Achillies Tendonitis Recovery Plan

Triathlon Forum
1

So I picked up this injury overdoing it a few weeks ago but mixing too much intensity, mostly on the treadmill (not sure if that mattered) and probably also pushing my shoe mileage a little too far as a contributing factor.

I’m using an anti-inflammatory 2-3 times a day, switched to a 8mm offset well cushioned shoes (Saucony Ride 6) from my Cortanas and Kinvaras, icing occasionally if it’s visibly swollen, doing 1 legged eccentric heel drops on the edge of stairs 1-2 times a day to try and strengthen it, cut back my run mileage by about 2/3rds and I’ve been sleeping with a night splint to keep my foot close to 90 degrees. I’ve ordered a new pair of Cortanas, and I think I’ll stop using the Kinvaras. That’s just too little shoe. I may stick with the T7’s for 70.3 and less since it has a higher offset, but at this point will probably race my IM in the Cortanas.

It’s better than it was a week ago, but seems to have plateaued. I guess the lack on patience that got me into this has me nervous about how long it takes to get out of it.

So what to do now? Cycling doesn’t make it worse and there’s only mild discomfort oddly at lower intensity levels. There’s only mild discomfort running, and a little more walking downstairs.

Do I need to swim only for a week to see if it gets better? Should I continue to run at reduced mileage and ramp up cycling and swimming to fill the gap in terms of training load?

I realize that no matter what, I’ll have to “claw” my way back to where I was at. Probably follow a BarryP type plan on only IM pace running speeds and after a few weeks re-introduce a very limited amount of tempo.

I’m looking for a damage control strategy to test here. I suppose if I go after a swim focus now, I could then back off my swimming later on and focus back on cycling.

I’m having trouble figuring out how much cycling is likely to inhibit recovery of this type of injury. Obviously it places a load on that tendon, but it’s static, not a high impact dynamic load. I have my Time cleats positioned all the way back. I did that to reduce knee soreness a few months and ago and it’s worked perfectly.

Some more history. This left leg has a little less strength, has had plantar fasciitis issues on and off in the past, that leg has had knee issues in the past and looking at my shoe wear pattern I heel strike a little harder with that foot, though I mostly have a midfoot strike and run with a descent 176-186 cadence depending on pace. Its’ worst in the morning, and evening which I think is typical.

If it manages to heal, is it really fully healed, or will I always have some serious concerns with this injury?

Should I be switching back to a less flexible, posted shoe like Hurricanes for training to take more load off the calf?

2

Have you thought about Active Release Therapy?

I went through what seems like the exact same process as you last year, I backed off my running mileage a bit - spent more time in the pool and someone recommended ART… I went twice a week for maybe 4 weeks and I was completely fine after that. I worked on strengthening that leg over the winter and so far I’ve had no problems.

3

I’m still recovering from this and just getting back into running after about 2 weeks off after I tried to run through the issue. I didn’t start to see progress in the recovery until I found the root cause of the problem which was a knot in my calf. Once I had the knot out of my calf, my achilles had less pressure on it and was finally able to heal. I roll my calves and achilles before and after each bike or run and perform eccentric calf drops on both legs after my workouts. I’ve started back slow with my running, just three days a week, and for a whole lot less time than I was doing just a month ago.

If it doesn’t bother you cycling, then cycle more for the time being. Taking time completely off from running worked for me along with resolving the root cause of the issue. I can say this, I’m in my second week back running, and I have zero pain in the achilles while I run.

4

My massage therapist that I use once a month uses Neuromuscular techniques and I believe ART techniques to remove what she usually calls “junk” from my muscles. I may try adding a 30 minute sessions this week to have her work specifically on my calves, feel, ankles and legs for a couple weeks to see if that helps as well.

I also went ahead and ordered some Hurricanes and Mirages (15 & 3 models…so they were 40% cheaper, then full retail for 16’s and 4’s). When I first got PF a few years ago, going to Hurricanes made a big difference. They have an excellent heel cup and good “support”. I think I’ll just not run for a few more days until it seems to improve a little more. I have a deeper running base than cycling or swimming, so I should be able to bounce back pretty quick.

5

I had this issue last year about four weeks before a big race. Mine was so swollen my friend who is a PA said he was amazed it didn’t rupture. There was zero running or biking for the first week. I did only open water swimming because even pushing off the wall hurt it. After a week I did some gentle spinning, but nothing hard and no standing on the pedals.

