I’m an experienced runner (D1 runner, 10+ marathons, etc.) who all but stopped running because of chronic achilles problems. One thing that has been a huge, recent benefit to me is increased strength training – lots of lunges, step ups, fire hydrants and bird dogs, etc. I realized running in front of a mirror on a treadmill that my ankle was turning, because my knee was collapsing inward, because my glutes weren’t activating. So I’ve been doing a lot of leg work, with dumbbells. Just getting stronger, better alignment and tracking of limbs, and the natural HGH and testosterone boosts from lifting heavy things probably helps with healing, too. Something for you to think about. As I get older, my injuries are never caused at the spot of the pain, but usually farther “upstream” at a different joint closer to my core.
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Re: achilles tendonosis? [IronHoosier]
[ In reply to ]
Re: achilles tendonosis? [mortysct]
[ In reply to ]
mortysct thanks for the great information! Please provide a post on Achilles tendinopathy. Your posts have been very helpful and some more detail specifically on Achilles tendinopathy would be greatly appreciated.
Re: achilles tendonosis? [atasic]
[ In reply to ]
atasic wrote:
I had three episodes. The key each time was 8 weeks or so NO, zero, nada running.This. Don't run. At all. Sucks, but that worked for me too.
"The first virtue in a soldier is endurance of fatigue; courage is only the second virtue."
- Napoleon Bonaparte
Re: achilles tendonosis? [IronHoosier]
[ In reply to ]
Sharing some results from Matt Russle
https://instagram.com/p/BdptJV-FQ0V/
Dave Jewell
Free Run Speed
https://instagram.com/p/BdptJV-FQ0V/
Dave Jewell
Free Run Speed
Re: achilles tendonosis? [TNK75]
[ In reply to ]
I've just started to write a post about achilles tendinopathy. Posting it here when it's done!
Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede
Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede
Re: achilles tendonosis? [mortysct]
[ In reply to ]
It grew long... Happy reading and good luck loading yourselves!
As requested I’m putting together this short piece on Achilles Tendinopathy (AT) since I’ve noticed that just as in the high hamstring tendinopathy thread, a lot of people are having trouble managing this issue properly.
I’m a newly graduated physical therapist from Sweden with a special interest in (the treatment of persistent) pain, tendinopathy, load programming and triathlon coaching and movement positivism in general. I’m very anti to passive therapies such as ultrasound, laser (I do like Major Lazer tho), needles no matter if they inject something or not, rubbing with hands or metal butterknifes (“IASTM”) or pulling hastily in someone joints to create a pop. I’m very pro active therapies such as doing stuff yourself so that you can keep doing what you love and be in power of your own health.
First, we need to talk about the Continuum of Tendon Pathology by Cook & Purdam:
As you can see, a tendon that has been put through more load than it can take will become reactive. This is what many of us athletes have felt when ramping up swimming or running volume: our shoulder/Achilles start hurting. It's a load-induced hurt and the pain is usually 0/10 in rest. Taking a few days off, maybe some ibuprofen and like magic, its gone. That is "appropriate modified load" for the reactive tendinopathy.
However, if one continues to apply excessive load or if any other individual factors becomes worse, the tendinopathy will not resolve by itself and will enter a disrepair/degenerative phase. This is often called "chronic" tendinopathy because it's much tougher to get rid of, but as you can see looking at the model "appropriate modified load" can get you out of the degenerative phase as well.
So, what loads a tendon?
Tendon is loaded by movements, and there are 3 types of load we can apply to the tendon.
The first, most basic load is tensile loading; this is simply done by flexing the muscle that inserts into the tendon. This is generally well tolerated even by a degenerative tendon. The amount of tensile loading is proportional to the muscles contraction (add weight and it's more loading). An example for Achilles tendinopathy is to just raise your heel 1 inch off the ground, standing on your toes. An easy way to quantify this type of load is to start with isometrics and count time under tension. Isometrics might also immediately reduce tendon pain through a mechanism way out of scope for this text, but it’s a cool thing to try. For AT, you probably want to stand in a doorpost and do a shoulder press to increase load on the tendon. The second type of loading is compressive loading. This is when a tendon wraps around a bony structure and is put under tensile loading, compressing it towards that bone. A good example is the peroneal tendons, wrapping around the lateral malleolus:
This type of loading is often aggravating for tendons. The reason is also beyond this text. Here is a pic which describes where the common tendons are compressed.
The third type of loading is energy storage; what tendons are best at. This is also often aggravating and especially if it is combined with compression (like the peroneal tendons or distal Achilles tendon when running). This type of loading comes from a lengthening of the tendon from an external force when the muscle is 'locked' isometrically. Think of the calf complex when running; the calf will contract isometrically but the foot will reach maximum dorsiflexion at mid stance; this loads up the tendon with mechanical energy that will be released at toe-off.
