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Achilles Tendonitis - What to do?
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I have a painful case of Achilles Tendonitis and I don't want it. I'm 1/4 of the way through marathon training and I'm getting worried. It wasn't too painful until after a 10-mile race yesterday. I'm icing it as much as possible for 30-min stretches and it really reduces the pain, but it's still pretty swollen compaired to the right side. I've yet to call my HMO, but I can if necessary. I guess learning POSE is out of the question.


Sean
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Re: Achilles Tendonitis - What to do? [haystack] [ In reply to ]
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oh, that's a major pain...I had that in 99-00...trained and raced with it and each time lead to really excruciating pain on the run to DNF...
woke up during 1yr limping for the first 1h until it warmed up...and eventually stopped when it was partially torn...

advice 1: be super cautious...
advice 2: no pain killers. they hide the pain, but the problem is still there.

what worked for me is a combo of

physiotherapist+cross friction massage (super painful) twice a week
electrostimulation (compex on capillarisation program to increase blood flow in the area) even slept with it.
3000mg a day of glucosamine
changed shoes: ran for years with DS trainer of asics. got Saucony Grid hurricane and the pain was gone with the new shoes (even though I do not think it was the shoes alone but the combo of all the above).
also did some calves raises at the gym coupled with stretching of the calves (with straight legs and bend legs so you work both muscles)....

good luck.
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Re: Achilles Tendonitis - What to do? [haystack] [ In reply to ]
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I got one last year, like in February. I tried to train through it without luck. I then reduced the biking and riding, but still I could not get ride of it until I totally stopped biking and running for a full month. Swimming did not appear ro interfere with it.
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Re: Achilles Tendonitis - What to do? [haystack] [ In reply to ]
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Ice is good for inflammatory reduction. However, an achilles tendon is a different animal. If you choose to train while having achilles tendonitis, and you may be setting yourself up for bitter disappointment by choosing to do so, that means that you should ice it after every workout. But, heat and electrostimulation, and possibly ultrasound therapy, are what allows the thing the heal more swiftly. I'm was leaving out the really most effective treatment here, because you might not want to hear it...but, that treatment is REST.

I had a relatively mild case this spring because the heel counter on my shoe wasn't perpendicular to the ground. A sharp-eyed veteran running shoe owner picked up on that and gave me a new pair of shoes....a month later, with electrostimulation/heat/ice/heat/ice/heat/electrostimulaton two or three or four times a week, and I was well. This was for a mild case, mind you. And I didn't run during that month. If you have a more advanced case, it could take longer to heal. Then again, if you are much younger than I, it could take you less time.

But, simple ice therapy isn't most effective treatment for this problem, and depending upon how you choose to do it, you could slow the healing process by using only ice.



Quid quid latine dictum sit altum videtur
(That which is said in Latin sounds profound)
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Re: Achilles Tendonitis - What to do? [haystack] [ In reply to ]
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That doesn't sound good if you're bad achilles is noticabely more swollen than the other.

I just wanted to add to what others said. The problem with that tendon is it has so very little blood flow to it and therefore heals much slower. They take their time to heal so a good 3-4 days off may do the trick. But that is the reason why others reccomend the electrostimulation, ultrasound, hand massage etc. Also, if you are still running, giving it some heat and a good massage will loosen it up good before you run.
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Re: Achilles Tendonitis - What to do? [haystack] [ In reply to ]
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I'm actually working through a case of achilles tendonitis right now. It flared up when I went out for a long run a week after a 1/2 IM. I didn't stretch very well beforehand and proceeded to run an uphill trail for the first hour. I experienced swelling in the right achilles that was tender to the touch. I took 5 days off from running, tried to go out for a 1/2 hour run, and the pain returned. I've determined the contributing factors were:
  • Not giving myself enough recovery. I felt fine energy-wise and aerobically after my 1/2 IM, but obviously my tendons and support muscles weren't ready yet.
  • Stretching is key. When the calf muscles and hamstrings are tight (shortened) it places more strain on the achilles tendon.
    • Massage is also an important recovery tool for this.
  • Running up hill places a greater strain on the achilles and should be avoided when recovering.
  • Cleat placement on my cycling shoes. I ramped my cycling in response to this injury and found my achilles was still getting sore after my long rides. I finally noticed that my right cleat placement was 2mm forward of my left cleat. Moving the right cleat to a position where the centerline of the pedal spindle is behind the centerline of the ball of the foot placed less of a strain on my achilles.


