Achilles Tendonitis

davegilly · 08-04-2021 5:40pm #1

Anyone suffer from this? Had it last year, wasn't sure what it was but it was reasonably mild and I'd only suffer from it at the start of a run and it would disappear a k or two into the run. No pain afterwards. Bit of soreness in the mornings again but would disappear again 15 mins after getting up.

About 6 or 7 weeks ago it flared up again after a hard run. Not as mild this time and was bothering me during the day as well. Pain would ease and return throughout the day so I decided to stop running for a while. Iced it every evening for the first week and lots of heel raises. No real improvement. Been doing concentric heel drops for the next three weeks. Lots of improvement since but Its still tender when I wake in the morning. 30 mins later its all fine again.

I know it's not healed because if I squeeze the tendon it's still a little tender but apart from the first 30 mins in the morning all is good. So my question or two questions are:
1. How long does this take to clear up fully? It's been 4 weeks now of icing and heel raises/drops. Been cycling only since.
2. I haven't run in a month and I miss it. Now that there is a good bit of improvement - still some mild discomfort in the morning - would it be ok to start running again? Maybe some short slow distances for a while?

What do you think? All ok to.run again?

JohnOne21 · 08-04-2021 10:13pm

Hi Dave, I have been going through something like this for almost a year now. It gradually got worse to a point where I stopped totally in January and went to a physio to sort it out properly.
I was given exercises to do including calf raises, glute, hamstring but these didn't work for me.
If you are anything like me you have watched every leg related video on youtube and have seen that for every one you watch that gives advice there is another one telling you not to do that exercise you just saw.
I'm back running a bit now and can feel my leg improving almost daily. What actually worked for me was to stop stretching and doing heel raises/drops, totally. After about 3 days my leg started feeling looser and I did some self massage which was a massive help. Next step is to visit the physio for a deep tissue massage and I know that I will be all good after that.
At the moment I still am very sore in the morning and what I do is flex both my feet maybe 50 times before getting out of bed and then some walking on my heels. After a while there is no soreness at all which is good.
Like anything, everyone is different and what worked for me might not work for someone else but this is just my story. Hopefully it helps because I know how much of a headwreck this can be.

Ceepo · 08-04-2021 10:36pm

davegilly wrote: »

Anyone suffer from this? Had it last year, wasn't sure what it was but it was reasonably mild and I'd only suffer from it at the start of a run and it would disappear a k or two into the run. No pain afterwards. Bit of soreness in the mornings again but would disappear again 15 mins after getting up.

About 6 or 7 weeks ago it flared up again after a hard run. Not as mild this time and was bothering me during the day as well. Pain would ease and return throughout the day so I decided to stop running for a while. Iced it every evening for the first week and lots of heel raises. No real improvement. Been doing concentric heel drops for the next three weeks. Lots of improvement since but Its still tender when I wake in the morning. 30 mins later its all fine again.

I know it's not healed because if I squeeze the tendon it's still a little tender but apart from the first 30 mins in the morning all is good. So my question or two questions are:
1. How long does this take to clear up fully? It's been 4 weeks now of icing and heel raises/drops. Been cycling only since.
2. I haven't run in a month and I miss it. Now that there is a good bit of improvement - still some mild discomfort in the morning - would it be ok to start running again? Maybe some short slow distances for a while?

What do you think? All ok to.run again?

While you can appreciate that medical advise is not allowed on Boards.ie.

AT can be one of them stubborn issues to solve.
Calf raise are the "go to" exercises but as point out they don't always work for everyone (so called non responders)

My advice would be to stop applying ice, and foam roll the calf a 2 x times a day, find and stay on and tight areas for as long as it takes for it to "ease out "
You could introduce a light runs of 10 minutes and gauge how it reacts,
You could possibly wear a small heal raise in your runners while running to take some of the pressure of the AT and calf.
Also walking around the house barefoot will help to get some form a stretch and strength component.

09-04-2021 11:37pm

Sorry to hear that you are dealing with a problem with your Achilles. I know from past experience, how bad it can be, and it's especially annoying want to do is get out and run.