So this gives a very basic understanding about what tendinopathies are; an inability to tolerate the current load. By modification to this load, we can create adaptation and get the tendon functional and pain-free again. How long this takes depends on how long you've had the tendinopathy, individual factors (training response, morphology, psychological factors, etc.) and how much demand you will put on your tendon.
So how does one start rehabbing a tendinopathy?
Step one is to find your current load tolerance and build from there. Start with tensile loading out of compressive positions. For the foot's tendons this means maximum plantarflexion, but if you have mid-portion Achilles tendinopathy the good news for you is that if you are barefoot, there is likely no compression. Start with an isometric program only for a few days and see if this calms the tendon down or aggravates it. If you tolerate it, start doing some actual movement. If you don’t, reduce load. Keep track of what you do and add in more exercises the more you can tolerate. When you can do pretty much, start adding in some compression. When you tolerate this, add in energy storage. It's all simple in writing but takes time, tears, commitment, experimentation. It's like ironman finish times; easy to do it fast on paper.
Special considerations for Achilles Tendinopathy:
Ideally you need to find out a few things about your tendinopathy before you construct your rehab plan. There are 3 major types of AT:
Midportion AT:
The most classical. You have pain about halfway through the tendon, maybe 3-7cm above the insertion at calcaneus. It’s most likely that you got this tendinopathy from running. The most obvious way to add compression to this tendinopathy is to have a tight heel counter in any if the shoes you are using.
Insertional AT:
Common among the stubborn cases. The pain is at the calcaneus. Plenty of morning pain. The presentation is more like plantar fasciopathy in that the prognosis is slower and that you be pain free after warmup up, reducing your motivation to rehab and further adding to the slow progress.
Midportion AT with compression from plantaris tendon:
If your midportion AT hurts primarily medially (medial = towards the midline) and does not respond well to the traditional heel raise program, you might have plantaris involvement. The plantaris is an artefact of a muscle that’s now just a tiny sliver at the back of your knee, with a long tendon running next to the Achilles tendon. Dorsiflexion of the foot, especially with an extended knee, causes this tendon to compress against the Achilles tendon. This causes compressive load and happens to be coupled with energy release at terminal stance of running. Strangely enough this kind of AT is the subvariant that is aggravated by cycling (well not too strange; each pedal stroke is knee extension+ankle dorsiflexion = compression). The reason why this kind of AT is a bad responder to the traditional heel raise program is that the heel raises on a step with a straight leg keeps the compression loads high and we want a rehab protocol to start in a non-compressive position.
Another sub-type is AT with paratenon involvement. If you have plenty of crepitations (feeling like theres sand inside there), you might have paratenon involvement. Treat like plantaris tendon involvement.
Midportion AT:
The easiest to treat. There is plenty of general programs out there, I’m presenting a basic one. If you want another one you can google the “Silbernagel protocol”. First you remove aggravating loads: those that make you hurt a little extra the next day. You also want to minimize compressive loads, generally that’s from your shoes heel counter. Get shoes that’s very soft over the achilles (look at Adidas Ultra Boost for an example) and try not to use shoes at all most of the time.
Loading protocol:
W1-2: 3x30-45s heavy isometric straight leg heel raise. Use a barbell or a friend on your back. Likely you need to do one leg at a time. Then do 2-3x30-45s with a really bent leg; more than 90 degrees. A good way to do this is to sit down, wrap a solid textile band between the front of your foot and above your knee and do a heel raise with max force. Do this every day. If this gives you analgesia (removes pain) you can start with concentric-eccentric exercises as follows:
W3-6: Heavy one- or two-legged heel raises on a step that’s at least 5cm. Go slow; 2-3sec up and 2-3s down. That means a set of 15 needs to take at least 1 min. Use a metronome if it helps you. Do 3-4 sets of 10-15 reps. They can (and if you’ve been symptomatic for a longer time, will) be painful. After this you should do 2-4 sets of 10-20 reps with a bent leg (pref >90 degrees). Working with a bent leg is tricky, the gold standard is of course a seated calf raise machine. One can experiment with doing squatted calf raises (challenging), one leg wall-squatlike heel raises (leaning into a pilates ball or a skateboard) amongst other things or keep the band isometric from the above phase. If nothing fits you, double up on the first exercise (what I do when I get AT). Do these exercises with at least one rest day in between, so 2-3x/week. Monitor tendon grumpiness the day after loading. Also start getting back into normal training when you can’t make your tendon worse with heavy slow loading.
