Bodyworks: Achilles Tendinitis

How to recognise it, how to overcome it


Posted: 5 June 2000
by Patrick Milroy

Symptoms
Simple pain in the Achilles tendon on contraction, particularly if you tip-toe or run, although it may settle after a couple of miles. It is often stiff on first getting out of bed.

Signs
There may be little or no thickening of the tendon, which can be tender to touch. Many runners have uncorrected pronation which makes the tendon spiral slightly under running conditions and cause unequal stresses within it.

Medical investigations
A scan will confirm a chronic unresolved tendinitis and gait analysis with a video will show whether your pronation needs treatment.

What else could it be?
Other more severe injuries to the tendon, lower calf muscle tears or simple heel tab bruising can all produce pain within the tendon.

Self-treatment
This should include a heel raise of Sorbothane or foam, ensuring that heel tabs do not impinge upon your tendon when your toes are pointed (cutting the heel tabs off will certainly help, too). Applying ice in the form of a pack or massage and very gentle stretching will prevent shortening of the tendon.

Medical treatment
Your medical adviser should ensure that you have appropriate footwear, have pronation corrected, use ice, massage and possibly ultrasound most judiciously. Rarely, in the chronic case, you may need the tendon surgically decompressed.

Can you run through it?
Running through it is fraught with risk, though that does not stop many attempting it.

Recovery time
Promptly treated, a few days; left untreated, it may extend to years.


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Bodyworks: Achilles Rupture

Tendinitis, Achilles
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I am seeking your advice...
For the past few years i have suffered achiles pain when running, I sought medical help and was told it is basically the paratendon swelling, and there is not much they can do, After a short course of physiotherapy the problem calmed down a bit but still flares up every so often, and I have to rest.
This is on both tendonss and the right has a small lump in it..
Has anyone had any achiles problems and how did they deal with them?

Thank, feel free to email me.
Posted: 03/08/2002 at 19:06

Who did you go and see ? was it just your GP or did you go see a specialist. I've suffered with Achilles problems and eventually went to for a Gait analysis at the REBOUND clinic in Settle. Found the reason that the achilles was swelling was the way I run and orthotics as cured the problem. Hope this helps.
Posted: 06/08/2002 at 07:53

i also have achillies problems, only of late, after a run of we say 6 miles ,achillies stiffens up the following morning, sore to the touchan inch or 2 up , running in nikes at the mo any help here, am a neutral runner
Posted: 07/08/2002 at 19:14

Andrew, Michael, it is well worth seeing a sports medicine specialist. They will have encountered this problem before.

It may well be something as simple as a gait problem or the wrong sort of shoes, and you may need orthotics. If this is the case, the usual round of ice, ultrasound, stretching and anti-inflammatories will only give you temporary relief.

The inflammatory process can make the tendon weaker and more rigid, and a ruptured achilles can seriously damage your running. On the same note, if your doc suggests a soft-tissue steroid injection, get on your bike and cycle out of there fast. Most experts frown on injecting the achilles tendon because it increases the risk of rupture.

You might have to settle for cross-training during flare-ups.

Don't just put up with it. There is likely to be something that can be done.

Cheers, V-rap.
Posted: 07/08/2002 at 21:52

Micheal o.... your suffering the exact symptoms i have/had, I would advise you to follow yorkies advice and get a gait analysis/orthotics sorted and rest or take it easy till then, not like i have done and kept running, I have been using ibuprofen gel to keep the swelling to a minimum....,, Theyre not too painful after a run but the next day, or after a rest theyre really stiff and standing on your tip-toes can be painful..
Surprise-surprise I was running in nikes when mine first occured, air max, is this just coincidence???? I was running 12 mile a day at least so over doing it was half the problem i reckon as well..
One thing I can recommend is definitely warm up and down, with a good set of stretches on the calfs and lower leg, from the bottom of the calf to the bottom of the achiles especially, i lean against a wall lightly, one leg in frobt of the other and lean forward so i can feel the stretch in the achiles, seems to help but see the RW stretch guide in the archives if you can find it..
If you can do the stretches about 3 or 4 times a day,,I reckon that eased mine abit to start with, its all about flexibility, if your stiff then your always on breaking point

