I’ve got it. How do I stop it? Can I still cycle or could this be cycling related? I have read about old bike shoes and lateral movements with cleats being a point source cause. Could this be it? What are your experiences with this problem? Please help, I don’t want to be sitting on the couch all summer!
I am not a doctor, nor do I play one on TV, so take this as unqualified advice from experience and nothing more.
I had an AT problem this spring… very frustrating. What worked for me is exactly what you don’t want to hear… no running for 6 weeks, regular icing and Advil and after the initial acute phase eccentric stretching/strengthening.
I was able (after the first week or so) to bike regularly (icing/Advil afterwards) but as a precaution I taped my ankle to prohibit dorsiflexion past 90 degrees (heel drop). This seems to allow me to bike normally, with the exception of standing up to climb.
I was also able to continue playing hockey after the first week by taping up the cuff of my skate a little higher than I like it. Seems as long as you prevent unwanted dorsiflexion of the foot you are OK.
This will not go away if you don’t deal with it so better to start your time off (whether it’s 2,4,6 weeks) now than wait.
The eccentric work is done by standing on your toes on a stair/box/etc. Use both legs to lift yourself up and the lift the healthy foot up off the step and slowly lower yourself to heels below the step with the bad foot. I was told a small amount of discomfort is acceptable when doing this but YMMV.
As always, consult a health professional before following internet advice.
- Mike
I’ve been dealing with it since April. It took some rest and my ART guy to alleviate the acute pain. I was able to continue to ride (and swim) the entire time. I’m slowing building my running back up and deal with stiffnes after longer runs (7-8 miles).
YMMV
I got mine in February, it went away mid-May. (I’m 60, so mine might’ve taken longer to resolve.)
For me, rest worked - especially with running. My run mileage was pathetic for 2+ months, and in my four races so far this season, that is apparent in the results!
Let your discomfort be your guide for cycling. At first I had to modify my mecahanics a wee bit, and for a while longer I had to be very very careful getting out of the saddle and apllying too much force. After a few weeks I was fine, and I was able to cycling hard, comfortably, many weeks before I was able to run even half effectively.
For swimming, I de-emphasized the kick and eliminated any fin work; even with my short Zoomers, I could feel the strain on the Achilles. I don’t do flip turns, but just kicking off the wall initially created some discomfort if I wasn’t careful.
As it got baetter, I tried to stretch my calves more, especially the wall stretch geared to the soleus and just above the Achilles. I did these gently, and held each stretch for 45-60 seconds. I also used the Trigger Point toys on my calves.
I lived by the adage “two weeks now can save two months later”, and that worked well – but mine was then and yours is now, and I understand your misery as the race season is well upon us. (And if misery loves company, I separated my shoulder crashing on Saturday, so I’m swimless for 6-8 weeks, contemplating the bulk of the seaon doing duathlons. Your recovery should be faster than mine, if that makes you feel any better!)
I had this problem last year getting ready for IM Canada. With me the issue was caused by weak glut med muscles and bad use of hip muscles and a lack of knee drive in my run. Cycling didn’t bother me or make the condition worse but I’d guess that it didn’t help it go away any more quickly either. Check out this link http://www.coachgordo.com/gtips/various/triatletes_achilles_tendonitis.html that addresses your question about your cycling shoes.
One of the mistakes I made, is go to your best source for the answer to your problem. To make a long story shorter, I had too many cooks in the kitchen and it got confusing, which caused my recovery to be longer than it could have been.
Treatment for me, was stretching the calf muscles a lot to get some flexibility in that part of your legs. Stretch your gastroc and solius every day to try to take some stress off the tendon. I was also doing loaded eccentric calf raises with just my body weight to start with then up to a year later doing up to 100% body weight. Also doing a lot of stability work on wobble boards. Then during the accute phase I was doing ultrasound and ionto given by a physical therapist. Then as always lots of ice
Ankle and AT issues are slow to heal because most people have very poor blood flow in that part of your body, it takes a long time, be patient. You can push an AT issue to the breaking point and that will lead to a very long time in getting back to activity. After Canada I took 4 months off of everything, then spent the next 2 - 3 months doing specific activities to shore up my weak points that were causing my issues while getting back into specific triathlon training.
What are your symptoms and when do you feel it? That will dictate what you can do now.
