Living with it for 15 months and finally overcoming it
I'll mention here things to do and things to avoid during the recovery. Some of these ideas were from the SIT, some I learned myself by trial and error.
The more swollen your achilles is the harder it is to do these things but persevere!
DO NOT DO
The aim always is to stretch the tendon and attaching muscles, not contract them. Keep them warm and in use.
I expect there are other ideas. I'll give them as and when I remember them.
At this rate I'm going to be looking at causes last ...
... because I am sure what you really want to know is what running can be done (if any) while you are recovering?
OK, running. Or not? This is the question. Do you "run through" this injury, or rest up until all symptoms have gone?
This is where I've had to go out on a limb. I'd set myself some running goals and had race entries in. Generally speaking I'm not all keen at pulling out of things.
I could find no real good advice anywhere as to how far I should be thinking about running. The SIT could find no reference point for the distances I was contemplating. She was not used to long-distance runners and their mindset - and she didn't know me and wasn't able, at least initially, to judge whether I was being foolish or not. Obviously she wouldn't want her work undoing so I dripfed her with information about my events one at a time in order not to cause alarm.
We were both on a learning curve together here, I think.
My first runs had to be in the middle between therapy sessions. A few days after to recover from the session, but also a few days before the next one because those first runs caused some aggravation and there was no way I was going to let anyone near that tendon.
Ignoring that stupid hill run I did on 16 Nov 2010 which in all of the last 15 months was my worst mistake by far -and I'll talk a bit more about it later - my first run since Snowdonia marathon 30 Oct 2010 was a tentative 4 miles on 16 Jan 2011.
Well, I had to be a DNS at my first race for 2011, a 50K a week later. Even I could see the sense in that!!
My SIT was happy about resuming running and was listening to my feedback closely. Her expectation was that it would be sore to start off with, but the tendon should loosen up after a couple of miles and the pain ease off.
It did nothing of the sort - it was moderately painful throughout, with no easing off. By the evening of that day the pain was extreme and swelling huge. The next day though it was back to how it was before the run.
My next run was 11 days later, 8 miles. Again moderate pain until mile 8 when it got much stronger and I finished the run, as I put it in my log, with "loss of form". I also noted I was in "great pain for 36h".
I won't bore you with the details of all the runs, except for these initial ones.
Seven days later I was out again for 8 miles. This time "painful during miles 7-8, but no loss of form".
Ten days after that (13 Feb 2011) I was up to 10 miles, when for the first time I noticed the pain eased during miles 3-6.
By the end of February I was up to two runs a week, one short and one gradually getting longer. My first serious target event was 19 Mar so I was really working hard at getting the balance right between running and treatment, and focusing on what was creating improvement. My racing calendar for 2011 was driving me.
So I was doing these things alternately: a run then a torture session, each about two or three days apart.
On 27 Feb I managed 12 miles: "OK 2-7, getting painful 8-9, eased 10-12".
This "easing" was starting to happen, and post-race discomfort was getting less.
Something I was beginning to notice was that a day or two after each run the achilles was feeling really good, better than before the run.
Running was actually helping it.
[To be continued]
Sprint ST - yes, heel drops are very useful.
Before I go, something I haven't said is that these intial runs were at a vastly reduced pace to normal. I tried to concentrate on form and a proper gait.
Hmm. I admit we all need a maximum range of movement in the ankle when healthy. The trouble with tendonitis is that there is a real threat of tendon and muscle fibres becoming shortened. Contraction such as you describe should be avoided, certainly in the beginning stages of the injury. People with bad cases of AT, such as mine, would not physically be able to do toe raises anyway. Or would compromise themselves by using the good leg.
I always used to think, heel. Use the heel. Keep the tendon warm and stretched. When walking, or sitting, think about keeping the heel placed on the ground. Stretch out the tendon at every available opportunity.
In the second half of Mar 2011 I was having a few setbacks. I noted I was feeling "sore and tired". I had managed one 16-miler, recording "a struggle 13-16" and "sharp pincer-like pain at mile 9".
My warm-up race for 2011 was the Rhayader 20 which I did, recorded "no untoward pain". I was much slower than usual due to the injury and the lack of fitness.
This turned out to be the feature of the entire year! Lack of performance, constant nagging injury, but through it all gradual improvement.
The act of running was itself part of the healing process. Although often difficult at the time, and painful immediately afterwards, a few days later came a little more relief from the pain in the area and a little more reduction in the inflammation.
Between that race and my next on 10 Apr I only did one run, which was a 24-miler. I was just about doing the very minimum to still be able to do these events.
Don't try to do a heavy training programme. I didn't.
During this run I noted that "the achilles eased from 14 miles on". My SIT was a little surprised how far I had to go before noting this easing.
I was a little apprehensive on the start line of the Connemara 39.3, Co. Galway, but managed to complete it in just under 7 hours, about 45 minutes slower than normal. In this the achilles eased at 18 miles.
Next up to think about, and to dripfeed my SIT information with, was The Highland Fling 20 days later. This was 53 offroad miles with rocks and tree roots on the West Highland Way. She tried not to look too worried but I think by now she was slowly being drawn in to my madness. But there was more that I wasn't telling her about.
While I was in Ireland running that ultra I fell into conversation with an Irish runner who told me he had been plagued with AT for I think about a year or two and decided to visit Ireland's top surgeon specialising in sports injuries. This chap injected steroids (cortisone) directly into the tendon. He told me he had been symptom free since then, a few years.
Sounded drastic to me, but over five months into my own injury I thought I'd pay a visit to my doctor to see what he thought. He said if a GP injected into the tendon like that he would risk being struck off. The practice is extremely dangerous: it masks the pain and you risk further injury e.g. rupture, or the procedure itself can actually rupture the tendon. GPs wouldn't do it for risk of litigation. SIT was dead against it as well - she thought the body should heal itself.
Whilst at the Drs of course we had a general chat about AT and he printed out some very helpful notes, some of which I've incorporated into what I've said so far.
He also said, "The thing with achilles tendonitis it comes when it feels like it, and goes when it feels like it - there's not much you can do for it". Typical doctors! But he did suggest that I should keep moving and advised me it should be OK to resume my normal level of activity. If he had known I don't think he would consider my "normal level of activity" normal!
So, GP sanction to carry on and not rest up.
Back to Scotland, then.
Always quite a logistic exercise, this ultra. I camp the night before and get my stuff moved to different places along and at the end of the course.
Set out well enough but somewhere along the shore of Loch Lomond I stubbed my toe very badly. This sent shock waves into the achilles and I suddenly felt a rush of nausea and outrageous pain. Couldn't help the involuntary yelling. I had to stop.
Was my race over?
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