I've surfed the net looking for a treatment protocol beyond the RICE method. Here is what I've gleaned from my research.
  • You need to reduce the swelling first. This will mean stop running. Ice twice a day. Start taking Ibuprofen (not for the pain, but to reduce swellin).
    • No where did I ever see anyone recommend heat as a treatment. I don't know enough to say heat won't help, just telling you what I found in my web research.
    • Cross friction massage can irritate the area, causing recovery to lengthen, not shorten. This at least was the opinion from a very informative article (that ultimately recommended Active Release Therapy). http://www.drabelson.com/AchillesTendonitis.htm
  • Avoid stretching the achilles while it's still swollen. It's injured and the fibers are torn. It needs to heal and trying to stretch it will only make things worse. DO stretch the hamstrings and calf muscles, but do this with a flat foot, similar to the stretch you get when touching your toes.
  • Get a massage. This will help to lengthen the muscles all along your kinetic chain, which in turn will transfer less stress to your achilles.
  • Once the swelling has subsided, begin a program of eccentric calf raises for the injured achilles. Doing this on a board or stair, or with gym equipment, raise yourself up with your good calf, then use your bad leg to lower yourself in a controlled manner. Do 3 sets of 15 with you leg straight, then 3x15 with a bent knee. This should be done daily. This article explains the theory and exercise treatment better than I can: http://www.sportsinjurybulletin.com/...illes-tendonitis.htm
  • Avoid hills and hard running surfaces when you do start running again. I've just started running again last week. For the week I had three 15 minute sessions on a treadmill, with a recovery day between sessions. This week I'm up to four 20 minute sessions. This is an excrutiatingly slow way back, but I'm doing my calf raises every day. I have IMFL in less than 9 weeks and I can't afford to get reinjured.


Everything I've read said this is not an injury to mess with and that you can't just "train through it." The other suggestions on shoe choice would be a good place to look at too. As a midfoot to forefoot striker I found it helped to cut out the back of the shoe that rubbed on my achilles. It wasn't helping so I cut a notch with a utility knife.

As for maintaining or building your aerobic base, the best suggestions I have are swimming, pool running, and cycling (with the proper fit and cadence).

Good luck on your recovery. I'm not an expert and am only sharing what I've learned, for good or bad. Hopefully this helps.


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Re: Achilles Tendonitis - What to do? [switters] [ In reply to ]
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Thanks to all for the advice and words of encouragement. I'm going to suck it up and NOT try to train through this. Alternate workouts and therapies are great advice and provide a change that I would have not otherwise considered. Time to also hit the weights some more and come back stronger. I'll keep you posted of my progress.


Sean
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Re: Achilles Tendonitis - What to do? [switters] [ In reply to ]
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i know that the previous poster put up a link to sports injury bulletin, but there's another article in their archives that i think is much better. the url to it is http://www.sportsinjurybulletin.com/...lles-heel-injury.htm.

i really did my achilles tendon in last year and eventually had to take 6 months off of running to let it recover. the exercises explained in this article have been fabulous.

let the tendon heal, then take care of it. one way to keep running while letting it heal a bit is to create a sort of prosthetic achilles tendon using athletic tape. a good trainer should be able to show you how to do it.

