T Nation

Maintaining their Quads


#1

I injured the Peroneal Tendon in my left ankle during a hockey game recently. I thought it was just a sprain, but my orthopedist confirmed that I have a mild tear. Whether this thing heals on it's own (with the use of a brace) or I have to have surgery to repair, I know quad/calf atrophy is going to be a problem. My only option is leg extensions as I can't bend the ankle like in a squat, leg press or calf raise until this thing is resolved/healed.

Has anyone had experience with at least maintaining their quads with leg extensions during ankle injury? I'm having visions of chicken legs 4 months from now.

Thanks for any help.


#2

Do you have any weigth bearing precautions? If not, did he prescribe a cam walker or any other type of boot to limit mobility? With the leg press, you can try diffent foot placements to minimize ankle motion. Certainly, I would not try anything that aggravates the injury.


#3

Basically he said that these things sometimes heal on there own, but that if he was betting he would bet against it. He recommended a "lace up' style brace that would hinder lateral movement. I feel pain when I get near the bottom of squats which really sucks. I guess I could try leg presses and limit the range of motion, but I may be stuck with leg extensions for a while. I think calves will be tough as well as the flex or motion of the ankle is the same.


#4

I would avoid calves even more so than other exercises especially if you directly injured the peroneal tendon. 2 of the 3 peroneal muscles assist in plantar flexion, so by working calves, you would directly hit the peroneal muscles as well. Is it a tendon tear or did you tear the retinaculum and are having a peroneal tendon subluxation? If it is the latter, I recommend surgical intervention. If it is a tear to the tendon, it just depends on the severity of the tear. Best of luck with it all. Try some pool workouts if possible to minimize the load on your ankle. Taping/bracing may help to an extent, but don't expect it to solve the problem.


#5

to echo LevelHeaded,
take it easy - you can come back strong in your training once this heals but it's a big deal to heal.

Even in this state though, and whether or not surgery is recommended, keeping your ankle as mobile as possible - without pain - is a really great idea.

even if you're in any kind of brace for most of the day - time to do some mobility work will have a tremendous benefit.

It's something i can really see in the athletes i work with: those who are doing mobility work before an injury tend to come back much much faster. Those who use mobility as much and as gently as possible in recovery improve recovery times. Work with your osteo about this, and if you'd like some movement suggestions, PM me.

best
mc
http://begin2dig.com


#6

ps - sorry also as levelhead asks, would be great to know what kind of tear.


#7

I'm embarrased to say that i'm not sure exactly what type of tear this is. The ortho said I had a slight tear. I told him the sensation was like a "band" snapping over the ankle bone when I reached the lower portion of a squat. He had me squat in the office and we had trouble making it do the same (maybe because no weight on the shoulders?).
Anyway, he suggested a brace (i'm using one by Air Cast) and said that "regular' tears almost always require surgery. However, he noted that because we had difficulty making it "snap" (i.e. it is not snapping with every step etc.), that I had a mild tear that he said could possibly heal on its own.


#8

From the description, I would assume it is a tear to the retinaculum that holds the peroneal tendon down. I would be very careful with this and not force any movements that cause the "snapping" or cause pain. I've worked with an athlete who had the same thing and ended up requiring surgery. Be smart and if the problem continues, see the physician again or seek a second opinion.


#9

depending on the type of tear, conservative repair is totally possible with rehab. but if we're talking about a tear tear, an intervention may be necessary.

that's sorta what i was trying to get at.

i'd suggest asking him about a schedule to get out of a brace to do mobility work as much as possible.

and you may also want to look at rehab for micro tears with eccentrics using calf raise type work.
http://www.begin2dig.com/2010/04/eccentric-exercise-some-cool-ideas-as.html

best
mc


#10

Here's where i'm confused. I went to a very highly regarded orthopedist. They took shots of my ankle, but the post-xray briefing didn't seem very conclusive (i.e. how bad is the tear?). The doc basically said I could wear a brace, but wasn't optomistic that it would heal on its own. For 95% of my day, it doesn't give me a big problem. It gets tweaked here and there, but nothing too problematic. The big problem I have is when I squat. I get a very direct sensation of an air pocket (like you feel just before a joint cracks/pops) and then I get the slight "snapping" sensation over the ankle bone which does hurt. So, two things:

1) I'm afraid that eventually the weight I use to squat is going to create a major tear.

2) The information I was given from the orthopedist indicated that surgery was almost an inevitability, but I have no idea how I would rehab this (or who to see to try that avenue)if I wanted to try that first.

Any help or suggestions?


#11

X-rays won't confirm damage to soft tissue. Was an MRI of the ankle done? Have you gotten a chance to discuss this more with your physician and ask specifics (tendon tear vs retinaculum tear)?