I went to see a doctor who does ART and Electrodiagnostic testing and treatments. It hurt like a bitch and was expensive, but in four treatments over the next 2.5 weeks I was back jogging again. I would also recommend getting a CEP Achilles sleeve/brace to wear for a while. It holds the tendon in place. I wore it for a couple months every time I ran.

Doing all that got me back to operational in about 3.5-4 weeks. I didn’t run at all during that time and ended up having a pretty crappy race, but that at least got me to the start line and able to train healthy afterwards for my next race. If it is sore when you are running you’re really not doing yourself any favors to keep pushing it. It will just prolong the healing process or cause more damage. Just my two cents.

6

I’ve been through a similar problem - I developed AT in both legs 6 weeks out from IMLOU last year. I freaked out and did as much biking as I possibly could because I was worried about losing fitness. As you pointed out, it does put some strain on the achilles, and made my problems much worse to the point that I could no longer cycle. I ended up doing my IM, but it wasn’t pretty - 16 hours of pain. I have not been able to run or bike since.

You’re right about moving the cleat back. Also make sure your seat isn’t too high so that you aren’t ankling.

Just a warning, if you push this injury too far, you will be dead in the water. Let it heal.

7

Some good advice here so far. I’ll add my personal experience. I had serious achilles pain early last year in preps for training for a 50 miler. It was because I tried a new trail shoe and didn’t pay attention to the heel drop being low. I took a full week off with just easy spin class and swimming with the heel drop stuff, ice and rolling the calf as well as the achilles itself. After that I started my way back to running but slowly and just dealt with the pain. To help I used KT tape for it and it made running bearable. Hills make it worse for me. Again this year another pair of trail shoes with too low drop(I’m idiot and now will always go 12mm or higher in all my shoes) and it’s back. Doing the same thing as before and now finally after 6 weeks just getting to feel somewhat like a normal runner. It still hurts in the first mile of a run and is sore after longer runs but just running through it.

I read a bunch that tendonitis and potential rupture aren’t linked hence just running through the injury as opposed to a bunch of serious time off due to how slow the achilles heals due to lack of blood flow.

Oh one last thing if you cycle, I cut out all standing on the bike for many weeks.

Good luck…

8

I’ve had achilles issues a couple of times. For me, rest was necessary to get past that initial pain stage where it just seemed to hurt no matter what i was doing. That is at least a week off running and cycling. Then I was able to quickly get back into cycling but I tried not to extend/stretch my achilles too much (i.e. I pointed my toes a little more than usual - not sure if this is medically advised, but worked for me).

Then go back to shorter, less intense runs. My strategy involved rolling my calves before and after each run (even for just a minute or two) and avoiding static stretching. I also went to a shoe with higher offset and even placed a heel wedge in my dress shoes to ensure I wasn’t putting strain on the achilles during the day at work.

I struggled to find a solution the first time and was out of commission for many months. The 2nd time, doing the above, I was back to regular mileage in 4 to 6 weeks.

9

Good to hear that they aren’t necessarily linked. I think I’ll quit using my lower drop shoes. I think my Virattas and Kinvara Trail shoes are a root cause. I’ll stick to 8mm and my T7’s (12mm).

I think I’ll take another day off and then work slowly back in and cut out any standing on the bike. Although I go to a downward toe point when standing. I might drop the seat just a little more to be safe.

Sounds like I can just battle through it a little. I think warmer weather will help a lot, but that could be… crap 10 weeks away at this rate.

The KT tape is something I’ve never tried. Can you get this “made up” custom to your foot shape and apply it yourself?

10

Good to hear that they aren’t necessarily linked. I think I’ll quit using my lower drop shoes. I think my Virattas and Kinvara Trail shoes are a root cause. I’ll stick to 8mm and my T7’s (12mm).

I think I’ll take another day off and then work slowly back in and cut out any standing on the bike. Although I go to a downward toe point when standing. I might drop the seat just a little more to be safe.

Sounds like I can just battle through it a little. I think warmer weather will help a lot, but that could be… crap 10 weeks away at this rate.

The KT tape is something I’ve never tried. Can you get this “made up” custom to your foot shape and apply it yourself?

It’s just this: http://youtu.be/p7OAD4zIBos and is easily applied. I tape before all my long runs and then try my best to keep the tape from falling off in the shower, in the pool and in bed to get a few more runs in with the extra support. It could be a placebo but it works for me.