This may be a bit controversial, but what helped me was ditching my previous pair of running shoes and instead going down the road of minimalism by buying a cheap pair of minimalist shoes on Amazon and then working on my running form to make sure I'm not over striding and landing with a heel strike. Instead these days, I focus on trying to land foot with my foot directly underneath my centre of mass.

I'd also recommend a good strengthening routine. Personally, I'm a big fan of Eric Orton's foot and core strengthening routine as outlined in his book The Cool Impossible. Although you'll need equipment such as a exercise ball and slant board to carry out the exercises he recommends.

https://www.amazon.co.uk/Cool-Impossible-Running-Miles-Yourself/dp/0451416341/ref=sr_1_1?crid=8DNBRZOSC3GQ&dchild=1&keywords=the+cool+impossible&qid=1618007793&s=books&sprefix=the+cool+%2Cstripbooks%2C124&sr=1-1

Another good book that I have heard mentioned is Build Your Running Body
https://www.amazon.co.uk/gp/product/0285642987?pf_rd_r=BZ40D49XK5JNAS7RH22P&pf_rd_p=6e878984-68d5-4fd2-b7b3-7bc79d9c8b60&pd_rd_r=7bca0d3f-e264-4e5f-8a24-0faff14561f0&pd_rd_w=Q08Aq&pd_rd_wg=zx6YZ&ref_=pd_gw_unk

The above book has various exercises you can do that help with running and supposedly help prevent injury.

Hopefully you recover quickly and are able to get back to the activity you enjoy.

Unknownability · 10-04-2021 12:25am

Has anyone actually fully recovered from tendonitis?

I've had it in my hamstring for over 2 years now and while it doesn't stop me from running but "I know it's there".

I go to the physio every 4 weeks and a rub helps but I'd love it to go back to the way it was.

JohnMcm1 · 10-04-2021 12:32am

Unknownability wrote: »

Has anyone actually fully recovered from tendonitis?

I've had it in my hamstring for over 2 years now and while it doesn't stop me from running but "I know it's there".

I go to the physio every 4 weeks and a rub helps but I'd love it to go back to the way it was.

If the physio is just giving you a rub and telling you to come back every few weeks you'd be as well going to the local church and asking the priest to say a prayer, he'd probably do it for free too.

Adequately dosed training is the treatment for tendinopathy, preferably strength training. To be clear, massage can offer a temporary relief from pain but it's not doing anything for your injury.

JohnMcm1 · 10-04-2021 12:38am

davegilly wrote: »

Anyone suffer from this? Had it last year, wasn't sure what it was but it was reasonably mild and I'd only suffer from it at the start of a run and it would disappear a k or two into the run. No pain afterwards. Bit of soreness in the mornings again but would disappear again 15 mins after getting up.

About 6 or 7 weeks ago it flared up again after a hard run. Not as mild this time and was bothering me during the day as well. Pain would ease and return throughout the day so I decided to stop running for a while. Iced it every evening for the first week and lots of heel raises. No real improvement. Been doing concentric heel drops for the next three weeks. Lots of improvement since but Its still tender when I wake in the morning. 30 mins later its all fine again.

I know it's not healed because if I squeeze the tendon it's still a little tender but apart from the first 30 mins in the morning all is good. So my question or two questions are:
1. How long does this take to clear up fully? It's been 4 weeks now of icing and heel raises/drops. Been cycling only since.
2. I haven't run in a month and I miss it. Now that there is a good bit of improvement - still some mild discomfort in the morning - would it be ok to start running again? Maybe some short slow distances for a while?

What do you think? All ok to.run again?

You're generally looking at about 12 weeks to see some real improvement.

It's important to make the exercise progressively harder, you need to increase the tensile strength of the tendon through progressively loaded exercise so while bodyweight heel raises may have been great initially I would look to add some load now.

You could try some running and see how it feels. The important thing here is to find your starting point (ie a pace and distance that doesn't irritate the tendon). So better erring on the side of caution and start with 1 very short run this week at a very manageable pace.

Unknownability · 10-04-2021 3:29am

JohnMcm1 wrote: »

If the physio is just giving you a rub and telling you to come back every few weeks you'd be as well going to the local church and asking the priest to say a prayer, he'd probably do it for free too.

