So it's grown on the surgical side as a result of both the trauma and the repair. And on this side, this is a pretty darn normal looking tendon. So what my hope is, is that number one builds a little bit of the confidence that you have in that right side. I know that it's painful. And we're going to give you some stuff to work on that should, um, load it in a way that calms it down and allows you to get back into some of the trail running and the basketball long term.
But it's nice to see that this hasn't. You don't have a large tissue change on that right side. So even though there's pain present some other things that we looked at. Here's the comparison side to side. About 5.5mm on the right side. And here we were at about over 12mm. So double the size on the left. So like we said when there's whether it's surgery or there's a trauma that has your body has healed on its own, we get this thickening.
And so even though there's pain on the right side and that's more of a concern for you. Um, lots of pretty healthy looking tendon on that right side. We'll take a look at a couple more pictures here.
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So this is, um, I was talking about that Doppler, and so it's hard to say, but hard to see in this image. But inside this yellow box, this is right over your area of pain. And if you were, um, if your body was undergoing a significant, uh, inflammatory process in this tendon where it was really trying to heal it because it was in a lot of pain and it was really inflamed.
We'd see this tendon kind of light up with these blues and or, sorry, yellows and white colors, and that's just picking up on the movement of blood flow to the tendon and trying to heal it. So the absence of that just tells us that even though that there's pain present, this isn't in a really risky, inflamed state in this moment.
And I think that your exam also shows that you're able to do a lot without pain. And it's only when we stress you on a really higher level, like single leg hopping, a single leg broad jump. Those are really high level activities. That's the only time that we can bring on a little bit of your discomfort on that, on that right side, which is a total win.
We also noticed just if we look at the integrity of this tendon, tendons should be kind of this kind of similar shades of gray all the way through. Maybe some bright spots, but we shouldn't really see these focal dark areas. And this is a really, um, healthy looking tendon. If we were going to point out anything on it, we would be getting really, really picky and we'd be talking to things that probably don't matter much clinically, just in context.
If we compare that to the surgical side, we can see that it's more enlarged. There's more of these focal defects in the middle. But again, a lot of this is going to be normal post-surgical stuff. I'm just comparing that to so that you can tell, um, the healthiness of that, of that right side, hopefully build your confidence in it a little bit.
So where we go from here is, um, we need to load that, that tendon tendons require load to heal. Um, and typically if we load them in a way where we load them while they lengthen, we call it like an eccentric type of loading. That's a really helpful tool in early stage rehab for the Achilles tendon, um, for tendonitis.
And so what we can do is, is if you're up on a step and you work on some slow lowering with a weight like a reverse calf raise, almost where you help yourself go up and you slowly lower down. Um, lots of that. If you have access to a gym or a treadmill, even just walking backwards on a treadmill is this low load. Um, slow lowering of your heel to the ground over and over again, which again is going to help bring load while it lengthens into that tendon.
I'd be highly surprised if that bothers you pain wise at all. Usually it feels pretty good and all those things are just going to promote healing of that. Um, of that Achilles, in terms of all the other stuff that you're already doing, the hopping, the sprinting, the hiking, uh, all of those things are great.
You just might need to let pain kind of guide you a little bit. And so I have no problem with your rocking and your, your hiking or stairs or whatever it is that you're doing. I would just say, like, if you're getting pain at two miles, I would probably stick to a mile, a mile and a half for a period of time and just enjoy that for a couple of weeks and really slowly build yourself up while you continue to stretch.
Um, and load it eccentrically and do all this stuff that you've been doing for this left side that don't bother you at all. And then if we come back to your clinical exam today, the only real difference side to side, you're still working on the strength on this left side. And that's great. There was a little bit of strength deficits where the left was a little weaker than the right.
But you're actually maybe a little bit more stable on this left side than the right side. So I would be getting on one leg a lot, trying to plant that whole foot on the ground and balance eyes open, balance with your head, turning balance with your eyes closed, balance on that foam pad or a pillow at home, and just really trying to make that the balance and the reactivity of that right ankle.
Just catch up to the left, because the left looks pretty good. Um, and that I think will will take you a long way and hopefully start to build your confidence in some of the activities that you want to do. Okay. Basketball might feel like a long way out, but I can almost guarantee you right now you could go shoot free throws, you could do some light jogging around.
You could keep it really mellow. I probably wouldn't go play pickup at some gym where it's not in a controlled environment, but it's a really important thing to feel like you can do the activity. That's your long term goal, even if you're doing it a little bit. So I would go to baskets, shoot free throws, take a few jumpers.
I would just avoid playing the whole thing until we bring your confidence up in your sprinting and you're hopping and stuff like that. Great. Thank you. All right. Yeah. Any questions for me? No. This was really informative. I appreciate it. Cool. Thank you. Yeah. For sure. Thank you for joining us today.
To learn a little bit more about how we can integrate musculoskeletal ultrasound into our physical therapy appointments. Today we went over how to do a good subjective history, how to objectively test what's happening with a patient with our clinical exam, and then how to perform musculoskeletal ultrasound and integrate all of those things together to educate our patients on what's happening in their bodies and what they can do about it.