I put a pause on my PT appointments.
There are 3 major changes:
I had been going to the PT since week 12. In hindsight, the first PT didn’t provide a lot of value in term of recovery progress. The second PT took a more hands on approach in problem solving which was great, but the progress was still frustratingly slow. So I took the matter in my own hands. Armed with the knowledge from the second PT, I learnt that my posterior tibialis muscle wan’t working properly. It led to pain in the medial ankle (inside ankle) whenever I tried to do a heel raise. He prescribed the following arch strengthening and talus bone mobilization exercises.
After the first day of arch hold exercise, my ankle pain was greatly relieved. I was thrilled it actually fixed the problem. However, the pain came back after a couple more visits. The bent knee heel raise didn’t seem to have any effects on my recovery. The talus mobilization exercise with band seems like a good idea, but for some strange reason, never work for me.
I had been playing with the wobble board in the gym since week 16. My idea was to use the soleus muscle as it is intended to – provide balance and stability. I started with slowly performing circles with both feet on the board going clockwise and then counter-clockwise. Then move on to single legged back and fore movement, mimicking single legged heel raise.
It had some effects but not a lot. Then one day my wife bought a Fitter First Wobble Board for my up coming birthday. It was a god send. Even though I had been doing exercises with wobble board for weeks, I had never have a chance to do them in front of a mirror and comparing the muscle movement of my legs like a hawk. Wow, what a different did it make!
I immediately noticed my right posterior tibialis and gastrocnemius muscles not firing. You see, I had been banging out heel raises after heel raises by firing my leg muscles in the wrong way. This action along helped me go back to my weight training root – it’s not about what you do, but how you perform a movement. I needed to relearn how to fire the right muscles in the right sequence.
From my PT, I learnt that my ankle ROM restriction was mainly due to joint mobilization rather than muscle tendon length. When I performed the knee to wall stretch, I never felt the stretch on my calf, I only felt compression at the front of the ankle. It meant the talus bone wan’t sliding back and fore as it supposed to. What the PT did was to push the talus back by hands while I performed a lunge stretch. While it worked while I was in the PT office, it quickly slipped back to the origin position the rest of the day.
A little research on the internet raised the question – after the talus bone was push back in place, WHAT is holding it there? The article mentioned the tibila bone moved to facilitate ankle movement as we walked. Since the tibila connected the ankle and the knee, it safe to say if my ankle bones were not moving properly, it might mean my knee was not moving properly as well. It might also mean if my knee if moving properly, my ankle joint would move properly as well. I immediately put this hypothesis to the test on the track. As I walked on the track, I consciously monitor and mirror the movement of my non-injured leg. Ha, that’s exactly what happened, my right knee wasn’t moving the same way my left knee did. I slowly relearnt the knee movement and it instantly “loosen” up the ankle joint.
I didn’t buy the Voodoo band for my achilles rehab, I bought it for my golfer elbow. Since I realized my ankle ROM was a function of joint mobility rather muscle tendon length, I shifted my focus and researches onto ankle joint mobilization. One of the video from youtube is:
Let me tell you, it worked far better and faster than all the PT manual work combined. It could feel my ankle bones and ligaments move back to where they are supported to within once session. I highly recommend it.
My PT recommend using orthotic for arch support. However, I was mainly staying at home barefoot during the day. I found little use for orthotic. I used KT Tape in the past for plantar fasciitis, it served similar purpose.
Bye bye crutches. Wait not so fast! How can I possibly get rid of the crutches at 6 week post op. You are right. I was getting rid of the Canadian crutches since the my all mighty forearm crutches had arrived! Forearm crutches were so much easier to use but they demanded much more upper body strength. I was lucky that I had been practicing gymnastic ring hold for some time, the transition was a breeze.
The incision wound healed a lot faster since I switched form a water proof pad to a breathable pad. The last bit of
The way I tend to handle task is I add them to my mental stack and I tackle them one at a time. I find it hard to keep hammering at one task from start to finish in one go. What I have learnt and worked for me quite well is to rotate the task and work on them as my passion for it revived. If I do it consistently and every time I put my mind on an item on the mental stack, I enjoy the process and hammer it for as long as time allowed. My mental stack will slowly but surely be completed in a relatively easy manner. This methodology aligns with my core value of having a “Peace of mind and Enjoy Life”.
