My PT suggests running to help with Achilles tendon pain – thoughts?

Jan 7, 20 12:21

Post #1 of 17 (2471 views)

I've been dealing with pain in my right Achilles for the past month. No idea how/why it started and no history of Achilles issues, so I'm in new territory.

I've been seeing a PT since it flared up. He's been working on my ankle mobility, calf flexibility, and I've been doing the eccentric heal exercises. I started off with body weight and only lowering to the floor but now I'm up to eccentrics on a step with 40 lbs in a backpack. This past week I tried two test runs, each just a very easy mile. I can definitely feel my Achilles pain while running, maybe about a 4/10 on the pain scale and it doesn't loosen up or get better as I go along.

Today my PT suggested that I should increase my run as a way to help add more load to help rehab the Achilles. He even said something like "sometimes you need to push through it to help get better," which surprised me. I questioned him on the advice since I don't want to do anything that's going to set me back, but he reiterated that as long as the pain is in that 4-6 out of 10 range then it should be safe to run.

He's not advocating I jump back to previous mileage, but instead progressively increasing the length of my runs with a day off in between because, apparently, tendons take 24-36 hours to recover from exercise. Some pain (4-6) is good to help load the tendon, lots of pain (>6) means I'm overdoing it. I've read a lot of people on the forum say "Don't Run!!" with Achilles issues, so I'm cautious.

For people who have had mid-portion Achilles pain, what are your thoughts/experiences regarding "running as rehab?"

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [Northy] [ In reply to ]

Jan 7, 20 12:53

Post #2 of 17 (2441 views)

That's a similar to the instructions I've been given in the past---but maybe a bit more agressive on the allowable discomfort. My achilles injury was 15 year ago, though...and, the general approach has continued to evolve toward a more rapid return to active rehab. I'd trust your PT, but keep him/her informed of any INCREASES in discomfort as a result of the added load.

I went through a similar thing for a severe abdominal strain a couple years ago. After a period of healing and rehab exercises, we started to add load as long as the discomfort didn't get worse. whenever it did, we backed it down and progressed more slowly.

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [Northy] [ In reply to ]

Jan 7, 20 13:08

Post #3 of 17 (2426 views)

He is right.

Rest does not cure Achilles tendonitis.

Properly loading the tendon does.

"Good genes are not a requirement, just the obsession to beat ones brains out daily"...the Griz

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [Northy] [ In reply to ]

Jan 7, 20 13:11

Post #4 of 17 (2420 views)

There was a podcast on that triathlon show this year that had an injury / rehab episode.

I recall them citing a number of recent studies that said the same thing.

Some discomfort is okay.

Kind of sounded like you have to train your body to not overreact to the stimulus.

For sure no intensity until you are back to 100%. Lots of low intensity until you are built back up.

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [Northy] [ In reply to ]

Jan 7, 20 13:24

Post #5 of 17 (2395 views)

Agreeing with the others. One of the things I read here by someone smarter than me is that Achilles like the right level of loading. Not too little, not too much. Like a Goldilocks thing. Unless your Achilles is acutely damaged then resting it won't solve anything. The trick is knowing if it is acutely damaged. Since you work with your PT I'm sure it isn't.

Increasing your run or pain out of 10 is getting into the specifics . So can't help there. But the general idea seems right.

Obviously what you need to do is warm up way more than you normally might. So read loads on that. Experiment with clothing and shoes. Compression stuff? Full length trousers? Thick warm socks? Maybe try a gel pack you can microwave and that velcros around the lower leg. Not static stretching but mobility exercises to get things moving. Oddly the one that worked for me is something I haven't read anywhere and is simply moving the foot in circles from the ankle. Just both feet and both directions for as long as it takes. With shoes off if you can because I find sometimes the heel tab aggravates the Achilles. I came up with that in desperation starting very short runs and having to stop because everything was way too tight.

I didn't run through it as such, I just did little and often and tried to find ways to warm and loosen it up as much as possible.

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [Northy] [ In reply to ]

Jan 7, 20 15:01

Post #6 of 17 (2339 views)

I suffered with achilles pain between 2014 and 2016. I don't know if there is one thing that fixed it as like you I tried a lot of "cures" but I will say that I credit being able to keep running by putting heel lifts underneath my running shoes insoles. I ran with them for about a year until I was able to wean myself off of them. I'm careful now to wear a shoe with a good drop and I avoid walking barefoot anywhere/anyplace.

Last edited by: TJ56: Jan 7, 20 16:20

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [stringcheese] [ In reply to ]

Jan 7, 20 18:27

Post #7 of 17 (2241 views)

stringcheese wrote:

He is right.

Rest does not cure Achilles tendonitis.

Properly loading the tendon does.

Thanks everyone. Sounds like the consensus is to trust that *appropriate* loading of the tendon is a good thing, even if it hurts a bit.

Now I just need to make sure I can find, and stay within, that sweet spot.