Adequately dosed training is the treatment for tendinopathy, preferably strength training. To be clear, massage can offer a temporary relief from pain but it's not doing anything for your injury.

Sorry, I wasn't clear. The injury has improved overall by about 95% from when I went to the physio first through strength training, stretching and rubbing, it's the finally few percent that I'd like to know if anyone has experienced full recovery.

Ceepo · 10-04-2021 9:27am

Unknownability wrote: »

Sorry, I wasn't clear. The injury has improved overall by about 95% from when I went to the physio first through strength training, stretching and rubbing, it's the finally few percent that I'd like to know if anyone has experienced full recovery.

To answer your original question, yes is the answer.

And while the traditional treatment usually involves training a strengthen component into the tendon, it may well work the finest, for others it doesn't work (so called no responders)

My approach it access biomechanical dysfunction to ascertain the route cause, and its rarely the lack of strength.
You need to check for pelvic stability, and the orientation of the hip complex..

Feel free to pop me a pm if you want. Same for the original poster.

thomas anderson. · 10-04-2021 9:31am

Only things that worked for me are lots of pilates and barefoot running.

JohnMcm1 · 10-04-2021 10:36am

Ceepo wrote: »

To answer your original question, yes is the answer.

And while the traditional treatment usually involves training a strengthen component into the tendon, it may well work the finest, for others it doesn't work (so called no responders)

My approach it access biomechanical dysfunction to ascertain the route cause, and its rarely the lack of strength.
You need to check for pelvic stability, and the orientation of the hip complex..

Feel free to pop me a pm if you want. Same for the original poster.

No evidence whatsoever to back any of that up? What are your qualifications if you don't mind me asking?

I certainly hope you're not a physio because false narratives like that which you've essentially plucked out of your bum do more harm than good.

Ceepo · 10-04-2021 11:54am

JohnMcm1 wrote: »

No evidence whatsoever to back any of that up? What are your qualifications if you don't mind me asking?

I certainly hope you're not a physio because false narratives like that which you've essentially plucked out of your bum do more harm than good.

Fair enough, you're entitled to your opinion.
As am I.

Now if you don't think things like anterior pelvic tilt can influence how the glute reacts, or how it can lengthen the hamstring. Then so be it.

JohnMcm1 · 10-04-2021 11:58am

Ceepo wrote: »

Fair enough, you're entitled to your opinion.
As am I.

Now if you don't think things like anterior pelvic tilt can influence how the glute reacts, or how it can lengthen the hamstring. Then so be it.

So do you think the problem stems from tight iliopsoas which takes the glutes out of their optimal length to produce force? Again it's a nice idea and something I bought into myself before. The problem is, is that it makes a lot of assumptions.

The argument is more so whether those things actually matter? And whether we can do anything about it?

The other issue is that the language used can make patients feel "broken", they think because their pelvis is out of line, tilted, asymmetrical etc that it's a problem and that they are more likely to be injured. There is a lot of research supporting the fact that patient believes can have a a large impact on their perception of pain, particularly when it comes to lower back pain.

Realistically as physiotherapists, s and c coaches etc we need to get off our high horses and accept that in most cases these issues will resolve themselves. We are simply guiding/possibly speeding up the process. I think the greatest thing we can do for patients is reassure them and show them how to work around their injury in order to maintain as much of those trained adaptations (strength, CV fitness, etc) without exacerbating the injury.

JohnMcm1 · 10-04-2021 1:14pm

https://www.thestrengththerapist.com/single-post/posture-it-s-time-to-talk

Great article reviewing the research behind posture and pain/injury. I would really recommend looking through it Ceebo.

Ceepo · 10-04-2021 2:56pm

JohnMcm1 wrote: »

So do you think the problem stems from tight iliopsoas which takes the glutes out of their optimal length to produce force? Again it's a nice idea and something I bought into myself before. The problem is, is that it makes a lot of assumptions.

The argument is more so whether those things actually matter? And whether we can do anything about it?