Once in a while, my mental stack will growth so big that I sometime feel overwhelmed. In that case, I choose to pick one of the low hanging fruit, set up the work environment, so they are visible and ready to be worked on. Then take a break, I mean physically and mentally taking a break from everything. The next time I see the work environment, I will picking the low hanging fruit.
The idea is to set up small wins to clean up the task and having small successes.
From my early app store experience, I was inspired by a comic book effect app and started hacking away with open GL shader languages (GLSL). It took me many sleepless nights to finally put together a half ass app. Then I found out another guy has already created a similar app, but the effect is apply in the live camera (ToonCamera). I immediately went back to research, after yet another couple weeks of sleepless nights, I finally cracked it. Along the way, I found half a dozen GLSL shader codes on a couples of sites.
Coming from a software architect/developer background certainly help me quickly refactor the code into reusable components. The result is a series of GLSL effect apps dominating the US, UK Entertainment Top Chart.
The same applies to web apps. Software As A Service has been taking the software industry by storm, not because of commoditization of cloud platform, not because of the popularity of micro services, and certainly not because of army of aspiring solopreneurs. SaaS, in terms of technology, have been around since the beginning of the dot com boom. The only meaningful difference between traditional software and SaaS is in the charging model. It was called “utility computing” long time ago. There’s really nothing new under the sun, the only difference is new players playing the game.
To build a SaaS app cheap, it has to start or refactor into a few reusable components. Those components or a code base will be used as the building blocks to build a dozen SaaS.
I have always wanted to branch out from the mobile app business ever since I have some success with it. The idea of putting all the eggs in one basket and the fact that all the revenue are heavily relied on the a platform I don’t own if always on my mind.
My app portfolio have been doing quite well despite all the changes Apple had done to the appstore in the past 5 years, from the new release traffic boots trick, keyword stuffing title, trending keywords stuffing to completely destroying the app store for indies by hiding the top chart and changing to a card layout. I have survived all those changes and my app business is still making some pretty decent amount of money each month.
Since my job was outsourced late last year, I have been feeding this desire by creating 6 WordPress plugins and have them approved in the wordpress.org directory. You can find out more here:
During theWordPress plugin submission process, I realized that theWordPress plugin directory approval process is relying on a few prominent volunteers. After a few email exchanges, I was immediately put off by the eco-system. I want to have my own thing, my own assets making dough with my own rules. I certainly don’t want to jump into yet another platform I don’t own.
I have been following the open revenue dashboard published by Baremetrics and came to the conclusion that it would be really nice to have a portfolio of Web Apps that generate recurring revenue all going into my pocket.
While most people are struggling with startup ideas and what not, I realized that the path to success is ownership and execution rather than idea. To simply put it, you need to be good at making money. Same ideas, two different people, two different results. My solution to the startup ideas problem is to simply emulate successful business, be it mobile apps or web apps.
Instead of pulling my hair out to find the next great idea, usually one that you have never heard of, but many people have tried it a thousand times, I opt to emulate existing web app with the cheapest development cost and leverage the platform to build multiple web apps. Since I have been in the software engineering roles all of my careers, it’s just second nature to me. And I plan to outsource all the work and build the web apps portfolio with the goal of being operational irreverent from the start. I just want to be the owner of a series of revenue generating assets. They just happened to be software related.
There are a lot of different strategy for start up: Lean, MVP (Tim Ferris), 30×500 (Amy Hoy). I always go back to my core strategies:
While most people waste time on validating ideas, I use my engineering prowess to build and launch at a cheapest price point I can manage. Most people think IDEA to PROFIT is a straight line. With the RIGHT idea, profit will come. From my experience, you can always start with an ok idea and pivot until you get some traction, kinda like shoot, ready aim.
The idea people think in the ready, aim, shoot sequence. They think turning a business from launch to profit is like shooting a bullet at the target. It takes precision and absolutely no margin of error. From what I learn through the years, from zero to profit is a lot like shooting a flamethrower. You want to shoot first, pivot and adjust the aim along the whole journey.
