ChicagoJack
Hall of Fame
1. I made a promise, if ever returned to the game of tennis, I would also return to the tt board to share how I did it. 3 months ago, at the low point of my 14 month struggle, playing tennis seemed a remote possibility. I was then 8 weeks post surgery from a knee operation that left my cracked and chipped patella smooth as a baby’s bottom, but the kneecap wandering off on its own accord, apparently unaware of the muscle tissue I was laboriously rebuilding around it, via the utilization of torture devices known as balance mats, surgical tubing, physio balls, leg press machines, standing hip machines, and free weights. The examination MRI’s of my lower back have never failed to instantly change the mood of any room. You might not understand what a grade 2.5 spondylolesthesis at L4/5 means, but let’s just say it doesn’t take a trained eye to see there’s a problem from a quick glance at a set of films. My Achilles problem, a triple scoop sundae of tendinitis, bursitis, and a partial tear, was stubbornly defying all attempts at repair. I’d started experiencing pain in my achilles early last summer, and by september had made the decision that perhaps the way to beat all my injuries was to quit tennis, in order to focus on my physical therapy full time. This was an easy decision to make, as my lower back was sending sciatic pain to both legs, my left knee was killing me, and now my right achilles was out of commission. I would have limped around but didn’t have any good side to lean on. After 14 months of battling this bevy of injuries I’m back to my usual routine of practice matches 2-3 times mid week, then playing competitive matches with team matches on the weekends. How I manage my back and knee issues are topics best saved for another post.
2. The information provided is not intended as substitute for medical guidance or diagnosis. I wish to share what was effective for me, and for those who wish to learn more on the topic, a few quotes and links. While it is irresponsible for even qualified medical professionals to attempt diagnosis without direct physical examination, standard medical text is replete with the the practice of citing individual case histories to illustrate symptoms, progression and possible course of treatment. It is in that spirit, in that context, that I present my case history.
3. How my Initial Symptoms Appeared, and Progression: Pain in the area at back of heel, from as low as .5 inch from the ground when standing to as high as 3.5 inches from ground when standing. Center of pain is mostly at the small pea sized point where the achilles arcs over heel bone and bursa at 2.5” up. Pain occasionally radiates around heel area to sides of heel at about 1 inch up and 2 inches towards front of foot. Pain at this specific location would suggest classic insertional achilles tenditinitis, tendinosis, or retrocalcaneal bursitis. Pain initially began as mild morning tenderness that would dissipate as day progresses. First occurrence was the morning after a 4 day tennis camp, which passed on its own after a few days. Second occurrence was a few months later, occured the day after 5 straight days of intense practice sessions followed by two days of multi-match tournament play. Pain began to appear with more increasing regularity over the course of the next 3 months to the point where I was sore during, and after every time I played, still most intense in the morning. Sought treatment when symptoms grew to a point where normal everyday activities were producing symptoms.
4. Initial Diagnosis, timeline of my unsuccessful traditional physical therapy, followed by very effective eccentric training: Achilles Tendinitis, Retrocalaneal Bursitis, and Partial inter-tissue tear of Achilles Tendon. This was the conclusion of two orthopedic surgeons, and a 3rd opinion from the best sports doc in the city of Chicago. I am a 45 year old male, 6ft 0”and 158 lbs. I have been a multi-sport athlete my entire life, participating heavily and consistently in judo, cycling, volleyball, and tennis. Lower back issues narrowed my focus to tennis exclusively and have been playing 3-5 times per week for last 8 years.
My initial diagnosis was singular as achilles tendinitis. On the second week of my professionally guided physical therapy I quit tennis entirely, and the next 8 weeks of guided physical therapy proved ineffective. At this point I got an MRI which revealed a partial tear, and bursitis. I was then instructed to wear a walking boot/plastic and velcro cast from shin to toe for 6 weeks. After removal of cast, walking was very difficult for the next few weeks, and I lost faith at that point. 10 weeks of excercise did not work, 6 weeks of immobility did not work. Shortly thereafter I had surgery performed on my opposite knee, and of course post surgical physical therapy was required. I declined all PT directed at my achilles, [I’d lost faith ]and focused on getting my knee working right for the next 6 weeks.
During that time period, when I was doing nothing but icing and resting my achilles, the pain diminished significantly. I could not run or even lightly jog, I’d get symptoms if I tried to hit against a backboard for longer than 5 minutes, but the pain was minimally present with my normal daily activities. I decided this was a golden moment, and could now proceede into physical therapy again, but I did not trust anything I had tried before. I wanted a fresh approach.
After weeks of research, I came across the university hospital of umea sweden study which involves eccentric calf muscle training for the treatment of achilles tendinosis. The test group was small, but the results were impressive. Interestingly enough, I was already working eccentricly with my knee rehab, per my sports doc/surgeons direction. My sports doc is the team physician for the Chicago Black hawks Hockey team, and has worked with the USA volleyball team. He’s big on eccentric PT, his endorsement of the concept was good enough for me. I showed the Umea study to my physical therapist and he gave me the thumbs up to proceede on my own. In The Umea sweden study, all 15 in the study group were able to return to running at the end of 12 weeks. I was able to return to light hitting for half an hour at 6 weeks, 1 hour at week 7, then twice per week by week 12.
