Share your Achilles stories/problems

[simonfoley]

So many people have had a problem at some time with their achilles. I have been having a nightmare for over 18 months now. I will outline my story and it would be great if others could contribute. Have you had any problems? What were the symptoms? What started it? How long? How did you treat it? Gone away now? Exercises for it? Did you stop training?

My story

I am 31 now. I was a good runner as from the ages of 10 - 13. State cross-country stuff. I ALWAYS rode a bike as a kid but just for fun (at the age of 14, I remember cycling 18 miles to the local swimming baths for a swim and then cycling back). In high school other things took over like trying to look cool, chase girls etc. In college I played waterpolo despite being not a great swimmer but really stopped running and cycling.

From 21 to now, I was a very keen rock climber (still am) and although stayed fit from climbing to crags and mountains, other than a weekly run, I never really did much. I was always fascinated by triathlons. By now I lived in Thailand as an Economics teacher and I was running a bit more. I swam to keep fit and someone invited me to a race.

Five months later, I had done two sprint triathlons, one adventure race and a couple of 10km or 12km run races. I did the Laguna Phuket Triathlon (1.8km, 55km, 12km) in 100f degree heat over an amazingly hilly bike course and was feeling it a bit in my legs. The week after I went out for a bike and over did when my legs were not quite recovered. We rode 120km quite hard. The next day my achilles were sore and had been feeling quite stiff up to then. This put me over the top and I decided to rest immediaty.

This was in Nov. 2001. I took the required time off. I rested, got some orthotics for my shoes and took it easy. I still swam but it was not the same without a focus. Everything I did seemed to aggravate the injury. I did not run or bike. Going up stairs would aggravate it. I had some ultra-sound and took anti-inflammatories. After a long and torturous 7 months the pain seem to have subsided (one second to write but was a long, long 7 months). There was some fibrous stuff there still and it was quite stiff but not painful. I tried some cross fibre massage to get rid of it and started some light training.

Whenever I have done any training, it seems to reoccur immediately. I have tried to keep my training down to just one ride a week. A small run every two weeks and lots of swims. This is over the last few months. Even pushing off from the side of the pool causes it to inflame.

This Febuary, time had come to try and train. I kept it very, very light and sinceI have done two races. An Olympic distance and a slightly longer one. The result is that I am just back where I was 18 months a go. I should say here that I trained very, very lightly and although rode fast, ran very, very slowly and gently even in the races

In such a long time you feel that resting has not got rid of it, well I may as well train lightly. I have to exercise so I may as well do a bit. I have tried changing my bike seat height, calf massages, stretching, not sterching, resting, ice after use, shoes inserts and so on.

I have read all I can on the subject and I know there seem to be three phases to recovery for any tendon injury. I should say here I never care too much about how I do in a race I just love exercise. I am not competitive and I take part just for the fun of doing just that.

One article I read said that there were 3 phases in the healing process of any tendonitis: inflammation, proliferation, and maturation

Inflammation is probably the stage I am back to now. If I keep on re-injuring the tendon, I will never leave this stage and the injury becomes even more chronic than it is now. This is why I am resting once again.

The proliferation stage is characterized by the laying down of new tendonis fibres and scar tissue. The scar tissue is not as strong as “normal” tendon tissue and is more brittle. Stretching (warming up first and icing down afterwards) can be done in this phase of recovery. I heard this takes about six weeks.

Maturation is the final phase and I believe I had gotten there after about 8 months. The problem is whatever I did the problem came back no matter how little I did.

I know I need a good orthopaedic and physio to help me but there really are none here in Thailand who knows what they are talking about.

To say I am out of ideas is an understatement. I have just bought the most expensive shoes I can find (Asics Kayano IX) and got a new running orthotic from a mate who sent the moulds here from Germany, I did them and we sent them back with photos of my feet and the problem.

I can not face the prospect of not being able to run and bike anymore at the age of 31. I am determined to overcome this, but how? Does anyone have any ideas? At times I honestly think I am stuck with this forever and will never heal fully. What a bummer. It would be awful to not be able to run or bike or keep fit. I am not asking to be competative, better, just to be able to keep fit and race once in a while.

Lastly, I am saddled with very thin legs. This is one of the route causes I feel. I have some photos of these one with where it hurts marked on. You will be amazed by my freaky feet. An orthotic is certainly in order, but why does cycling also aggravate the injury?