The other issue is that the language used can make patients feel "broken", they think because their pelvis is out of line, tilted, asymmetrical etc that it's a problem and that they are more likely to be injured. There is a lot of research supporting the fact that patient believes can have a a large impact on their perception of pain, particularly when it comes to lower back pain.

Realistically as physiotherapists, s and c coaches etc we need to get off our high horses and accept that in most cases these issues will resolve themselves. We are simply guiding/possibly speeding up the process. I think the greatest thing we can do for patients is reassure them and show them how to work around their injury in order to maintain as much of those trained adaptations (strength, CV fitness, etc) without exacerbating the injury.

I dont disagree with the vast majority of what you say tbh.

And yes in most cases injuries can resolve themselves, however as you know some don't and will need some form of intervention,

I have previously worked in a physiotherapy clinic before opening my own practice.
You asked about my own qualifications, ITEC IMST certified Sports Injury Therapist. And have done some courses on biomechanics.

Yes of course the language used is important, and care need to taken to allivate and concerns they may have, as well providing them with a care/recovery plan.
I have had multiple clients that attended different therapist including physiotherapist who are almost frightened to move in case they break, and that is certainly not good for the mental or physical health.

I do believe that muscles act and react differently, due to a number of factors including joint position and movement patterns, yes i do, do I believe it can be changed, again yes I do. I've seen it regularly.

Haven't had a chance to read the link you provided but will do so at a later stage when I get time.

Always good to engage

JohnMcm1 · 10-04-2021 3:49pm

Ceepo wrote: »

I dont disagree with the vast majority of what you say tbh.

And yes in most cases injuries can resolve themselves, however as you know some don't and will need some form of intervention,

I have previously worked in a physiotherapy clinic before opening my own practice.
You asked about my own qualifications, ITEC IMST certified Sports Injury Therapist. And have done some courses on biomechanics.

Yes of course the language used is important, and care need to taken to allivate and concerns they may have, as well providing them with a care/recovery plan.
I have had multiple clients that attended different therapist including physiotherapist who are almost frightened to move in case they break, and that is certainly not good for the mental or physical health.

I do believe that muscles act and react differently, due to a number of factors including joint position and movement patterns, yes i do, do I believe it can be changed, again yes I do. I've seen it regularly.

Haven't had a chance to read the link you provided but will do so at a later stage when I get time.

Always good to engage

Fair points!

11-04-2021 2:19am

Just wanted to add, I found the videos on running form and other topics from Eric Orton's YouTube channel to be very helpful and so far I'm injury free.

https://www.youtube.com/user/trainwitheric

mista11 · 11-04-2021 2:50am

Hi,

I had this badly at one stage, best thing i did was change all the shoes, running and everyday shoes, dont wear flip flops etc - get shoes with heal support in them, i started wearing timberlands

I also used to drive alot, if you do change your seat position in your car.

I didn't do any physio rubs etc at all, the above worked for me in 6 months

Mista

6run28 · 11-04-2021 9:01am

I had it last year - extremely frustrating injury but no issues with it now. I stopped running for 4 weeks - iced every day, stretches in bed, foam rolling..went for a couple of short runs and it was straight back.
A friend then mentioned not to walk barefoot or in socks around the house (I usually did this) so bought a pair of runners for wearing at home and new running shoes (no real logic to this as they were just updated model of ones I was wearing previously). I did six weeks of no running and no walking where possible and then slowly went back to running. It hasn't flared up since. Rest seems to be the key but I think not going barefoot helped. I'd point out I have no physio or medical background.

NIMAN · 11-04-2021 9:03am

I had incredibly bad AT about 10 or 12 years back, getting custom insoles made fixed it for me.

11-04-2021 9:21am

The phrase "Achilles heel" comes to mind - this tendon must have been bringing many a young warrior down a notch or two since ancient times. I agree with Ceepo that the origin stems higher up, hips, back. I have no qualifications on the matter, other than being observant of my own body. Achilles tendon has been flaring up of late. Two things I find help somewhat - keep the calf muscle loosened by massage and trigger point pressure, and grab into the hollow space behind tendon above heel and rub hard back and forth with thumb and forefinger for a minute or so. Not up and down. Go across the fibres. Still though, sorting hip, back or issues further up leg is probably needed.

beauf · 11-04-2021 10:44am

Sitting at the desk or anywhere with my legs tucked back aggravates mine. Also trying to avoid any flat shoes and have runners for inside and custom insoles.

davegilly · 11-04-2021 11:02am

So I went for a short run yesterday. Warmed up with a very very slow jog/walk for about 5 mins. Bit of stretching followed. Ran slow for 10 mins then walked 5 followed by another 5 mins run. Walked again for 5 mins as a cooldown.