5. I’m currently back on the court, playing practice matches 2-3 times per week for 1.5 hours each, then competitive team matches every weekend. It’s not a complete victory by any means. I still do the calf strengthening and lateral stability excercises, 3 days per week. For now this is the right balance of PT, tennis and rest. If I start to flare up again, I rest for a few days, reduce the court time for the next few weeks, and replace those days with building strength up. In this time period of successful PT I also discovered an anti-inflammatory that does not irritate my stomach, celebrex. I used 400-600 mg per day for the first week or so of doing the swedish routine, currently all that is needed is 100-200 mg per day, and some days is not needed at all. I’m not home free, but I am effectively managing it. I’m committed to making my achilles-calf complex into a rock of gibraltar where chance of injury is extremely low, and to that end my work has only begun.
6. I wish to thank the following kind hearted persons who have gave me advice in my moments of confusion, hope in my moments of despair. I could not have done this without you. NobadMojo, Marius, Chess9, Phil, Ronaldo, Blabit, KevinT, Jonolau, Vamazona, Chrisd, Scotus, Physioam, TennisLady.
Best regards
-Jack
2. The information provided is not intended as substitute for medical guidance or diagnosis. I wish to share what was effective for me, and for those who wish to learn more on the topic, a few quotes and links. While it is irresponsible for even qualified medical professionals to attempt diagnosis without direct physical examination, standard medical text is replete with the the practice of citing individual case histories to illustrate symptoms, progression and possible course of treatment. It is in that spirit, in that context, that I present my case history.
3. How my Initial Symptoms Appeared, and Progression: Pain in the area at back of heel, from as low as .5 inch from the ground when standing to as high as 3.5 inches from ground when standing. Center of pain is mostly at the small pea sized point where the achilles arcs over heel bone and bursa at 2.5” up. Pain occasionally radiates around heel area to sides of heel at about 1 inch up and 2 inches towards front of foot. Pain at this specific location would suggest classic insertional achilles tenditinitis, tendinosis, or retrocalcaneal bursitis. Pain initially began as mild morning tenderness that would dissipate as day progresses. First occurrence was the morning after a 4 day tennis camp, which passed on its own after a few days. Second occurrence was a few months later, occured the day after 5 straight days of intense practice sessions followed by two days of multi-match tournament play. Pain began to appear with more increasing regularity over the course of the next 3 months to the point where I was sore during, and after every time I played, still most intense in the morning. Sought treatment when symptoms grew to a point where normal everyday activities were producing symptoms.
4. Initial Diagnosis, timeline of my unsuccessful traditional physical therapy, followed by very effective eccentric training: Achilles Tendinitis, Retrocalaneal Bursitis, and Partial inter-tissue tear of Achilles Tendon. This was the conclusion of two orthopedic surgeons, and a 3rd opinion from the best sports doc in the city of Chicago. I am a 45 year old male, 6ft 0”and 158 lbs. I have been a multi-sport athlete my entire life, participating heavily and consistently in judo, cycling, volleyball, and tennis. Lower back issues narrowed my focus to tennis exclusively and have been playing 3-5 times per week for last 8 years.
My initial diagnosis was singular as achilles tendinitis. On the second week of my professionally guided physical therapy I quit tennis entirely, and the next 8 weeks of guided physical therapy proved ineffective. At this point I got an MRI which revealed a partial tear, and bursitis. I was then instructed to wear a walking boot/plastic and velcro cast from shin to toe for 6 weeks. After removal of cast, walking was very difficult for the next few weeks, and I lost faith at that point. 10 weeks of excercise did not work, 6 weeks of immobility did not work. Shortly thereafter I had surgery performed on my opposite knee, and of course post surgical physical therapy was required. I declined all PT directed at my achilles, [I’d lost faith ]and focused on getting my knee working right for the next 6 weeks.
During that time period, when I was doing nothing but icing and resting my achilles, the pain diminished significantly. I could not run or even lightly jog, I’d get symptoms if I tried to hit against a backboard for longer than 5 minutes, but the pain was minimally present with my normal daily activities. I decided this was a golden moment, and could now proceede into physical therapy again, but I did not trust anything I had tried before. I wanted a fresh approach.
After weeks of research, I came across the university hospital of umea sweden study which involves eccentric calf muscle training for the treatment of achilles tendinosis. The test group was small, but the results were impressive. Interestingly enough, I was already working eccentricly with my knee rehab, per my sports doc/surgeons direction. My sports doc is the team physician for the Chicago Black hawks Hockey team, and has worked with the USA volleyball team. He’s big on eccentric PT, his endorsement of the concept was good enough for me. I showed the Umea study to my physical therapist and he gave me the thumbs up to proceede on my own. In The Umea sweden study, all 15 in the study group were able to return to running at the end of 12 weeks. I was able to return to light hitting for half an hour at 6 weeks, 1 hour at week 7, then twice per week by week 12.
5. I’m currently back on the court, playing practice matches 2-3 times per week for 1.5 hours each, then competitive team matches every weekend. It’s not a complete victory by any means. I still do the calf strengthening and lateral stability excercises, 3 days per week. For now this is the right balance of PT, tennis and rest. If I start to flare up again, I rest for a few days, reduce the court time for the next few weeks, and replace those days with building strength up. In this time period of successful PT I also discovered an anti-inflammatory that does not irritate my stomach, celebrex. I used 400-600 mg per day for the first week or so of doing the swedish routine, currently all that is needed is 100-200 mg per day, and some days is not needed at all. I’m not home free, but I am effectively managing it. I’m committed to making my achilles-calf complex into a rock of gibraltar where chance of injury is extremely low, and to that end my work has only begun.
6. I wish to thank the following kind hearted persons who have gave me advice in my moments of confusion, hope in my moments of despair. I could not have done this without you. NobadMojo, Marius, Chess9, Phil, Ronaldo, Blabit, KevinT, Jonolau, Vamazona, Chrisd, Scotus, Physioam, TennisLady.
Best regards
-Jack