For me my achilles/calves are so used to massive heel drops from running in Nike Structures that they just can’t handle low stuff. This time I thought if I slowly build mileage in low stuff it would be fine but nope so I’m stuck.

As mentioned above, if it hurts just walking around add some folded up cardboard under your heel in your shoe for extra relief.

11

Captain Obvious says to stop running until it heals.

12

Are you doing your heel drops with a weighted backpack? If not, you aren’t getting the full benefit of the exercise. Sta with something like 5 lbs and work your way up. I was doing 20-30 lbs in my package one point.

Recovery is hugely individualistic. What works for some doesn’t work for others. Personally, I found both cycling and swimming to be hugely therapeutic. As others noted, move your cleats back to reduce stress on the Achilles when riding. Also, stay seated and avoid hills. Standing closely mimics the running stresses on your Achilles.

For me, moving to a low drop show was a key to my recovery, along with running slow and short. Like 15 min / mile for .5 mile kinda slow and short. I then SLOWLY increased paced and distance.

Good luck…Achilles issues can really suck but it should eventually clear.

13

I had achilles issues (not sure if it was tendinitis or tendinosis) for about 5 months…during those 5 months, I iced it a lot with no improvement. For about a week, I decided to apply heat to it…it was gone within a couple of weeks after starting that. Never really lowered my mileage during the icing or the heating (didn’t hurt enough to stop…not the smartest move but i don’t always do the smartest thing).

14

I had a very similar situation. I was able to run short distances with mild discomfort and after looking around I found this video. I used a foam roller but I imagine the rolling pin probably isolates it better (and hurts way worse). I was completely better within a week and a half with this, advil, stretching, and rest.

https://www.youtube.com/watch?v=DgHoePuZaPw

So I picked up this injury overdoing it a few weeks ago but mixing too much intensity, mostly on the treadmill (not sure if that mattered) and probably also pushing my shoe mileage a little too far as a contributing factor.

I’m using an anti-inflammatory 2-3 times a day, switched to a 8mm offset well cushioned shoes (Saucony Ride 6) from my Cortanas and Kinvaras, icing occasionally if it’s visibly swollen, doing 1 legged eccentric heel drops on the edge of stairs 1-2 times a day to try and strengthen it, cut back my run mileage by about 2/3rds and I’ve been sleeping with a night splint to keep my foot close to 90 degrees. I’ve ordered a new pair of Cortanas, and I think I’ll stop using the Kinvaras. That’s just too little shoe. I may stick with the T7’s for 70.3 and less since it has a higher offset, but at this point will probably race my IM in the Cortanas.

It’s better than it was a week ago, but seems to have plateaued. I guess the lack on patience that got me into this has me nervous about how long it takes to get out of it.

So what to do now? Cycling doesn’t make it worse and there’s only mild discomfort oddly at lower intensity levels. There’s only mild discomfort running, and a little more walking downstairs.

Do I need to swim only for a week to see if it gets better? Should I continue to run at reduced mileage and ramp up cycling and swimming to fill the gap in terms of training load?

I realize that no matter what, I’ll have to “claw” my way back to where I was at. Probably follow a BarryP type plan on only IM pace running speeds and after a few weeks re-introduce a very limited amount of tempo.

I’m looking for a damage control strategy to test here. I suppose if I go after a swim focus now, I could then back off my swimming later on and focus back on cycling.

I’m having trouble figuring out how much cycling is likely to inhibit recovery of this type of injury. Obviously it places a load on that tendon, but it’s static, not a high impact dynamic load. I have my Time cleats positioned all the way back. I did that to reduce knee soreness a few months and ago and it’s worked perfectly.

Some more history. This left leg has a little less strength, has had plantar fasciitis issues on and off in the past, that leg has had knee issues in the past and looking at my shoe wear pattern I heel strike a little harder with that foot, though I mostly have a midfoot strike and run with a descent 176-186 cadence depending on pace. Its’ worst in the morning, and evening which I think is typical.

If it manages to heal, is it really fully healed, or will I always have some serious concerns with this injury?

Should I be switching back to a less flexible, posted shoe like Hurricanes for training to take more load off the calf?