OK yorkie,,, I seen my GP, who referred me to a specialist physio who was very good but could not solve the problem...
My next step is a gait analysis but where do i go? anyone any recomendations in the NE, I have been running in Asics 2060 the past few months and they havent been to bad, just bought some Kayano 8 but i think they will be chewy as the heel tab is quite high...
What sort of cost was the analysyis and orthotics yorkie?
All your help is appreciated, and who knows if i can get it sorted Ima get to run my first half marathon in over 4 years!!!...
Many thanks.
Posted: 07/08/2002 at 21:55

Here is a page with some good calf stretches on....
http://www.runnersworld.co.uk/news/article.asp?SP=&V=4&UAN=484
Posted: 07/08/2002 at 22:16

I too have suffered achilles pain in the last 4 years...but now have it under control..i'd suggest daily cross frictional massage (to break down any forming lesions that build up from time to time)and plenty of calf stretching...also put a heel raise in your shoes (both running and casual)
hope this helps and good luck
Posted: 08/08/2002 at 13:12

Im also suffering from a long standing achilles pain and recently had severe pain and slight swelling in the calf muscle of my right leg. Im resting at the moment but want to continue running. How do I avoid further injury ? any advice or self help suggestions? Im a forefoot striker and tend to wear down the outside of my shoes on the ball of my foot.
Posted: 08/08/2002 at 16:31

Oh dear,,, what have i started here... seems like a common injury....
I am going to ask a work colleague, who competes regularly and whom i consider to be a running god(!!?!) for his oppinion, and i wil let you all know what he says, I am sure he will know a good physio or place to get help.
One other thing is get shoes with a low heel tab,, I have just cut the tab of an old pair of runners as an experiment so ill let you know how that goes too.
Sian, I am a heel striker, but I do tend to wear the outer edges of my shoes as well.. I think orthotics is the way to go now, there seems to be commonalities from everyone with similar probs i speak to. Special thanks to yorkie for the tip on that one,,,,
Thanks all.
Posted: 08/08/2002 at 20:59

I have had achilles problems on my right foot since last May. Physio, better attention to stretches and avoiding hill runs and distances over about 6 miles has allowed it to settle after a year. But in the past few days I have started experiencing pain in both archilles and in my ankles and calves. My running has not changed, the only thing that has is that I no longer go to the gym for weights (stopped about 6 weeks ago due to cost)but do a few weights at home. Has anyone any ideas about this?
Posted: 08/08/2002 at 22:26

I had achilles problems last November and stopped running/x-training for 5 months (coincided with birth of baby so was easier to do). During this time I stretched up to 5 times a day - including nerve stretches taught to me by my physio. Then gradually built up - 2 mins running on the spot, then 10-15 minute runs plus gym sessions, finally back up to 6 mile runs. I now pay a lot of attention to stretching both achilles after every session, and even massage/stretch it at work just to keep it supple and it's been fine since March. Main thing it taught me is that you can't just repair the damage and then return to bad habits or it will reoccur.
Posted: 09/08/2002 at 12:28

hello all u achillies people,
we all seem to be in the same boat here, great to share info, yes i too am cutting a pair of runners i have , will let u know the results, bought a pair of addias yest, ATTUNE they are called, anyone run in those, i have laid off for a few days so mon i 'll try those new ones for a short one, anyone hope to do the dublin city marathon this year, 1 here does...hopfully, anymore hints let rip folks catch u all later. mick..........
Posted: 09/08/2002 at 21:38

Hi fellow sufferers.
HI've had trouble with both my tendons for over a year now. Rest, Stretching, ulrasound, accupuncture, (mri scans which confirmed no tearing)- had the lot! And against all advice (inc V-rep's above!) finally succumbed to a cortisone injection in one. Fantastic result. No pain -joy. Now the other one has flared up (pain and inflammation around the connection with the heel bone). I'm in agony now, after a 10 km run this morning. I'm definitely going for the second needle! Does anybody have long term experience of cortisone in the achilles tendons?
Posted: 31/08/2002 at 14:34


