Suffered through this for almost a year and tried ART and ASTYM and modified heel drops. None of those made it go away. When I did run it was not comfortable and it was poor quality. What fixed it? You won't like the answer but REST. 2-3 months no running. Almost a year later I am pain free but I am reminded after a hard effort that it still lurks down there.

Can read this --> http://www.runningwritings.com/...tric-heel-drops.html

but I'm still searching for a solution. It's been nearly 2 years of this and it's not going away. I've tried 3 months rest for 2 times now (basically sit on butt and do nothing. Up to the point of finding excuses not to walk).

But it doesn't help any at all.

Try isometric exercises to start with (shown to build strength while also decrease pain).
seated calf raises with weight on your knee is best.
If have access to the gym can use a bar in the smith machine.
Use a relatively heavy load eg 20kg plus the bar.
Lift and hold 30 sec, rest 2 mins repeat 3-5 times. The rest between reps is really important.
If your pain is 1-2/10 that's ok, if your pain is 3-4+/10 stop.
Progress by increasing time to 45 sec (eg over a week or 2).
Then increase the weight, using the pain scale as your guide.
Try and do 2 times per day.

DON'T stretch - especially initially in the rehab. Especially for insertional tendinopthies.
Best way to describe it is you don't want the tendon to be 'pulling away' from the attachment site, early on in the rehab. Give it a chance to heal.

That's also why you don't start with eccentric heel drops.
I see it a lot with my patients (and see it a lot on this forum) - wondering why they are not getting better with stretches and eccentric heel drops.

The most important thing to fix a tendon is build up strength. If you rest it's just getting weaker.
I say you need 'relative rest' for a few days at the start of the rehab, do the exercises, then slowly add low load activities eg swim and bike. Then progress to running.

Progression is isometric, then isotonic (eg calf raises 2-3x10 up and down on floor), then eccentric.

when you want to get back to running start with a jog/walk - start 1min jog : 1 min walk.
Progress run (jog) time using the same pain scale ie 1-2/10 = ok; 3-4+/10 stop.
If you are still getting pain 24 hours post run then you have done too much.

Hope that helps.
NB This is only a guide, individual cases can vary quite a lot.

Took me a year to get to the point where I wasn't noticing it all the time. My PT told me heel drop is not the answer for insertional issues and gave me several exercises to strengthen the area in a progressive way and told me not to ice given the limited blood supply. I found this article pretty much mirrors what she told me.

http://www.michaeljlord.com/...6/9/29/achilles-pain

I also taped the area in question to reduce rubbing.

I have battled Achilles issues of many kinds over the past 15 or so years.
Tendonosis, pain when the tendon joins the heel bone, bumps on the tendon. Swelling.
Of all the treatments that I have tried, Arrosti is the only one that I feel confident reccomeding.
Man I hope you don't struggle with this as much as I have, good luck!

it's a bear.. have it since 2008, crippled early 2011 until 2013 with minimal running.
Stopped running for 6 months doing the eccentric work, the flat eccentric heel drops helped where the stair drops did not. Also did a lot of cycling, this provides a good flow of oxygenated blood to the tendon without putting any stress on it.
Hokas really helped my recovery. I did the eccentric drops both flat and stair 3 times a week as maintenance.
Recently got lazy and neglected the drops, the pain is back and bad, stopped running again and back in rehab for a month or two, we will see.
Back on the flat eccentric drops, also doing Dave Roche's lunge routine since I suspect that weakness and instability of the supporting muscles and tendons may well be a factor. I'll add back calf strength exercises as pain permits.

It might be caused by glute or hip flexor issues; the Achilles is just compensating for imbalance. Perhaps try a deep tissue massage in those areas or, if possible, find a trainer who specializes in this stuff. I had a ton of scar tissue in my hip socket and right glute not firing = left Achilles problems.

Arnica Gel works surprisingly well; I put it on my affected calf and Achilles nearly every day.

You may want to read Kelley Starrett's book Ready to Run. One main recommendation is zero-rise shoes. Bought Altra Escalantes just for casual use. Wow, game-changer! Those are amazing! Can feel the Achilles stretch out; feet feel great. I don't wear them for running, though, they feel sluggish. I'm using a moderate rise (4mm) Saucony Freedom vs Nike Pegasus which I used for years.

can you describe your symptoms for 'insertional' achilles tendonitis? I've been battling something like achilles tendonitis since February with massage, physio, acupuncture to no avail. I can still run but not quality. It would be appreciated. Thanks.