Does anyone have any ideas or experiences they could share?

Should I stop training and really rest? If so for how long? I am thinking now I will rest for two full months. After that really try and work on the scar tissue and get it soft and flexible again and then try some light stretching and running once more. Ice every time and a good streching program. That said, I tried that last time and as soon as I started even a bit (10 mins very light jog) it came back. L

[Titan]

My first bout with AT was in the mid 1980’s training for the Assault on Mt. Mitchell…we rode 153 miles from Greenville, SC to Gatlinburg TN in one day…4 big climbs. The next day we rode 1/2 way back, and on Sunday rode the remainder…on Sunday, going up the last climb, I was standing and felt something pop and hurt in my AT. I barely made it home. Went to an Orthopod that put me on Butazolodine? (very scary stuff) and I rested a couple of weeks. Had to take it easy for a couple of months, but could ride hard. It gradually hurt less and less and in 2 years I was completely painfree.

A few weeks ago, during an 1/2 marathon, this same AT started hurting about 2 miles into the run…and it just got worse the entire run. I finished in a marked limp, but at a PR of 1:37:00 nonetheless. Bought ice immediately and kept it iced for 30 minutes, did that 3 or 4 more times that day and the next. Monday, went to my sports medicine guy, Dr. Ed Steel, and he began heat/ice/heat/electrotherapy on it every day for two weeks, the last two weeks he added massage to the treatment.

I was able to run a duathlon Sunday, 3 weeks out from my injury, and felt OK (had the fastest running split and second fastest bike split!), but I have a couple of sore knots in my upper calf. I have a 1/2 ironman on Saturday, and think I’ll be fine. This was a big scare, but I think I must have just bled into the tendon sheath this time and irritated it, rather than actually tear fibers…I didn’t feel it pop this time. The calf pain came from compensating for the achilles pain, now that the achilles doesn’t hurt, the calf is coming around nicely. Still, Saturday will be a big test. It could possibly end my season if I re-injure it, but, I think I’ll make it fine…it’s a very flat course. If it doesn’t get sore from this weekend, I’ll declare it healthy and get back to running more and pushing harder on the bike again.

Good luck with yours. You really need good experienced care from someone to help you get through your injury.

[orthoman]

Nicely stated. Some wt. bearing pics with you standing on your orthotics and pictures of the orthotics would also be helpful.

From your pictures it would appear that you have a high arched or cavus foot type. This pattern goes along with a tight gastroc mucsle and often achilles problems. Also lateral foot overload and peroneal tendon pathology, as indicated by your arrow pointing to the lateral side of the hind foot. It is likely that your current set of orthotics are making your problem worse instead of better. You don’t need an arch support. This is not to say that an appropriate orthotic couldn’t help somewhat. The appropriate orthotic is not an arch support.

For chronic cases of achilles tendinosis where the tendon is fully degenerated and might have even partially or completely ruptured. Surgery might be indicated. Specifically, transferring the flexor of the big toe to the heel bone. This provides increased strength and the all critical blood supply necessary to heal the degenerated achilles. Of course this would be the last step after all non-operative measures have been tried. That said, this procedure is very successful.

[TriBaby]

Other people’s experiences with injuries can really only be anecdotal at best, but for what it’s worth, here’s mine:

I was blessed never to suffer any significant injury in 10 years of triathlon, but then almost exactly one year ago Achilles tendinitis laid me low. After a remarkable spring of hard training and significant improvement in my running (largely due to a focused weight loss effort), I had a breakthrough race at Wildflower. 10 days later I took a vacation in Maui where I ran nearly every day, and this is where the problems began.

All my runs in Maui were on concrete/asphalt, and nearly every run involved pounding up and down some fairly significant hills. I ignored the first twinges of soreness in the Achilles, but by the time I returned from the trip, I knew I had a problem. Taking a week or two off of running did no good. Actually, nothing really seemed to do any good!

It was probably 7 or 8 weeks (during which time I did the frustrating dance with useless doctors and difficult insurance) before I finally got hooked up with a physical therapist who basically saved my season. Although it was too late to save Ironman Canada, it wasn’t too late to save Kona!