W7-12: Use the same exercises as above. Do more running. Cut down on the reps, increase the weight. Get to 5-6 sets of 4-8 reps where each set is taken to the point that you heel raise height is greatly reduced.
Insertional AT:
Slow one… Compression comes from the calcaneal bone, where the tendon wraps around it. Just like in peroneal tendinopathy, the tendon is compressed towards the bony structure when the foot is in neutral (“90 degrees”). The compression is removed when the foot plantar flexes, so you need to get a high drop shoe, add in another heel cup (women can start walking in heels. Ofc gents can do this as well, sadly its not in fashion…). Also, do not stretch. Stretching the tendon adds a lot of compression with only very little tension. It will not help you. You might also want to adopt a more toe-pointer pedal style on the bike.
W1-3: Heavy isometrics as per above, keeping the heel at least 4-5 cm above the surface. The rich triathlete can get a diagnostic ultrasound by a skilled therapist and find out at what angle the tendon starts compressing against the calcaneal bone and work above that angle and make sure that the shoes got just enough drop to be in a position with no compression.
W4-8 Start with 1-3 sets of isometrics, then go with concentric-eccentric heel raises. 2-4 sets of 10-15 reps with a straight leg, 3-6 sets of 10-20 reps with a bent leg. Don’t go deep at all, rather put a book or something under the heel to reduce how deep you go in these. You want to be out of compression still. During this month, go gradually deeper by reducing the height of the book. Keep at least one rest day between these sessions and monitor for increase in pain.
W9-16: Keep increasing your range of motion. Increase load; reduce your reps. Maybe you could already introduce running in your new high-drop shoes, otherwise try it now. Run on flat courses, uphill requires more dorsiflexion and thus more compression.
Achilles tendinopathy with plantaris tendon compression:
Follow the program for insertional AT, but substitute some of the straight leg heel raises for bent ones. You might need to reduce biking as well and lower your saddle. Pedal like Froomey.
I suspect that in the future we will use collagenase treatment to the plantaris tendon to simply get rid of it if it is deemed to cause AT. As a side note, I think that I’ve ruptured mine; I used to have a lot of AT in my right calf and did only biking for a few months, it just got worse until one day I had a snap at the medial side of my tendon during a >1000w sprint followed by a palpable difference in my tendons. Since then: no AT. You don’t need the plantaris. It’s an artifact. It’s jokingly called “the freshmans nerve” since it’s often mistaken as a nerve by first year med students during anatomy class. If you don’t respond to the program above, get the tendon cut.
Best of luck in treating your tendinopathy. It's a slow process. Not complicated, but slow. You need to keep at it. Even if you are pain free you need to keep the loading up for a while after returning to normal running, since tendon adaptation is slow af and heavy slow loading is a better strategy to achieve adaptation than just tri training.
Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede
As requested I’m putting together this short piece on Achilles Tendinopathy (AT) since I’ve noticed that just as in the high hamstring tendinopathy thread, a lot of people are having trouble managing this issue properly.
I’m a newly graduated physical therapist from Sweden with a special interest in (the treatment of persistent) pain, tendinopathy, load programming and triathlon coaching and movement positivism in general. I’m very anti to passive therapies such as ultrasound, laser (I do like Major Lazer tho), needles no matter if they inject something or not, rubbing with hands or metal butterknifes (“IASTM”) or pulling hastily in someone joints to create a pop. I’m very pro active therapies such as doing stuff yourself so that you can keep doing what you love and be in power of your own health.
First, we need to talk about the Continuum of Tendon Pathology by Cook & Purdam:
As you can see, a tendon that has been put through more load than it can take will become reactive. This is what many of us athletes have felt when ramping up swimming or running volume: our shoulder/Achilles start hurting. It's a load-induced hurt and the pain is usually 0/10 in rest. Taking a few days off, maybe some ibuprofen and like magic, its gone. That is "appropriate modified load" for the reactive tendinopathy.
However, if one continues to apply excessive load or if any other individual factors becomes worse, the tendinopathy will not resolve by itself and will enter a disrepair/degenerative phase. This is often called "chronic" tendinopathy because it's much tougher to get rid of, but as you can see looking at the model "appropriate modified load" can get you out of the degenerative phase as well.
So, what loads a tendon?
Tendon is loaded by movements, and there are 3 types of load we can apply to the tendon.