I am also guessing this may be the cause of my Left one getting bad. (right achilees is the original one. still hurts).
I've been using a ball to hit the Trigger points on the Hips and see how it's working. Really _really_ painful, hence My mind tells me that I'm hitting the right spots.

I went from 4mm to a 12mm which was better, then on one fine day that I didn't have my 12mm, i took the 4mm and ran 5k (Super Slow pace) and ended up w/ VERY sore achilees immediately after.

Could Tight ITBs also cause the issue?

Always have to recommend getting with a doctor to try and get a proper imaging, physical exam and diagnosis. There is a differential diagnosis list for injuries to this area that may vary treatment protocols for your specific case and working that out with your MD would be best. Most likely you are going to end up with some mobility mobility work of the gastroc/soleus especially if ankle rocker is problematic for you.

Here is a link to some of our resources - https://www.thetrainingplansource.com/achilles-tendinitis

Best In Health,

Scott Proscia, BS ATC M.Ed ACSM CPT
IRONMAN Certified Coach
Head Performance Coach
IREP Athletics / The Training Plan Source
Coaching - http://www.irepathletics.com
Training Plans - http://www.TheTrainingPlanSource.com
coach@thetrainingplansource.com

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just so u know.. your site dont render properly on chrome(Version 60.0.3112.113) nor IE

fairly simple - pain in the heel is probably insertional, pain above the heel is plain old tendon.

See the runningwritings.com link already posted for a diagram and further explanation..

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"It is a good feeling for old men who have begun to fear failure, any sort of failure, to set a schedule for exercise and stick to it. If an aging man can run a distance of three miles, for instance, he knows that whatever his other failures may be, he is not completely wasted away." Romain Gary, SI interview

irrelevant if its insertional, tendon, bursitis. Back off on any mileage or intensity and go into healing mode.

walk/ light jog as is comfy

as much heat therapy as possible

patience and focus on the other two disciplines. They are both very safe and therapeutic for your Achilles. just nothing explosive in effort

I'm dealing with this right now. Asked about it here just last week. Doing the eccentric heal drops on flat ground. 3x15 reps twice a day. Barefoot on carpet. Hardfloors make the big toe joint hurt by the 45th rep. Got an IM in 2 months. Damn it.

Tried running yesterday for the first time in 9 days since this flared up. I did 15 minutes / 2 miles, very deliberate midfoot strikes, not pushing off with the rear leg very much at all to keep the tendon from extending, and instead compensating by increasing cadence. That seemed to work but the heel was a little more sore last night and this morning, this after 8 days of progressively less and less pain. Seems like rest is the only way.

So heat works? I'll try microwaving an ice pack tonight.

http://www.raynersmale.com/...ned-loading-programs

This is necessary reading. Learn how tendons heal. Many people do not respond to just eccentric loading. I didn't. It wasn't until I incorporated both concentric and eccentric loading that my tendon started healing.

Tendons heal by loading them.

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"I went from 4mm to a 12mm which was better, then on one fine day that I didn't have my 12mm, i took the 4mm and ran 5k (Super Slow pace) and ended up w/ VERY sore achilees immediately after. "
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THIS!!!


So many Achilles issues from zero drop, minimal etc. shoes. People do not understand or respect the amount of time it takes the body to adapt to these shoes....

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Mike

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Owner/General Manager North Central Cyclery, Dekalb IL
http://www.NorthCentralCyclery.com

Great thread I no idea that tendon heal by load..
I got currently Achilles tendinitis, I have one question though is there a difference between load and pressure? Im guessing bad pressure that comes from palces not supposed to can cause damage right? Im thinking of getting this ankle support.. will it help?

I noticed improvement switching to Altra (75â„… of runs).Also, I foam roll my heel, lifting butt off ground so ibtry to hear a popping sound on each roll. Has really helped


Now I also know a local top AG here who went to Finland for a spec surgery. He is back and stronger than ever at 50 years old smoking some itu level guys