I have let patellar tendinitis (it is similar to achilles in progression and treatment) progress to tendinosis because I ignored it too long. Years later I am still dealing with it. Unfortunately despite having CLASSIC fvcking symptoms of this and reporting them perfectly to my care providers (and there were many) not one of the damn fools told me the proper treatment for the problem, which is eccentric strengthening–frequently.
You should mostly avoid whatever is causing you harm, but some limited amount of symptom onset is good. I’ve found that if I totally rest my symptoms will wane but I see no actual strengthening (so pain comes on quickly again with activity). It can be difficult to find a balance.
I assure you you want to deal with this earlier rather than later. Don’t let it progress to become severe.
Also, identify imbalances that are causing this problem in the first place, particularly with one side and not the other.
Mike28 is dead on with what you need to do. Do it at least once a day and your goal IS to bring some pain on. Not too much, but some. You may eventually find that your tendon feels best hours or a day after what you thought at the time was an injurious strengthening session. These tendons truly hate total inactivity and need to be worked out.
I had AT issues last year and have ankle issues this year - for both problems cycling and swimming were not an issue, only running. I found a very good orthopedist and he said it’s all about giving your calves a lot of attention when stretching - do both straight-leg and bent-knee calf/soleus stretches every day and make sure when you do it your back, butt and leg form a straight line. I find those stretches and ice really help. My doc also told me to NEVER do calf raises in the weight room because my problem is my calves are already too big and yanking the shit out of the tendons in my lower leg. Don’t know if that applies to you, but his advice worked for me!
Also, if you find running really aggravates it, I found that mixing in elliptical helped my AT and ankle recover quicker without losing much run fitness.
My symptoms are the classics for this type of injury. I have pain when I wake up in the morning and I limp around the house for the first 15 minutes of the day. Then the pain starts to go away. I don’t really have much pain on the bike but in my experience with other injuries, that doesn’t mean that I’m not getting hurt on the bike and the problem shows up on the run.
I had an IT problem a year ago and everyone said it was due to the run because IT is a running injury. Turns out it was a saddle height issue. I dropped my saddle 3 mm and all was fine over night!
Back to the Achilles- The first 300 yards of the run hurt like hell but after a point the pain stops and I can run like normal. This is probably not a good thing. Unfortunately, like all triathletes, I have learned to soak up the pain and keep moving forward.
After checking my pedals and cleats, there is a lot of slop and lateral play there. I have had the same pedals and shoes for 5 years and the same cleats now for 2 years. I ride 180 miles a week. Could this be it?
Thanks for the help.
“there is a lot of slop and lateral play there. I have had the same pedals and shoes for 5 years and the same cleats now for 2 years. I ride 180 miles a week. Could this be it?”
yes it could - tendon might be working overtime to stabilize the foot.
http://www.endurancecorner.com/library/injury_prevention_treatment/achilles_tendonitis
Treatment is here,
http://www.sportsinjurybulletin.com/archive/achilles-tendinitis.html
good luck…
It’s wild that this is a post for today, since I’ve been dying with figuring out why my heel/back of the ankle are killing me. I rode 150 miles this past weekend and didn’t have any pain until Monday morning when I woke up. I have had a relatively light running load the last 2 weeks due to work, so I doubt running had anything to do with it. I have 3 triathlons, including one next week, and the Chicago marathon coming up in October. Should I rule out any of the events, especially the tri next week? I would hate to shut it down for the tri’s and marathon later this summer/fall… but can’t imagine taking 4-6 weeks off.
Your symptoms sound exactly what I had this spring, right down to the old cleats and shoes.
I would change your cleat immediately, this could be the underlying problem. I can’t say for sure it was the cleat causing the problems in my situation but it won’t hurt to change it.
I was also stretching and icing lots and taking Advil occasionally. I also bought the Strassburg sock and used that. I think that made a difference as my achilles wouldn’t be sore when I woke up in the morning.
In any case I hope things work out for you…
BB
I had WICKED AT in 2002. I tried all the usual palliatives, stopped running, iced, Strassberg Sock, EVERYTHING— nothing worked. I was desperate and despairing. Saw one totally USELESS supposed “sports medicine doctor” who said, “Stop running.” Gee, thanks, I can see you really understand what I’m going through.
Finally saw a REAL sports med doc, who referred me to a high-level trainer who was always trying the “latest and greatest” treatments 'cause he was the head trainer for a major PAC-10 university.