The first, most basic load is tensile loading; this is simply done by flexing the muscle that inserts into the tendon. This is generally well tolerated even by a degenerative tendon. The amount of tensile loading is proportional to the muscles contraction (add weight and it's more loading). An example for Achilles tendinopathy is to just raise your heel 1 inch off the ground, standing on your toes. An easy way to quantify this type of load is to start with isometrics and count time under tension. Isometrics might also immediately reduce tendon pain through a mechanism way out of scope for this text, but it’s a cool thing to try. For AT, you probably want to stand in a doorpost and do a shoulder press to increase load on the tendon. The second type of loading is compressive loading. This is when a tendon wraps around a bony structure and is put under tensile loading, compressing it towards that bone. A good example is the peroneal tendons, wrapping around the lateral malleolus:
This type of loading is often aggravating for tendons. The reason is also beyond this text. Here is a pic which describes where the common tendons are compressed.
The third type of loading is energy storage; what tendons are best at. This is also often aggravating and especially if it is combined with compression (like the peroneal tendons or distal Achilles tendon when running). This type of loading comes from a lengthening of the tendon from an external force when the muscle is 'locked' isometrically. Think of the calf complex when running; the calf will contract isometrically but the foot will reach maximum dorsiflexion at mid stance; this loads up the tendon with mechanical energy that will be released at toe-off.
So this gives a very basic understanding about what tendinopathies are; an inability to tolerate the current load. By modification to this load, we can create adaptation and get the tendon functional and pain-free again. How long this takes depends on how long you've had the tendinopathy, individual factors (training response, morphology, psychological factors, etc.) and how much demand you will put on your tendon.
So how does one start rehabbing a tendinopathy?
Step one is to find your current load tolerance and build from there. Start with tensile loading out of compressive positions. For the foot's tendons this means maximum plantarflexion, but if you have mid-portion Achilles tendinopathy the good news for you is that if you are barefoot, there is likely no compression. Start with an isometric program only for a few days and see if this calms the tendon down or aggravates it. If you tolerate it, start doing some actual movement. If you don’t, reduce load. Keep track of what you do and add in more exercises the more you can tolerate. When you can do pretty much, start adding in some compression. When you tolerate this, add in energy storage. It's all simple in writing but takes time, tears, commitment, experimentation. It's like ironman finish times; easy to do it fast on paper.
Special considerations for Achilles Tendinopathy:
Ideally you need to find out a few things about your tendinopathy before you construct your rehab plan. There are 3 major types of AT:
Midportion AT:
The most classical. You have pain about halfway through the tendon, maybe 3-7cm above the insertion at calcaneus. It’s most likely that you got this tendinopathy from running. The most obvious way to add compression to this tendinopathy is to have a tight heel counter in any if the shoes you are using.
Insertional AT:
Common among the stubborn cases. The pain is at the calcaneus. Plenty of morning pain. The presentation is more like plantar fasciopathy in that the prognosis is slower and that you be pain free after warmup up, reducing your motivation to rehab and further adding to the slow progress.
Midportion AT with compression from plantaris tendon:
If your midportion AT hurts primarily medially (medial = towards the midline) and does not respond well to the traditional heel raise program, you might have plantaris involvement. The plantaris is an artefact of a muscle that’s now just a tiny sliver at the back of your knee, with a long tendon running next to the Achilles tendon. Dorsiflexion of the foot, especially with an extended knee, causes this tendon to compress against the Achilles tendon. This causes compressive load and happens to be coupled with energy release at terminal stance of running. Strangely enough this kind of AT is the subvariant that is aggravated by cycling (well not too strange; each pedal stroke is knee extension+ankle dorsiflexion = compression). The reason why this kind of AT is a bad responder to the traditional heel raise program is that the heel raises on a step with a straight leg keeps the compression loads high and we want a rehab protocol to start in a non-compressive position.
Another sub-type is AT with paratenon involvement. If you have plenty of crepitations (feeling like theres sand inside there), you might have paratenon involvement. Treat like plantaris tendon involvement.
Midportion AT:
The easiest to treat. There is plenty of general programs out there, I’m presenting a basic one. If you want another one you can google the “Silbernagel protocol”. First you remove aggravating loads: those that make you hurt a little extra the next day. You also want to minimize compressive loads, generally that’s from your shoes heel counter. Get shoes that’s very soft over the achilles (look at Adidas Ultra Boost for an example) and try not to use shoes at all most of the time.
