Achillies Tendonitis

Hi, I have developed achillies tendonitis. I've been treating it with cold therapy and ibuprofin and it seems to go down but then I train again and it comes straight back.

 Any advice??

 Thanks

Eccentric loading

Thanks for the in depth response...... I'll google it

What you are probably experiencing is called Achilles Tendinopathy.  It used to be called Tendinitis, but recent rsearch shows us that it is not inflammatory, it is degenerative.  First thing you may find beneficial are heel raises in both shoes - about 6mm (example here: http://www.algeos.com/acatalog/EVA_Heel_Raises___6mm_Thickness.html).  Have a pair in all your shoes - stick them underneath the shoe inlay if possible.  This will reduce the tensile loading in the Achilles when walking.

Next thing you need to do is start eccentrically loading it. This means you stretch it, but whilst giving it your body weight.  Read this here for more info: http://www.sportsinjurybulletin.com/archive/achilles-tendonitis-1.html
Or here for some images: http://images.google.com.au/images?svnum=100&hl=en&gbv=2&q=Eccentric+exercise+in+treatment+of+Achilles&btnG=Search+Images

Sounds crazy that when something is sore and painful that you'd put more load on it doesn't it? Story of how this was found out many years ago: Dr Alfredson had a painful achilles tendon.  He was sharing a rural surgical coverage in Sweden.  He asked his colleague to treat it surgically.  The other doctor didn't want to work on Dr. Alfredson's achilles because then he'd have to cover Dr. Alfredson's practice during the healing process, so Dr. Alfredson tried to stress his tendon enough to rupture it to force the other doctor to attend to him. He did this by standing on the bottom step and lowering his heel below the level of the step. Instead of rupturing the increased stress convinced his body to repair it.  And so 'Alfredson's prescription' was born (and with it he became a legend).

Thanks a lot, I'll give it a go. I feel bad for the abrupt answer to your initial response!

i have a bit of this going on in my achillies and massaging helps. im now trying not to spend too much time and money at the physio so curious about massaging it myself. any particular way i should do this?

I'm recovering from this.  Ended up being unable to run at all and after 8 weeks off it still felt tender.  Physio 'prescribed' the eccentric loading described above.  Seems to be permanently tender to the touch and feels 'odd' but I'm back running again albeit straight line jogging up to 5 miles only and with a day's rest between each.  Got to carry on with the eccentric loading for around 12 weeks total.

2 x 20 on each leg with knee straight then the same with knee bent, morning and night.

Massage wise I seem to recall that any massage can be good but 'cross hatching' works particularly well in helping the repair process to be 'neat'.

Is the eccentric loading supposed to aggravate the Tendonitis? I found when I did the eccentric loading exercise the Tendonitis got more painful.

I found that for the first week or so too, but afterwards it began to very slowly improve.  Still sore every morning after nearly 6 weeks of them.

If you only got your Achilles sore now and want to avoid long term problems, go to a good sport physio!! I had the same issue about a year ago and went to a physio who described ice, rest & massage treatment. The pain went away for a little while but returned again and again until it was so sore that already walking caused pain.

I found a physio who is specialised in running problems and he put my running on hold for next  at least 3-5 months. I had developped a chronic tendonitis where there's already scar tissue developed around the lower part of the tendon. The problem I have is that my leg muscles are not strong enough for the amount of training I do (I run or RAN couple of marathons a year) and that caused my knees to bend inwards a little bit, which in turn loads & twists the tendon.

The answer for me is 4-5 times a week strenght training where the tendon is working on fairly heavy loads PLUS core training. Exercises that I do are such as 1 leg cable row, reverse lunges, squats, 1 leg presses etc.. so far I have done this for 2 months and it seems to be helping a little bit but I have still a long way to go.  For cardio I cycle & swim.

If the strenght training  is not helping the next step, which I hope I never get to, is Platelet Rich Plasma injections. But as said - I don't want to go that far.

So I would recommed to get your running assessed and go to a specialist to avoid long term issues!

other than building your muscles could you look at a way to stop your knees rolling in. and do you also get patela pain?

What Dub Runner says.  You have to be patient and stop running for a while to  allow the tendon to heal whilst at the same time making it stronger and more flexible.  I'm now able after about 6 weeks (and being unable to even put weight on the affected leg at first) to run 4 miles or so painfree, and am introducing gradients.  But this has to be alongside a strengthening programme - standing on one leg to bat about a balloon, wobble board, weighted calf raises and plyometrics etc and as a veteran runner I think this will have to be a lifelong regime now.  I find that massaging the tendon's sore spot in a horizontal manner (from the back of the tendon "in" towards the foot) first thing on a morning helps and after a while it goes numb.  Also massage calves, these are often tight and it is a cause.  I had a few physio sessions which were helpful and informative - included accupuncture and ultrasound although I'm no expert on the science.  All the best with your recovery.