15

10 years, 10 IMs chronic Achilles issues however kept under control with the following…
Rest, Ice Elevate until not tender to squeeze(could be 3 days, could be 3 weeks). Rest! If you skip this first step, forget all advice and just admit that you aren’t looking for a cure but rather an excuse to keep training. I guess you can swim as long as you don’t push off but better to rest because you are still shortening the tendon while kicking…
Once there is zero pain, yes zero, start eccentric heal drops. You will continue these the rest of your career . Look it up if you don’t know what I’m talking about.
Do them until ever so slight soreness and then stop. Repeat every day going forward until no tenderness with 3 sets of 15 each leg. Continue that amount the rest of your life.
Get a night boot that allows you to stay dorsiflexed. I like this one http://www.ebay.com/itm/like/200443062895?lpid=82 Most comfortable and not too aggressive like others can be.
Figure out why you have Achilles problems and change it.
Common issues are bike related: speedplay pedals, cleat mounted on shoe to far forward, and Run related: too low of a drop in running shoe(kinvara4mm, so is cortana), too little medial posting in a pronator.
I find most people blame the run where it really starts with the bike.
Disregard this with caution
Luck

16

I had achilles tendonosis last fall and after diagnosis from a sports doc I saw a physiotherapist twice a week for 8 weeks. She prescribed a number of exercise which I did religiously and during the sessions used ultrasound, tens machine and shockwave therapy. With pretty much no improvement after 8 weeks I went back to the sports doc and he told me to stop going to physio and just focus on the eccentric heel drops with lots of weight. He told me I needed to cause pain in my achilles before it got better.

I went and purchased a hiking backpack that could support the weight and loaded as much weight as possible in the backpack. I was doing 4 sets of 15 straight legged and 4 sets of 15 with a bent knee twice a day with 120lbs in the backpack. It was hard as hell since 120lbs is close about 70% of my body weight but it worked. After a month of doing those I was completely pain free and have not had a problem since and that was at the beginning of December.

17

Captain Obvious says to stop running until it heals.

Nope too easy.

I’m going after a multifaceted approach.

  1. I made an appointment with a Orthopedic Specialist on Thursday including and X-ray (I doubt will show anything).
  2. I then stopped by a Chiropractor I know to drop off a flyer and talked with him for a bit about it. He’s trained in ART, but doesn’t; do it a whole lot normally. I think he’s like me as a regular patient, so I let him work my Achilles and I have to admit, they felt a lot better afterwards. I might be sold on that. I’m going to make an appointment to have that done a couple times a week until it goes away and see if an overall adjustment will help. It is likely that hip/back alignment is causing all of my left leg issues including PF and occasional knee soreness all on that same leg.
  3. Use more ice and STOP using the night split. He believes it’s counter productive that it will heel faster in a relaxed & contracted position rather than stretched.
  4. Continue the eccentric calf exercises.
  5. make sure I do some core work a couple times a week. I’ve been neglecting this and it could be impacting these issues.
  6. Get some stretch cords and work on strengthening my glutes. They might be parts of the issue as well. I may be driving off my calf rather than activating my glutes.
18

Have had this twice. Probably about ~6 years between the two occurrences.

Things that worked for me:

  1. Eccentric heel drops. Usually done twice a day, 3 sets of 15, straight leg, with increasing weight per set. Usually no added weight, then 20~25 lbs in a back pack, then 30~35 lbs. Then 2x15 with a bent knee. No weight for the first one, then 20~25 pounds via back back on the second set. Did them for about 6 weeks in both cases.
  2. The Stick to roll out the knots in the calf as others have mentioned. That was probably biggest turning point early on. I found a painful knot within a couple days of initial pain.
  3. Most recent occurrence, I didn’t find the night splint was doing much for me, and I had no pain in the morning for the first few steps. Not an ice or anti-inflammatory guy, didn’t really use those in either case.
  4. Saw a Sports Medicine Dr. Was reassuring to visit with a Dr. He did an ultra sound on the AT to gauge the thickness and deformity within the tendon itself. In his opinion it wasn’t that bad - wasn’t a need to stop training just reduce volume and intensity and be smart.
  5. Grasston technique. Did 2 sessions of this for the most recent occurrence.

My pain came on roughly 2~3 hours after completing a long run. Initially had slight pain while running (what I’d call a 3 out of 10), pain downstairs like you have described, and I also had no pain while cycling but soreness after completing a bike workout. Also could feel it pushing off the wall while swimming. In both cases I continued to run through it with 25~50% volume, took a week or so off of cycling. Continued to swim throughout. Both cases lasted about 6~7 weeks from initial onset to completely forgetting about it while training. Both cases I did react and adjust early on.

19

Beginning to struggle with this too, I fear. What’s the latest on your injury rehab, Moto?