Loading protocol:
W1-2: 3x30-45s heavy isometric straight leg heel raise. Use a barbell or a friend on your back. Likely you need to do one leg at a time. Then do 2-3x30-45s with a really bent leg; more than 90 degrees. A good way to do this is to sit down, wrap a solid textile band between the front of your foot and above your knee and do a heel raise with max force. Do this every day. If this gives you analgesia (removes pain) you can start with concentric-eccentric exercises as follows:
W3-6: Heavy one- or two-legged heel raises on a step that’s at least 5cm. Go slow; 2-3sec up and 2-3s down. That means a set of 15 needs to take at least 1 min. Use a metronome if it helps you. Do 3-4 sets of 10-15 reps. They can (and if you’ve been symptomatic for a longer time, will) be painful. After this you should do 2-4 sets of 10-20 reps with a bent leg (pref >90 degrees). Working with a bent leg is tricky, the gold standard is of course a seated calf raise machine. One can experiment with doing squatted calf raises (challenging), one leg wall-squatlike heel raises (leaning into a pilates ball or a skateboard) amongst other things or keep the band isometric from the above phase. If nothing fits you, double up on the first exercise (what I do when I get AT). Do these exercises with at least one rest day in between, so 2-3x/week. Monitor tendon grumpiness the day after loading. Also start getting back into normal training when you can’t make your tendon worse with heavy slow loading.
W7-12: Use the same exercises as above. Do more running. Cut down on the reps, increase the weight. Get to 5-6 sets of 4-8 reps where each set is taken to the point that you heel raise height is greatly reduced.
Insertional AT:
Slow one… Compression comes from the calcaneal bone, where the tendon wraps around it. Just like in peroneal tendinopathy, the tendon is compressed towards the bony structure when the foot is in neutral (“90 degrees”). The compression is removed when the foot plantar flexes, so you need to get a high drop shoe, add in another heel cup (women can start walking in heels. Ofc gents can do this as well, sadly its not in fashion…). Also, do not stretch. Stretching the tendon adds a lot of compression with only very little tension. It will not help you. You might also want to adopt a more toe-pointer pedal style on the bike.
W1-3: Heavy isometrics as per above, keeping the heel at least 4-5 cm above the surface. The rich triathlete can get a diagnostic ultrasound by a skilled therapist and find out at what angle the tendon starts compressing against the calcaneal bone and work above that angle and make sure that the shoes got just enough drop to be in a position with no compression.
W4-8 Start with 1-3 sets of isometrics, then go with concentric-eccentric heel raises. 2-4 sets of 10-15 reps with a straight leg, 3-6 sets of 10-20 reps with a bent leg. Don’t go deep at all, rather put a book or something under the heel to reduce how deep you go in these. You want to be out of compression still. During this month, go gradually deeper by reducing the height of the book. Keep at least one rest day between these sessions and monitor for increase in pain.
W9-16: Keep increasing your range of motion. Increase load; reduce your reps. Maybe you could already introduce running in your new high-drop shoes, otherwise try it now. Run on flat courses, uphill requires more dorsiflexion and thus more compression.
Achilles tendinopathy with plantaris tendon compression:
Follow the program for insertional AT, but substitute some of the straight leg heel raises for bent ones. You might need to reduce biking as well and lower your saddle. Pedal like Froomey.
I suspect that in the future we will use collagenase treatment to the plantaris tendon to simply get rid of it if it is deemed to cause AT. As a side note, I think that I’ve ruptured mine; I used to have a lot of AT in my right calf and did only biking for a few months, it just got worse until one day I had a snap at the medial side of my tendon during a >1000w sprint followed by a palpable difference in my tendons. Since then: no AT. You don’t need the plantaris. It’s an artifact. It’s jokingly called “the freshmans nerve” since it’s often mistaken as a nerve by first year med students during anatomy class. If you don’t respond to the program above, get the tendon cut.
Best of luck in treating your tendinopathy. It's a slow process. Not complicated, but slow. You need to keep at it. Even if you are pain free you need to keep the loading up for a while after returning to normal running, since tendon adaptation is slow af and heavy slow loading is a better strategy to achieve adaptation than just tri training.
Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede
Attached Files:
-
Tendinopathy continuum.jpg (157 KB)
Re: achilles tendonosis? [mortysct]
[ In reply to ]
I didn't read your post because I no longer am searching for a cure for insertional AT. Believe me, last year ago I would have studied it intently. I suffered from plantar and insertional AT for four years and read every article I could find on it, visited multiple specialist, tried lots and lots of therapies (almost fell for the surgery trap), but never totally stopped running, probably because I was finishing the legacy program and was selected during the time I was afflicted by this malady.
I just completed a 260 mile running training block last month. Unthinkable for me. There is hope! What was the cure? God only knows for sure and it's always the last thing you tried that gets the credit which for me was 1. a month of no running, 2. going back to maximum support shoes (i.e Brooks Beast), and 3. the BarryP back to running plan (available on ST).
Good luck to all that are suffering from PF/AT/insrtAT. There is hope!