The season-saving technique this guy practices is known as “Augmented Soft Tissue Mobilization”. It involves “scraping” at the injured area with specialized tools that appear to be made of acrylic. It hurts like all hell, but it does two things: breaks up scar tissue and, by inflamming the surrounding tissues, stimulates healing. I couldn’t believe how quickly this treatment worked. I was back to running double-digit mileage in just a few weeks. With continued treatment, the scar tissue was all virtually eliminated, and I’ve been pretty much pain-free ever since. When I feel the occasional twinge, I go back to Don and he gives me a “touch up” treatment.

This technique has also been tremendously effective at keeping insipient patellar tendinitis at bay. The one “itis” that this treatment doesn’t seem to be helping as much (for me) is my current case of plantar fascitis. I think it may be because the plantar fascia is so deeply embedded under the fatty pad of the heel, it’s a lot harder to get at it and effectively “scrape” the injured area. He really has to DIG—ouch!

The downside is that this technique is relatively new in the physical therapy realm, and it’s apparently quite hard to find practitioners. You can try searching on the 'net, but I already know that there isn’t a heck of a lot out there. And in Thailand? I’d really doubt it’s migrated that far beyond the US at this point.

One other thing: I was told by the shoe guys at my local running shop that it’s very likely that my heavy duty motion control shoes may have actually contributed to the AT. Something about inhibiting natural motion, leading to a “bow-stringing” effect on the Achilles. So it sounds like too much arch support (as Orthoman suggested) is probably NOT helpful for those suffering with AT. (Of course, lucky me, I need the arch support for my knees and now for my patellar fascitis, so I just have to really pay attention to my Achilles as I continue to run in heavy-duty MC shoes).

Again, this is purely anecdotal. You really have to work directly with a seriously sports-oriented doctor and/or physical therapist to be sure you do what’s right for YOU. But I cannot recommend highly enough the ASTM treatment, if you can find someone who practices it.

Best of luck! Achilles tendinitis is NOT fun! But for that matter, neither is plantar fascitis! Keeping my fingers crossed that my feet hold up long enough to get me through Ironman USA this year…

TriBaby

[orthoman]

One more thing… I did notice that you said you wore the Asics Kayano. This is a stability shoe. You need a cushioning shoe without any extra medial posting. Within the Asics brand these would be shoes like the Nimbus or Cumulus. Any stability or motion control features will only make your feet (rigid, high-arched feet) worse.

[Train_Wreck]

I’ve shared this story with a bunch of people. I really hope this helps you.
A few years ago I decided to go ahead and do my first full ironman distance race. But Achilles tendonitis was holding me back. After 18 months of struggling with it, and being told yet again to rest it for two more weeks with no activity, I was told I was facing bone spurs and possible surgery if I didn’t back off. About the only thing I hadn’t tried yet were night splints. I decided I really had to do something different. Rest and Ice was getting me nowhere.
I found Julie Donnelly on the Internet, a massage therapist that has worked on athletes for years, and had written several books on the subject of repetitive strain injuries, tendonitis being one of them.
Here is what I learned. It is so simple that many people are quite skeptical, but it works for me.

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. Start easy, however. You will get over this, but it won’t be a quick fix. You have had this for quite some time and the spasms in the calf muscle are stubborn.

I did not miss any training. My AT was so bad I could not run two miles without limping home. After the first day of treating my calves, I could run and far as I wanted. When the pain started. I would simply stop; do the treatment, stretch, and then start running again. You can actually press out the spasms when you are standing by finding something to hold onto (mail box, telephone pole) to balance yourself, and pressing your opposite knee into your calf.

I still get flair-ups, but I can get over them within a day or two, and not miss any training.

There is a VERY informative forum about this and other repetitive strain injuries at www.julstro.com that is moderated by Julie
It’s a sports injury website.
Good luck

[NJbiker]

I recommed the web site that Train Wreck mentioned, www.julstro.com
I had heel pain (maybe PF) most of last season (Jun-Oct) and just kind of ignored it thinking I would take a long break in the winter. I took 2-3 months off or with very light training, got a pair of over-the-counter inserts (superfeet), and iced daily but when I started to run again the pain came right back. After doing some of calf and glut/lower back treatments from the website and the ‘Pain Free Triathlete’ ebook I noticed improvements. I also got rid of the superfeet because I think they were making the problem worse. I have been now been pain free for 3 months and counting.

A