I got Achilles Tendonitis on 5 May this year after a month of big miles. The increase in mileage caused it for me. Rested for 3 weeks and came back to running. It flared up. Rested for another 6 weeks and eased back in but after 7 runs (the longest being 2.5 miles), it flared up again.

Now considering not running until January 2012. Have done eccentric exercises throughout, and iced and massaged. Seen physio etc.. but rest and eccentris seem to be the only answer.

It really is a nightmare of an injury to beat. I used to run 40 miles or so a week and in January I did a 28 mile off road Ultra with several other big races planned this year and now I can't even manage 2 miles without suffering a slight twinge the following day.

smalleyboy - i feel your pain.. I'm so frustrated not being able to run. I had Dublin Marathon and couple of smaller scenic runs planned and i'm trying to start training for my first ever Iron Man competition.. but can't do other than swimming and cycling at the moment.

it's such a hard problem to get rid of..

Dub Runner - keep up with your cycling and swimming to keep your fitness up. I have a friend who does Ironman events and he is currently suffering from the dreaded Achilles Tendonitis. He got his 4 weeks before the Zurich Ironman and did minimal running before the race after he got the injury. He ended up with a PB on the day but took ibuprufen during the run. He is now paying the price though with a very sore achilles.

I believe rest and eccentrics/strengthening exercises are the only way to heal it. I now have no stiffness in the morning when I waken but will still leave it for at least a full month before I ease back into running. I would prefer to lose a month now to increase my chances of a full recovery than risk running too soon and losing 2 or 3 months if it flares up.

Good luck

I've been running for about 5 years and recently suffered my worst injury to date which was some kind of Tendonitis... right on the outsdie of my heel. Felt like some kind of heel spur or fracture and was quite excruciating for a week or two.

 I visited the doctor and he referred me to a physio on the NHS. They were very helpful and offered me some massage therapy on my calf muscle and gave me some ulrta sound to speed up healing, this combined with the exercises has helped clear it up within two months. I initially had some good advice and diagnosis off a Worcester podiatrist (have included a link to them), they diagnosed the same as the doctor but they think there is more to it than just the injury, I am now undergoing tests for my gait, although I've had it tested at a running shop some time ago, the podiatrist advised that a full analysis by a professional is a better option, although I can't really afford to spend too much so will see what the quote is first. They have already identified a small difference in my leg which was Ok, and think that the calf muscle on the good side is extremely tight and affecting my running style, this rings true with the wear on my trainers and tallies with what the physio is saying.

Some of the tips which seem to be helping me is to do strengthening exercises for the calf muscles, by standing on tip toe with legs shoulder width apart for 30 seconds three times a day, then the same exercise but on one leg (holding onto something if balance is not great), also rolling the soles of my feet over a gold ball... I was told this may be painful but it actually feels more like a massage to me.

The ultra sound seems to have helped if you can get it on NHS but I know not all practices have this facility, or even believe in it. The calf massages are vital I think, I was told by my podiatrist that the achilles heel can be affected by tightness in the muscles further up the leg, so I've been stretching my calf muscles even when not running, and also my hamstringsand this seems to help too.

Not sure if any of the above helps, you probably know all this but thought I'd add my thoughts as I know how painful and restricting it can be. Even now it still pulls slightly but the exercises and physio really do seem to help.

There are loads of hamstring exercises but I've posted the one I find easiest to do as an image here. Good luck anyway! I'm hoping mine holds out for the Birmingham half marathon in October.

Hi! I could do with some help here please.

I'm marathon training and running a half this weekend. I've taken things easy this week not least because I've had a stiff back. So I've had a couple of sports massages to sort the back out and a regime of lots of hamstring stretches and that's worked pretty well.

I went out yesterday for a gentle 30 mins to see if the back would flare and no problem, however bizarrely I've got a mild achilles pain on the LHS which is a surprise as I took it really easy. It's the first time I've experienced any problems with my achilles - so I'm new to this.

The problem manifested itself as some morning stiffness, some mild tenderness when the tendon is pinched at its thinnest point behind the ankle bone, and some pain when the tendon is fully stretched.