I just completed a 260 mile running training block last month. Unthinkable for me. There is hope! What was the cure? God only knows for sure and it's always the last thing you tried that gets the credit which for me was 1. a month of no running, 2. going back to maximum support shoes (i.e Brooks Beast), and 3. the BarryP back to running plan (available on ST).
Good luck to all that are suffering from PF/AT/insrtAT. There is hope!
Re: achilles tendonosis? [mortysct]
[ In reply to ]
i started having AT pain 2 weeks ago. i took a week off and then stupidly raced a half marathon. (i'm kind of proud i can run a 1:30 even with achilles pain though!) anyways, for a few days afterward even cycling on the trainer hurt. i took another week off and the pain still comes back after 2 miles of running.
i'm considering taking a month off of running while doing the exercises you posted but i'm curious if i should stop riding too. i was able to ride on the trainer pretty hard the last two days without pain, but if it'll hurt me instead of helping i'm willing to stop that too
i'm considering taking a month off of running while doing the exercises you posted but i'm curious if i should stop riding too. i was able to ride on the trainer pretty hard the last two days without pain, but if it'll hurt me instead of helping i'm willing to stop that too
Re: achilles tendonosis? [mortysct]
[ In reply to ]
Thank you so much for posting this! Not only is it great information regarding AT, it explains why I have received somewhat conflicting treatment advice from different medical professionals (stretch vs don't stretch, wear a wedge heel vs wear a flat shoe). Eccentric heel drops have not worked for me at all and although resting is effective, the pain inevitably comes back. I'm going to try the isometric raises and see how that works out.
Re: achilles tendonosis? [Lilly44]
[ In reply to ]
Lilly44 wrote:
Thank you so much for posting this! Not only is it great information regarding AT, it explains why I have received somewhat conflicting treatment advice from different medical professionals (stretch vs don't stretch, wear a wedge heel vs wear a flat shoe). Eccentric heel drops have not worked for me at all and although resting is effective, the pain inevitably comes back. I'm going to try the isometric raises and see how that works out.We tend to hang on to our biases as health professionals... If someone has high hopes in stretching, gives stretching to their patients and they improve, they attribute the improvement to their intervention. Most shit get better just by time and therapists can start believing they are wizards even though their interventions might be shit (cough chiros cough).
If your pain is mid-tendon, both stretching and wearing low drop shoes is not really contraindicated, just unecessary. Give my progression above an attempt and when you can do dynamic heel raises you can start experimenting with running again.
jazzymusicman wrote:
i started having AT pain 2 weeks ago. i took a week off and then stupidly raced a half marathon. (i'm kind of proud i can run a 1:30 even with achilles pain though!) anyways, for a few days afterward even cycling on the trainer hurt. i took another week off and the pain still comes back after 2 miles of running. i'm considering taking a month off of running while doing the exercises you posted but i'm curious if i should stop riding too. i was able to ride on the trainer pretty hard the last two days without pain, but if it'll hurt me instead of helping i'm willing to stop that too
Give the progression in my post a try. If it doesnt work, consider plantaris involvement. Surely you should ride during; if you can ride without pain it is not doing anything bad for your tendon. Cycling is very low load for the tendon, especially if you move your cleat back and pedal slower cadences.
Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede
Re: achilles tendonosis? [mortysct]
[ In reply to ]
Great post.
I started having trouble with one achilless (my good one, the other one ruptured about 5 years ago) in August. Kept exercising, but a little less through September but it got worse. Reading now it was probably a midportion AT with possibly a compression of the plantaris tendon. Typically it would be painful and stiff in the mornings and at the start of a run, but used to get better after 10-15 min of running. I did some heel raise exercises and that seemed to help a little. In October I was on a big fieldwork trip during which I knew I wouldn't exercise, so I kept running and biking (which also caused pain) through September and planned on taking 4 weeks of rest in October. Some days during the fieldtrip I was limping the first 15 min of the day and there was no improvement at all. It was painful to touch and I could feel a swelling. Back home I started doing the heel raises more regularly and started running again. I planned to keep running if it got better or at least not worse, and stop/back-down running if it would get worse. I did the 3-2-1 programme with frequent but short runs and did 1-3 sets of heel raises each day (both straight legs and bent legs). I also started mixing in biking again. Slowly but surely it started feeling better, while I was also increasing the running up to January and from December also started increasing the biking. Running went from 35 km/week to 70 km/week, all running at a slow pace. From February I backed down the running duration and do a little more intense runs and longer long runs and increased the biking (mid-volume long-distance base plan from trainerroad). I realized this week that I hadn't felt the achiless the whole week! It took some time, but didn't really affect my training I'd say.