good luck.
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Re: Achilles Tendonitis - What to do? [haystack] [ In reply to ]
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excellent advice posted so far. I'd add to it only the three basic principles for any overuse injury: repair. rehabilitate, remediate.
1. Repair - first repair the worst of the damage - icing, ibuprofen, etc
2. Rehabilitate - then rehabilitate the injured area - stretching, quite often the stretching involves muscles other than the injured area, and strengthening of the area and its supporting muscles/tendons. The article from Owen Anderson is the first one I've seen that usefully addresses the strengthening issue for Achilles - thanks for the citation..
3. Remediate - before starting training again, identify and remediate the biomechanical problem that caused the injury in the first place. For running, appropriate shoes and orthotics usually make the most difference. Biking is more complicated, start with a professional fit or re-fit. Usually the answers can be found by asking 'what changed ?' New shoes, new training loads ? If nothing changed, then something probably wore out - running shoes lost cushion and/or collapsed, bike cleats allowed a different range of motion, etc.

See the 10 laws of running injuries,
http://health.iafrica.com/fitness/running/injuries.htm

I neglected a L Achilles problem for too long, with the result that it's now chronic. Don't do what I did..

"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
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Re: Achilles Tendonitis - What to do? [haystack] [ In reply to ]
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Sorryyyyy to hear! I had a case of AT for a year and a half. I tried everything. When I was told to take yet another two weeks to a month completely off or face bone spurs and eventual surgery, I either had to give up Ironman, or find another solution. What I found is going to sound too simplistic, but it worked for me. The AT occasionally comes back, but I can get rid of it now in a day or two without missing any training. You have done some "catastrophic" damage to cause swelling, so Ice is imperative. And you are going to have to let the tissue heal some. But if you don't relax and lengthen out your calf muscles, you won't get over this.

The following (cut and pasted from the forum on the Julstro sports injury website (www.julstro.com/18.html) should be useful.

When the two main calf muscles (gastrocneimus and soleus) contract, you stand on your toes. Then to put your foot back flat on the floor the two muscles must stretch fully.

If the muscle doesn't stretch it will pull on the AT, and that is the beginning of your problem. As the muscles pull on the AT they eventually try to pull the muscle from the bone. This will cause and inflammation and swelling. It could also cause your body to send bone cells into the area to hold onto the tendon attachment, and you will get a bone spur.

Stretching is vital, but are you getting the full stretch? Most people only end up stretching the Gastroc Muscle and not the Soleus. Also... What commonly cause tendonitis are muscle spasms. You need to do the basic therapy to your calf muscles. Start with this. Either sit or lie down and cross your "bad" leg over your other knee. You want your kneecap just below the back of your "bad" knee, at the top of your calf muscle. Press in hard, and slowly slide the knee down towards your heel (the movement is actually going to be lifting your bad leg up towards your chest.) You will find some very painful knots or spasms in your calf muscle. Try to cover the entire muscle, from the inside to the outside, but always moving DOWN the calf muscles with the motion. Stop before you get to your injury. Only go down to about four inches above the back of your ankle. Once you find these spasms, you want to press in with your knee on them for 60 seconds at a time. Press in as much as you can handle the pain. See if you get any relief from this.

Another method is done by crossing your leg and putting your injured ankle just above your opposite knee (typical "guy" position for crossed legs) and begin squeezing your calf muscle, just like you were kneading bread dough. Go in a direction from the top of your calf down to your AT. If you feel some points that are especially tender, those are spasms and you need to squeeze them, or press on them, for 60 seconds. This should take the initial pain away. You can then gently stretch the muscles.



I am speaking from experience here. You will initially need to do the self-treatments four or five times a day and stretch as well (only when warm). Start easy, however. You will get over this, but it won't be a quick fix.

Good luck.
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Re: Achilles Tendonitis - What to do? [haystack] [ In reply to ]
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 I cannot stress this enough: There is no way to cheat this injury. If you try to train through this, you could be laid up for months.. and battle a chronic injury for years. Last year - I could not sit my ass down. And I suffered as a result, now it comes back sporadically and I have to be ultra careful. I'm lucky, it could have been worse.

Sit down, give it lots of massage, do some pool workouts, but make sure you give it time to heal.
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