I can’t believe this isn’t more “out there”; so few people seem to know about it, but this was the treatment:
http://www.performancedynamics.com/
In a nutshell, it’s similar to ART, except it’s not done with the hands, it’s done with specialized “tools” that literally dig and scrape at the injured tissue to break up the scar tissue. The resulting inflammation actually promotes healing. Yes, it hurts like hell (bring a towel to tear and chew on), but it WORKS. Fast.
I can’t understand why it’s not better known, because, honest to god, it amounted to nothing less than a miracle cure for me (and I’m not given to hyperbole in general). When the trainer guy told me I’d be running again after 1-2 treatments— and that, in fact, it’s ENCOURAGED to return to regular activity right away as part of the “rebuilding” of the tissues— I was afraid to believe him. But it was true. If you can find a practitioner in your area, DO IT. I can only report my own experience, so there’s the chance that YMMV, but if you have the chance to try this, I can’t recommend it enough. Good luck— AT absolutely sucks.
I had a bad case 5 weeks out from IMWI last year. Dr. put me in a boot for 7 days and gave me a Medrol Dosepack. I was running the next week and made it the start line just fine. Cases will vary.
I had WICKED AT in 2002. I tried all the usual palliatives, stopped running, iced, Strassberg Sock, EVERYTHING— nothing worked. I was desperate and despairing. Saw one totally USELESS supposed “sports medicine doctor” who said, “Stop running.” Gee, thanks, I can see you really understand what I’m going through.
Finally saw a REAL sports med doc, who referred me to a high-level trainer who was always trying the “latest and greatest” treatments 'cause he was the head trainer for a major PAC-10 university.
I can’t believe this isn’t more “out there”; so few people seem to know about it, but this was the treatment:
http://www.performancedynamics.com/
In a nutshell, it’s similar to ART, except it’s not done with the hands, it’s done with specialized “tools” that literally dig and scrape at the injured tissue to break up the scar tissue. The resulting inflammation actually promotes healing. Yes, it hurts like hell (bring a towel to tear and chew on), but it WORKS. Fast.
I can’t understand why it’s not better known, because, honest to god, it amounted to nothing less than a miracle cure for me (and I’m not given to hyperbole in general). When the trainer guy told me I’d be running again after 1-2 treatments— and that, in fact, it’s ENCOURAGED to return to regular activity right away as part of the “rebuilding” of the tissues— I was afraid to believe him. But it was true. If you can find a practitioner in your area, DO IT. I can only report my own experience, so there’s the chance that YMMV, but if you have the chance to try this, I can’t recommend it enough. Good luck— AT absolutely sucks.Is it like Graston? Graston uses metal tools that are pushed around the tendon. I had it done a little, but results do vary and in my case it seemed like the guy was having a tough time getting to the tendon on my knee.
I’m glad that worked for you, though!
Is it like Graston? Graston uses metal tools that are pushed around the tendon. I had it done a little, but results do vary and in my case it seemed like the guy was having a tough time getting to the tendon on my knee.
I’m glad that worked for you, though!
From what I’ve heard about Graston, it sounds similar, but the tools they use for this ASTYM technique appear to be made of acrylic or some other hard, moldable plastic. I always described getting a treatment as “getting scraped”, 'cause that’s effectively what it was like.
I had good luck witht he ASTYM treaments also.
Hunter - sorry to hear about the achilles. The previous posters have a number of excellent suggestions and although the total immobilization and steroid dose pak may be a bit much for this stage, keep it on the back burner.
I’d suggest you google a number of the Med type web sites and glean what you can, particularly as it relates to your specific symptoms. I whole heartedly agree with the straight and bent leg stretches (knowing that it’s not a contest, do this easily and gradually, not so aggressively that it hurts. Then ice down the tendon with one of those gel ice bags that you can get anywhere for 10-15 minutes. Don’t sit on the couch all summer, but, as has been mentioned above, inspect your equipment for wear, especially consider moving your cleats backwards, etc. I did a blog on this subject 2/4/2009 www.johnpostmdsblog.blogspot.com which may be of some benefit to you.
If you understand that the “itis” issue in the achilles involves micro-tearing of the tendon, you’ll want to do your best to reverse this and not lose your competetive season. Good luck.
Wow, there is a lot of information out there.
Today I made a change to some new Look pedals and new Sidi shoes. I also started the calf raises and stretches. Ice goes without saying.
Thankyou to all that helped. Please keep the info coming.