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [OddSlug] [ In reply to ]

Jan 7, 20 18:32

Post #8 of 17 (2232 views)

OddSlug wrote:

Obviously what you need to do is warm up way more than you normally might. So read loads on that. Experiment with clothing and shoes. Compression stuff? Full length trousers? Thick warm socks? Maybe try a gel pack you can microwave and that velcros around the lower leg. Not static stretching but mobility exercises to get things moving. Oddly the one that worked for me is something I haven't read anywhere and is simply moving the foot in circles from the ankle. Just both feet and both directions for as long as it takes. With shoes off if you can because I find sometimes the heel tab aggravates the Achilles. I came up with that in desperation starting very short runs and having to stop because everything was way too tight.

On the short test runs I've done, the one where I spent some time on the elliptical first felt best. I think I'll keep with that warm up strategy for the near future.

Surprising to me, riding the trainer has been hit or miss. Some days it feels ok, some days it aches. Strangely it doesn't seem to correlate with effort either – it's hurt on easy days and felt fine riding sweet spot, other days it's the opposite... I'd be less bummed about not running if I could substitute lots of riding instead.

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [Northy] [ In reply to ]

Jan 7, 20 18:46

Post #9 of 17 (2221 views)

Northy wrote:

Today my PT suggested that I should increase my run as a way to help add more load to help rehab the Achilles. He even said something like "sometimes you need to push through it to help get better," which surprised me. I questioned him on the advice since I don't want to do anything that's going to set me back, but he reiterated that as long as the pain is in that 4-6 out of 10 range then it should be safe to run.

Well it can get worse if you continue to run, it can become chronic, but also rest probably won't help. He needs to figure out what's going on with it, what's causing the pain. Mine was problematic for over a year, it wasn't until my physio diagnosed tight hip flexors that the problem went away.

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [Northy] [ In reply to ]

Jan 8, 20 4:27

Post #10 of 17 (2132 views)

Northy wrote:

OddSlug wrote:

Obviously what you need to do is warm up way more than you normally might. So read loads on that. Experiment with clothing and shoes. Compression stuff? Full length trousers? Thick warm socks? Maybe try a gel pack you can microwave and that velcros around the lower leg. Not static stretching but mobility exercises to get things moving. Oddly the one that worked for me is something I haven't read anywhere and is simply moving the foot in circles from the ankle. Just both feet and both directions for as long as it takes. With shoes off if you can because I find sometimes the heel tab aggravates the Achilles. I came up with that in desperation starting very short runs and having to stop because everything was way too tight.

On the short test runs I've done, the one where I spent some time on the elliptical first felt best. I think I'll keep with that warm up strategy for the near future.

Surprising to me, riding the trainer has been hit or miss. Some days it feels ok, some days it aches. Strangely it doesn't seem to correlate with effort either – it's hurt on easy days and felt fine riding sweet spot, other days it's the opposite... I'd be less bummed about not running if I could substitute lots of riding instead.

Maybe look at your cleats. The further forward they are the more leverage there is that your calf and Achilles have to work against. Moving them further back helped me and hasn't been a problem since even though the Achilles can still be a problem running.

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [Northy] [ In reply to ]

Jan 8, 20 7:22

Post #11 of 17 (2021 views)

Thoughts????

Get a new PT

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [Northy] [ In reply to ]

Jan 8, 20 7:25

Post #12 of 17 (2017 views)

My PT told me the same thing about Plantar Fascitis. And they were right....gentle running helped more than sitting around

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [Scottxs] [ In reply to ]

Jan 8, 20 7:37

Post #13 of 17 (2014 views)

Scottxs wrote:

Thoughts????

Get a new PT

errrr....did you read the rest of the thread?

Those of us who've been through a treatment plan for an achilles injury have all had similar advice and success as what has been provided to the OP.

So, what would be the basis of your rebuttal?

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [Northy] [ In reply to ]

Jan 8, 20 15:56

Post #14 of 17 (1931 views)

agree with your PT..

had achilles issues coming up on 2 decades now, with a couple of years where I couldn't run at all.
as long as I keep doing the eccentric loading exercises a couple of times a week, and run enough, it's manageable.
if I miss a month or two of running at least twice a week, it stiffens up again and starts to flare up after runs.. even when doing the exercises.

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [Geek_fit] [ In reply to ]

Jan 8, 20 18:22

Post #15 of 17 (1904 views)

I'm dealing with very minor P-fascitis right now. When you say "gentle running" did you basically remove intensity and reduce mileage but continue to run regularly? That (plus icing, a brace and rolling on a ball) seems to prevent it from getting worse so far, though it doesn't seem ready to go away yet.

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [SJK] [ In reply to ]

Jan 8, 20 18:41

Post #16 of 17 (1892 views)

Like 5 minutes of running. Check symptoms for 24 hours.

Then..6 minutes of running.

I gave up on that stupid brace and sock and just rolled my feet.

Re: My PT suggests running to help with Achilles tendon pain – thoughts? [Northy] [ In reply to ]

Jan 8, 20 19:09

Post #17 of 17 (1877 views)

I agree with your PT as long as it is not torn. I ran through both plantar fasciitis and Achilles tendonitis. Eccentric dynamic stretching helps a ton with both especially the Achilles. I just did heel drops from a curb and held it for 5-10 seconds then repeated that a few times. A light load and stimulus will help heal both Achilles and plantar fascia issues. I would stay away from intense running, and keep your foot strike directly under your center of gravity when you run. Deep tissue calf massage helps a lot and loosens up both muscles that act on the Achilles. A small heel lift helps as well.

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