Week 5, I continued to start everyday with 10 minutes for stationary bike. My doctor’s prescription is use to use the vacoped as fixed boot, I opted for hinging. I planned to progress from 30 to 15 degree in 5 degree decrement instead of the old school jumping from 30 degree straight to 15 degree 3 weeks. I also tried to walk 1 mile per day either going to the track at the park when weather permitted or walk back and fore in the living room. I used a pedometer app to keep track of the steps I took.
Diet still consisted of high carb comfort food. It’s the first time in many many year since I ate so many pizza.
Incision scar was healing but not quite all cleared yet. It’s very tempting to pick on the last bit of flaky skin… so that I was all clear to take a shower without the plastic waterproof leg cover.
Weekly monitoring of the resting tension. At this point in time, my plan was to keep the resting tension higher than the non-injured leg. My theory was to try to heal short and stretch the calf muscle once the tendon was stiff enough.
What most people didn’t talk about was how much pressure you were going to put on your non-injured leg. I was always under the fear that my left Achilles was going to bail. My calf muscle was tight from all the single legged standing and walking. Luckily, I worked with an amazing register massage therapy. He helped tremendously to release the tight muscles on my back, hip and left leg. Back muscle tightness was the result of the motion imbalance because:
2. Even with the “Even up”, I realized that both the iWalk and Vacoped boot lack the much-needed propulsion my feet was designed for. My back was going to hate you for many weeks to come.
I had since progressed to stationary biking without boot. I made sure I leaned away from the machine and keeping my foot in the plantar flexed position.
In order to keep track of my progress against Ryanb’s first 100 days, I downloaded and installed this app called “Day+”. It reminded me where I was on my recovery journey. You entered the date of your surgery and that’s it. It will show you the number of days post op on top of the wallpaper you selected. Simple and neat.
I had been doing my research on how to bulk up calf muscles. It turned out calf muscles were notoriously hard to bulk up. Looks like I had to do my own research and found a way to rebuild my calf since nobody seems to know how to do it. I found a study stating the traditional 3 x 12 eccentric heel raises had no impact on athletes. Instead, they need a minimum of 3 x 80 eccentric heel raises to see results. I also found a few anecdotic confirmation on bodybuilding.com forum advocating high reps and high training frequency.
Families and friends were asking for photos of my recovery status. I switched between crutches and iWalk frequently, usually using crutches when I was home and iWalk whenever I need to carry things, going up/down stairs and taking my puppy out.
I usually try to stay away from starchy food and followed a Zone-ish diet. Because of this injury, I was keeping a calories surplus the whole time and added starchy food back, partly for comfort food and partly to promote inflammatory response.
Make sure you ask your doctor for one of these permit. It made a world of difference. They won’t just hand out the permit, you will need to fill in an application and submit to the corresponding government department for approval.
I noticed the base bone of my big toe was pretty swollen and I had limited range of motion (ROM) flexing it compared to my non-injured foot. I also noticed the inside ankle was swollen up.
Getting in and out of the car, taking my puppy to the vet had been proven quite challenging. Thanks to the support of my wife, life have been reasonably pleasant. Even though she could be cranky at time under pressure, I was truly grateful to have such a wonderful and caring partner.
This was as much tennis I could get for the time being.
I added 10 minutes stationary bike to my exercise on a daily basis. The goal was to put a little resistant on the rest of my legs and facilitate blood circulation.
I have known about the site Flippa for a long, long time. Originally, Flippa was a marketplace for domain flipping. In the early day of the internet, exact match domain name was like some kind of trophy. Companies paid high premium to acquire them the same way new found riches bid for special license plate number in auction.
Flippa was famous not because of the high flying domain flipping transactions, it’s most known for the scams run on the site. You will often see websites making thousands of dollars a month sell for a few thousand dollars. And there are plenty of questionable websites with tons of referral and direct traffic that claim to be making a killing with ad sense.
Now, in case you are wondering what’s the problem of referral or direct traffic. They are mostly fake. There are companies selling bot traffic where you can set referral or direct mode. Organic traffic is harder to fake. Also, beware when the seller said they haven’t done any advertising. Paid advertising done right is like printing your own money.