I started having trouble with one achilless (my good one, the other one ruptured about 5 years ago) in August. Kept exercising, but a little less through September but it got worse. Reading now it was probably a midportion AT with possibly a compression of the plantaris tendon. Typically it would be painful and stiff in the mornings and at the start of a run, but used to get better after 10-15 min of running. I did some heel raise exercises and that seemed to help a little. In October I was on a big fieldwork trip during which I knew I wouldn't exercise, so I kept running and biking (which also caused pain) through September and planned on taking 4 weeks of rest in October. Some days during the fieldtrip I was limping the first 15 min of the day and there was no improvement at all. It was painful to touch and I could feel a swelling. Back home I started doing the heel raises more regularly and started running again. I planned to keep running if it got better or at least not worse, and stop/back-down running if it would get worse. I did the 3-2-1 programme with frequent but short runs and did 1-3 sets of heel raises each day (both straight legs and bent legs). I also started mixing in biking again. Slowly but surely it started feeling better, while I was also increasing the running up to January and from December also started increasing the biking. Running went from 35 km/week to 70 km/week, all running at a slow pace. From February I backed down the running duration and do a little more intense runs and longer long runs and increased the biking (mid-volume long-distance base plan from trainerroad). I realized this week that I hadn't felt the achiless the whole week! It took some time, but didn't really affect my training I'd say.
Re: achilles tendonosis? [TriStart]
[ In reply to ]
Well done! Tendons love loading, so it's tough to rest it off. You gotta be smart with how you apply this load and it seems like you are.
Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede
Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede
Re: achilles tendonosis? [mortysct]
[ In reply to ]
mortysct wrote:
It grew long... Happy reading and good luck loading yourselves! As requested I’m putting together this short piece on Achilles Tendinopathy (AT) since I’ve noticed that just as in the high hamstring tendinopathy thread, a lot of people are having trouble managing this issue properly.
.......
In these days i'm starting to feel some pain in my achilles tendon. Is not the first time, in the last few years i've experience AT in both my tendons and the right one have a slight tendinosis but it is under control and in the last 2 years it did not get worse.
As i said at the moment the pain is really low but because i'm starting to raise my weekly run volume in order to prepare a 70.3 and an IM (in september) i want to be prudent. If i have to stop running i can do that at the moment it's always better than stopping run in the specific period (july or august)
I'll start to do eccentric calf raises ok, but i know that even with a very few reps (with only my boidy weight) the first times when i start to do this kind of exercise my calves hurt for some days even when i climb stairs. So what i really don't know if if i can run in these days or not.
Tommorow my plan was to do a 20km Run ..but whit this tendon i think i'll only run 14/15 km.
Re: achilles tendonosis? [mortysct]
[ In reply to ]
mortysct wrote:
Well done! Tendons love loading, so it's tough to rest it off. You gotta be smart with how you apply this load and it seems like you are.Just an update (need some positive opinions :) )
I ran only 16km yesterday with some little pain on both my achilles for the first 300/400 meters. Now i see that if i apply a pressure with my fingers in the left achille's tendon it hurts a little and i can feel like a little hard ball in my calf. I'll use a foam roller tryin to make it disappear but the question is always the same: can i run or it's better to stop runs for a week or two ? (my A priority race is the Italy IM on 22 September)
I ve changed my asics nimbus (with only 450km) for a new pair to see if this can help, maybe the cause of my tendonosis were the shoes
Re: achilles tendonosis? [IronHoosier]
[ In reply to ]
Can't recommend dry needling enough. Might be tough to walk for a couple days after, but the process clears up lagging injuries efficiently after a month or so of sessions.
Re: achilles tendonosis? [Fab4mas]
[ In reply to ]
Just out from my FT office.
I've a lighet peritendinitis, nothing serious but:
1) i have to cut off some pressure on my tendon by cutting my asics nimbus shoes (in the tendon zone i admit they are a lot rigid and 'high')
2) eccentric exercises the day i don't run (at the moment i run 3 times per week)
3) ice after every run
4) not too slow because tendon is more stressed if the cadence is low becaus it remains in 'stretch position' longer (this sounds a bit odd to me but anyway....)
5) no long runs (50/60' max)
6) foam roller for calves because mine are in terrible state: after 3 session of eccentric raises they hurt a lot and even climb stairs is difficult)
opinions? tips?
I've a lighet peritendinitis, nothing serious but:
1) i have to cut off some pressure on my tendon by cutting my asics nimbus shoes (in the tendon zone i admit they are a lot rigid and 'high')
2) eccentric exercises the day i don't run (at the moment i run 3 times per week)
3) ice after every run
4) not too slow because tendon is more stressed if the cadence is low becaus it remains in 'stretch position' longer (this sounds a bit odd to me but anyway....)
