After nearly two years of no movement below my knees, I was pretty surprised to discover recently that there is movement in the achilles tendons on both legs!
Back in late January, I went back to Craig Hospital for the annual re-evaluation of my spinal cord injury. During the four days of poking and probing my body, just like last year, they told me again, 'According to your internal organs, we can't tell that you have had a spinal cord injury.' This does not mean that I am unaffected, it means that I do not have the deterioration of internal organ function that they commonly see in the kidneys, liver, etc., etc. Many paraplegics are in a very bad way internally due to a whole host of issues that arise as side effects to the nerve damage. For example, I still have to deal with bladder and bowel issues from the nerve damage. Now, these issues have improved significantly from the time of the injury nearly two years ago, but I am also lucky enough that my injuries were not as bad as they could have been. (I could go on an on about the degrees of damage here but I will spare you the details.)
There were two really positive discoveries during my re-evaluation, improvement sensation and some new movement. First was the discovery that I have much more sensation in my hamstrings, lower legs and feet than I realized. Nerves heal at such a slow rate that it's difficult to gauge the level of improvement on any given day. But if you have a baseline against which you can compare, then you can quantify the amount of improvement. I knew that the sensation had improved, but it was difficult to tell how much it had improved. Additionally, if you know anything about nerve sensation then you know that there different flavors of it -- basically soft/light touch to heavy touch to sharp touch (and everything in between). Interestingly, damaged nerves sensation can go from numb at one end of the scale to hypersensitive at the other end. So they tested most of my body for nerve sensation and were able to compare my results to one year ago and to the initial injury and the improvements are significant. It proved that my body is still healing itself. Well besides the improved sensation, there was another big discovery that I already mentioned.
If you look at the two images above of the nerve dermatomes, pay attention to those from the waste down related to anything L3/L4 or below (this includes all the vertebrae in the lower spine L3, L4, L5, S1, S2, S3, S4 and S5). Right now I'm dealing with sensation issues in my feet, lower legs, hamstrings, tailbone and crotch areas. The great thing is that my body is still healing and nobody knows how far it will go over time.
The second discovery was that the achilles tendons in both legs have some movement! There was just barely movement there, but it's movement nonetheless. It is very similar to the way that my butt/glutes returned -- it was such a minor amount of movement that I did not believe it at first. However, during my recovery, I have also learned that even minor movement can snowball over time into much more movement as the muscles are rebuilt. My glutes have largely returned, but they are still not 100% and won't be for some time, so I continue to work on rebuilding them. The same will be true for my calves. Right now my calves are basically gone due to the muscle atrophy. But in time as I move them I will enlist these muscles more and more and they will rebuild. In fact, in the 30 days or so since the movement in my achilles tendons was discovered, I can now feel that my calves are just beginning to engage. But only just beginning. It's going to take a lot more work over a long period of time before I can visibly produce dorsi- or plantar-flexion of my feet (which is driven by the calf muscles).
As I have been telling everyone for the last year, in addition to waiting for my nerves to heal more, the big focus of my physical therapy has been fighting back against the severe amount of muscle atrophy that occurred as a result of my injuries. It took me a while to realize that the muscle atrophy was something from which I could recover (as long as there was movement). At first, I was so weak from the immobilization after the emergency surgery and spending nine months in a wheelchair that I just thought the weakness was caused by the paralysis. To a certain degree this was true, but what I have learned over time is that if I have movement I can rebuild the muscle. There is such a thing as having the movement return but perhaps not having 100% of the sensation return. Another positive thing is that I have experience dealing with muscle atrophy. Having dealt with this way back in high school with my first couple of knee injuries, I understand the dedication and hard work involved. It takes a lot of consistent, deliberate difficult work to rebuild muscles that have shrank away. As many people have asked me, 'Are you still going to PT?' and my response is, 'PT is a way of life for me, it won't stop for years.'
Anyway, because the movement is starting to return, I was fitted for a new kind of brace (this is the third type of brace now). The type of braces I need are called ankle-foot orthotics or AFOs. The first type of AFOs I had were rigid hybrids comprised of aluminum struts with plastic food and calf beds. The second type of AFOs I had were rigid plastic with some carbon fiber reinforcement around the ankles -- rigid meaning no flexion whatsover. I am now on the third type of AFOs and these are known as dynamic response AFOs and they are made of carbon fiber.
See the image to the right and notice that there is only a thin strip of carbon fiber along the back of the achilles tendon area. This strip is not only flexible for two reasons:
To enlist the calf muscles in the stride
To rebound once it is loaded from the ankle flexion so as to provide a more natural stride
Just like the previous change in AFOs, these new AFOs changed my stride again. It's much more natural and I don't need to pick up my feet as much because my ankles are flexing naturally. The downside is that I am pretty damn wobbly right now due to my lack of calf muscles, but this will improve over time. Also, my feet and lower legs are sore from the new material and they way it is squeezing me. I have already had a couple of adjustments to them and I will need more. But it is also a matter of your body getting used them, kinda like a new pair of shoes. Hopefully this will all improve over time.
Someday I will post all of the videos that Janene has made of me walking at the different stages throughout my recovery. It's pretty amazing to see the progress so far and I'm not even done yet. As I tell myself quite often, never give up.