This was the first week of non weight-bearing in boot. Since the Vacoped boot is longer and thicker than the fibreglass cast. I had to add a volleyball knee pad in the iWalker to match the thickness of the Vacoped boot. Whenever I had a chance, I would take of the boot and elevate my foot on a pillow while I leaned back on the sofa.
After researching the common traits for the people who recovered well on the Achilles blog, I found that they all sleep without boot during the recovery. I first noticed this was when I compared the resting plantar flexion of my non-injured foot and the injured foot. My non injured foot’s resting ankle was way more than 30 degree that was maximum setting of the boot. The idea was to let the Achilles tendon heal at the same length as the non-injured while I was sleeping.
Most re-rupture occurred between 6 to 8 weeks. I created a snapshot calendar to remind myself of the high risk period. According to study, the highest risk of Achilles tendon elongation is between 8 to 12 weeks, keep that in mind. I absolutely refused to do passive static stretch from 8 to 12 weeks. And only slight static stretches from 12 to 16 weeks. After 16 weeks, static stretch was allowed but eccentric stretch during weight training was much preferred.
Every time after showering, I replaced the old incision wound pad with a new one. I tried the waterproof ones, while they worked well for preventing water from touching the wound, but they also slow down the would healing. I replaced them with good old fashion cotton pad and it speeded the would healing way up.
Study showed that a daily dosage of 1000 to 2000 mg of vitamin C enhanced collagen production. I was taking 2000 mg religiously. Some time I would keep back to 1000 mg if my stomach did agree with it.
After reading about a ballerina’s struggle to keep the resting tension after 3 Achilles rupture repair surgeries, I started monitoring my resting tension once a week. Read more about her here. My goal was to keep the resting tendon higher (more pointy) as much as possible. My reason was to heal as short as possible and later on stretching the calf muscles to compensate the calf muscle unit. Most people on the Achilles blog healed long with short calf muscles, it resulted in lack of strength in end range plantar flexion (low single legged heel raises).
It was the 2nd week of non weight bearing. It means crutching around with the injured foot in the air in all circumstances. Getting around still feel very dangerous. I only use iWalk to get up and down stairs. When I went downstair, I turned my back to the bottom of the stairs with my hands holding onto the rail. It’s kinda like lowering down like some kind of special forces. It certainly felt more secure this way than facing down.
I continued with my diet of one box of jello, high protein, vitamin c and BCAA. The BCAA tasted so bad and I had to chuck up a whole bottle each day hopefully to reduce muscle atrophy as much as possible.
I have been using the vibrational massager over the cast, focusing on the healing achilles area. I had been doing some light exercises while in cast like this.
Big day, after a long wait, it’s finally the day to get the cast off. I know it’s only 2 weeks, but it felt like an eternity. I have nothing but good things to say about my surgeon, anesthesiologist and all the staffs in the Richmond Hospital. They are all incredibly patient, reassuring and caring during the whole process. My doctor is kind enough to allow me to record the cast removal process. The snitches looked like it something straight out of a scary movie… I am lucky to be operated on a skillful surgeon and the scar is relatively short compared to other that I have seen on the achilles blog.
I was surprised to see not much dead skin nor crazy werewolf like hair growth. Despite my best effort, all muscles in the lower leg and foot atrophied. Left calf was about 14 inches, while right calf is around 13 inches.
I brought my shiny new Vacoped boot along prepared to insist on getting into a boot if my doctor wants to put me back into another cast. My doctor was amused to see my boot, he asked me how it works and I explained that it can adjust the plantar flexion angle in 5 degree increment. And it’s also about “hinge”, which means it provides me the option to set the range of motion of my foot during the next 10 weeks or so.
He said the incision wound was healing quite well. The key was to keep the incision wound dry until it’s completely healed.
I went home and take the boot off while seating on the sofa. I did some toe circles in both directions and lite dorsiflexion stretch with tibia muscle just to get a feel.
My plan was to minimize atrophy as much as possible on the right legs before the internal suture dissolve around week 6.
Muscles atrophy didn’t just limit to the calves, in fact, every muscles on the mid to low right side of the body would suffer various degree of atrophy. I started doing isometric glute ham hold with left ankle over right knee for 90 sec x 3. I can feel max contraction on right hamstring and glute.