5) no long runs (50/60' max)
6) foam roller for calves because mine are in terrible state: after 3 session of eccentric raises they hurt a lot and even climb stairs is difficult)
opinions? tips?
Re: achilles tendonosis?
[ In reply to ]
RE: shoe mods.
Here's a video I found when I was looking for some solutions to achilles pain with Hoka Cliftons:
https://www.youtube.com/watch?v=-GefOAzmnx4
Even just cutting out the extra foam above the heel counter helps. I've been battling pain since I tried ramping up to a full standalone marathon this winter. I let my heel simmer down--but realized that even walking on grass in Cliftons was enough to aggravate it again, so...out comes the razor blade.
Here's a video I found when I was looking for some solutions to achilles pain with Hoka Cliftons:
https://www.youtube.com/watch?v=-GefOAzmnx4
Even just cutting out the extra foam above the heel counter helps. I've been battling pain since I tried ramping up to a full standalone marathon this winter. I let my heel simmer down--but realized that even walking on grass in Cliftons was enough to aggravate it again, so...out comes the razor blade.
Re: achilles tendonosis? [mortysct]
[ In reply to ]
mortysct,
Thank you!!!! By following your suggestions my Achilles Tendonosis has not caused me any problems for the last several months. I thought the Achilles Tendonosis would never go away, but your protocol saved the day. Thanks again for writing out an excellent, easy to follow protocol to eliminate this painful injury!
TNK75
Thank you!!!! By following your suggestions my Achilles Tendonosis has not caused me any problems for the last several months. I thought the Achilles Tendonosis would never go away, but your protocol saved the day. Thanks again for writing out an excellent, easy to follow protocol to eliminate this painful injury!
TNK75
Re: achilles tendonosis? [TNK75]
[ In reply to ]
Sweet! Tendinopathy is usually very easy to treat but sometimes very slow to respond. One needs to understand wth is going on in order keep it up and not start to foam roll, dry needle, inject whatever, etc.
Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede
Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede
Re: achilles tendonosis?
[ In reply to ]
I was dealing with a case of Achilles tendinosis last year. I noticed I was in less pain when I ran in my trail shoes When there was snow on the ground. My trail shoes (6mm) have a lower drop than the road shoes (8mm) I was wearing at the time. I switched to some low drop Hokas (4mm) and my Achilles problems went away. Though counterintuitive, lower drop seemed to help. I think the lower drop keeps my Achilles stretched.
Re: achilles tendonosis? [LouisQ]
[ In reply to ]
I've got long term Achilles issues that don't have a professional diagnosis. I used to either get shoes with large heel drops or add heel lifts. At some point I must of got bored to swapping the heel lifts around and I noticed being fine in shoes like some Hokas that don't have a large drop. At the moment I'm thinking all around comfort is a big deal. I've got a running pod that says the landing impact in the Hokas is low. Maybe a heavier landing was aggravating the calf muscle and tendon before? I was trying to tend to mid foot to heel landing because my natural is to fore foot strike and that can be a problem. Now I don't really think about the landing and can just run. Just mentioning it in case there are parallels for you and the drop is a red herring. Trail shoes tend to be firm. For me it might all be coincidence, I think running in a slow buildup barryp way was probably the biggest difference.
IronHoosier wrote:
Anyone out there overcome this overuse injury? I started back running after doing the NYC MARATHON last year and developed sharp pain in my achilles. Saw a dr and PT 1st week in January. Diagnosed it as achilles tendonosis. I have been doing the stretches, strenthening, ice, heat, rolling and now 4mths later I am still in pain and not better off then early january. I see a sports dr who works with the pacers/Colts in april. Would it help if they put a boot on me for a few weeks? Anyone have any luck overcoming this? Getting depressed not being able to run anymore..Fist this sucks....and it sucks for a long time.
I fought this for 2 years. Sucked up the pain, had it injected, was in a boot for a month. No running for 6 weeks, ran only flats after that. It still hurt and the final fix was self diagnosis. I was standing in front of a full length mirror and looked at my Achilles bilaterally. I knew I pronated but didn't know why. I noticed my ankles turned in, my arch collapse, and my Achilles bent inward (medial). I knew that couldn't be good and stability running shoes didn't help. I went to a different doc, he x-ray my feet and and my achilles was not inline with my big toe on both feet because of my pronation.
He did a 3D scan of my feet, fit me for orthotics for pronation and problem fixed.