As this is all so mild and incipient I'm wondering if the massage has caused a transient bit of achilles bruising - not that I'm looking to apportion blame, I'm interested in what might have caused this and how to treat it. I'll ice the foot and do more stretches before Sunday's half but probably avoid eccentric loading exercise (if it proves necessary) until next week.

I have a neoprene prosport ankle support that I'll use for the race - I haven't worn this for ten years since a bad sprain on the other ankle. Additionally I'll probably go for a steady pace over the distance and not a PB.

Any comments on this strategy and further suggestions? As I say, achilles problems are new to me...

Thanks. S_D

First of all, thanks to all who have already posted excellent advice on this thread.  I would like to hear from any runners who have successfully rehabilitated after achilles tendinitis, please.  I'm at the stage where I've done the ice and rest thing and put that to one side.  I have been doing eccentric loading of the tendon, pain free, every couple of days (bilateral calf raises on a step, 3 sets of 20).

My rule is, no pain -  continue,: pain -  discontinue instantly. Is this right?

So I've been doing pain free squats with free weights @half bodyweight - three sets of 12, as well as step ups onto a raised platform, holding a 24 kg weight in each (straight) arm.  And I've been using a machine with a circular platform which spins round at various angles, flexing the ankle - bilaterally and one leg at a time - great for balance.  I also do the Romanian deadlift.

I've kept my aerobic fitness up by doing elliptical trainer sessions as well as my road bike. Both are pain free.  (Even steep hills).  I suppose I cycle 60 miles a week,  do the equivalent of a tough interval session on the elliptical trainer and later in the week, the equivalent of a tempo run session on the elliptical trainer, lasting about an hour.   As I say, all of this is completely pain free. 

However, the other day I jumped down from a very low height and that was enough to remind me the injury hasn't gone very far away.   When I massage/ probe the tendon, it feels bruised.

 How long have runners found it necessary to do strength stuff as I'm doing  before it's safe to get running again?

I was hoping to race a mile at the end of this month but do feel that is strongly unrealistic, however small the distance may seem, as it's a very fast event.

QFS

All my searching on forums has shown me plenty of posts from people suffering but very few from people stating how they have beaten AT.

I could well be wrong but I believe the eccentric exercises are to strengthen the hamstring/calf so that it will reduce the load on the achilles when you exercise. I believe the aim of the exercises is to help avoid AT when you return to fitness. I think the only thing that will help the achilles repair is rest, massage to try and dissipate any thickening of the tendon and more rest.

I have reached a stage where I have rested on and off for 4 months and have started back to running last week with 2 x 3 mile runs.

My achilles is currently slightly stiff in the morning but this goes after 1-2 minutes of walking. I have no pain in my achilles during the day or night. I can pinch my achilles firmly and feel no pain. If I point my toes to the ground (extending the front of my foot but shortening the achilles) and rub my achilles with my fore finger, I feel moderate pain. I currently ice my achilles 1 or 2 times a day and also massage it for 10 minutes 1-2 times a day. I still try to do eccentric heel dips (50 reps, 3 times a day). I have no pain during or after running and plan to run 2-3 times per week for 4 weeks and then consider increasing my mileage gently if appropriate. 

Only time will tell how we all fare.

Good luck. 

Smalleyboy, thanks for this very helpful and in-depth reply. I'm glad that your achilles rehabilitation is going okay. It does sound as if a measured and consistent approach pays off. I've noticed, just as you do, that few people post the secrets of their recovery, yet many ask how to fix it.

Sounds promising that you are able to run again twice a week. I admire your self-restraint with the mileage and no doubt this will be better for you in the long term.

I'm now 4 weeks post-injury. Today I went to the gym and did eccentric calf raises x 20, then went on the balance machine (it's motorised and orbits around at various angles with the ankle in a flexed position - have you seen them?) as a warm up, both feet and then single feet.

I then walked at 6.5 km/hr for a minute, pain free. Then I jogged at 8 km/hr pain free for two minutes, then stopped.

I then repeated the eccentric stretches before running just 500 metres at 10 Km/hr. I stopped at that distance because I wanted to see what effects this running might have later today or tomorrow. It's a tiny distance but my first run for four weeks. My rule was if I started limping even a tiny weeny bit - game over instantly.

After that I was able to do 3 sets of deadlifts, completely pain-free, with about 75% of my bodyweight. The deadlift involves a huge number of muscles, including all of the calf group, according to an anatomy book that the gym instructor showed me.

I finished off by doing the classic runners' calf stretch for 30 seconds a side. Walked home without any limp.

Massage and achilles on ice later.

Thanks again for posting and will you give us updates? Very interested to see how it works out for you.