NRG
Yet another one with sore achilles. Started 9 months ago when I changes shoes from an Addidas Equipment Ride (new version of the Ride was not a patch on the previous version). Currently using New Balance 854s but desparately seaching for a shoes to solve my problems. I'm a fore foot striker, who mildly pronates and needs a wider shoe. In the meantime I doing the same as everyone else - massaging, stretching, heel raises, cutting off heel tabs etc but I can't shake off having sore achiilles. Can anyone recommend a shoe to help? NRG.....
Posted: 10/09/2002 at 22:33


mcc
Got more or les thes same problem - a slight swelling on my right achilles tendon which can hurt for the first 2 1/2 minutes of running before calming down. I know Ive got to take it seriously, but I'm in the last eight weeks of my training schedule for the NYC marathon so is it okay t carry on training for the next two months and then seek treatment and take rest?

Coincidently, my problems started with a pair of new Air Structure Triax - old style never caused me a hint of a problem. Moved over to Asics 2060s and my Achilles never hursts as much in these.
Posted: 11/09/2002 at 15:29

Hello again,, Since my last post, I have cut the heel tab of my Asics 2070 and boy has it helped!!, maybe my achiles is slightly better cos i dont run half as much now but I just been out, done 8 mil;e and its just a little sore. so my advice is get the scisors and cut the heel tab straight accross, maybe even a little lower if you can do it, this does pretyy much ruin your trainers for anything else but hey, your a runner and your trainers are for running in, so like nike say, JUST DO IT!,
P.S Also been taking glucosamine sulphate 500's 3 times a day (so 1500mg total), vitamin C and calcium to try and help the healing process, this also seems to have helped, maybe its just my imagination. I found the glucosamine in "the pound shop" in town at 3 quid for 90 believe it or not, which is no big loss if it dont do jack.
Posted: 11/09/2002 at 20:16

I had the same problem. I went to see a physio & had to massage the lump on my achilles and apply ice. I didn't start running again until my tendon was pain free (3 months!). Also, some daily calf raises on the stairs helped to strengthen the tendon.
The low blood flow to the achilles tendon means it heals slowly so don't run on it if it's painful or your recovery will take much longer than necessary.
I spend more time stretching my achilles now than I ever used to before!
Posted: 11/12/2006 at 20:46

Achilles people ( and that is 11% of all runners at some time in their career)

There was once a Scandinavian Runner who got so fed up with his achilles tendinopathy that he thought "bugger it - I am going to bust these tendones soone of these bloody quacks who keeps telling me to rest will just repair the goddammmned thing and I can get on with it"

So he set about dropping off a step with a ruck sack on his back and slowly increased the weights in it. As he did this he was encouraged as the pain got worse so he increased the weights and kept on running. At 6 weeks something very stranged happened, he got better and has been running ever since without any problems.

His name was Walt and he had invented Eccentric contraction exercises that encouraged the disrupted fibres of his tendone to realign themselves, and they got better. Achilles tendonitis is not an inflammatory process. It is an overuse tendinopathy. It responds to eccentric exercises like every other tendon in the body by getting stronger. The tendon does not scar unless there has been bleeding into it onlt when it has been rent asunder or if a surgeon has been there.

The secret of eccentri exercises is to not use your bad foot to get back up again, just drop down with it and use the other foot to get up. Combine this with proprioreceptive exercises and stretching and you can train on. As long as you reduce your pace (I recommend 2 min a mile slower than your long run pace) and correct the underlying problem (overproantion usually or mid foot striking in front of your cog, as well as too much heel cushioning allowing extra stretch) it will get better in 12 weeks although it may get worse at about 6 weeks.

Now I know there are many who will consider this advice to be dangerous. but it is the way all tendinopathies are now being treated in sports medical clnics and to date there has been no documented rupture, unless pace is not reduced.

ref

http://www.clinicalsportsmedicine.com/chapters/28d.htm

It is an alternative view, but it beats sitting around for months doing nothing waiting for it to get better and then realising that if you do nothing, and it does get better that it will get worse again when you start to run again.

Shoot me or maybe try it


Disclaimer this is assuming you have a true overuse Achilles tendinopathy and not a partial tear.
Posted: 11/12/2006 at 21:54

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