No pain or tenderness afterwards. Woke this morning and I "think" it's a little sorer than recently today, the tendon is definitely more tender. However once I got up everything fine again after walking around for 5 mins.

Will give it a couple of days and do 10,5,10 and see how that goes.

I tend to agree with others that this is eminating from elsewhere. Historically I have heel issues on my left foot as it has always felt uncomfortable no matter what kid of shoe I wore. My left ankle also cracks constantly, every step I take pretty much. Plus I have a slipped disk in my lower left back, L4/L5.

I run in the Nike React Infinity's which are supposed to be slight stability shoes - tried them on yesterday and they felt uncomfortable on my left heel so I wore a pair of NB Prism instead which I had bought a month ago so were brand new in the box. These felt lovely. I'd like to get a proper gait analysis done but I don't think anywhere is open for this at the moment. I think I might have an imbalance of some kind in my left foot which is probably not helping the situation.

Anyway, I'll try and keep running nice and slow for the moment and if it flared up bad again I'll just have to admit defeat for the moment and stop.

Ceepo · 11-04-2021 11:24am

davegilly wrote: »

So I went for a short run yesterday. Warmed up with a very very slow jog/walk for about 5 mins. Bit of stretching followed. Ran slow for 10 mins then walked 5 followed by another 5 mins run. Walked again for 5 mins as a cooldown.

No pain or tenderness afterwards. Woke this morning and I "think" it's a little sorer than recently today, the tendon is definitely more tender. However once I got up everything fine again after walking around for 5 mins.

Will give it a couple of days and do 10,5,10 and see how that goes.

I tend to agree with others that this is eminating from elsewhere. Historically I have heel issues on my left foot as it has always felt uncomfortable no matter what kid of shoe I wore. My left ankle also cracks constantly, every step I take pretty much. Plus I have a slipped disk in my lower left back, L4/L5.

I run in the Nike React Infinity's which are supposed to be slight stability shoes - tried them on yesterday and they felt uncomfortable on my left heel so I wore a pair of NB Prism instead which I had bought a month ago so were brand new in the box. These felt lovely. I'd like to get a proper gait analysis done but I don't think anywhere is open for this at the moment. I think I might have an imbalance of some kind in my left foot which is probably not helping the situation.

Anyway, I'll try and keep running nice and slow for the moment and if it flared up bad again I'll just have to admit defeat for the moment and stop.

Theres no evidence that in store gait analysis does anything to prevent injuries,
If you think you have a imbalance in your left foot, wouldn't it make sense to correct that,
For the sake of argument, if you have a left imbalance and get gait analysis done, if you buy the shoes that correct the left imbalance, what happens to the right foot.?

11-04-2021 12:32pm

Ceepo wrote: »

Theres no evidence that in store gait analysis does anything to prevent injuries,
If you think you have a imbalance in your left foot, wouldn't it make sense to correct that,
For the sake of argument, if you have a left imbalance and get gait analysis done, if you buy the shoes that correct the left imbalance, what happens to the right foot.?

Ceepo, what would you say are the best 2 or 3 stretches that you have found most useful for the hip/ lower back area that help to rebalance and most influence the Achilles tendon ?
I use lying spinal twists at the moment.

lenny palmer · 11-04-2021 12:52pm

I have been suffering with AT (never got an official diagnosis) since Christmas last year. It started after a bought a new pair of running shoe(I won't name any brand). I had been using the same brand for a number of years. It was in just my right foot for the most part. I ended up not running most of last year and when I did it was only for a couple of weeks at a time before it would be to sore to run. After 1 long break it all seemed fine and I was back running again. I then made the mistake of doing a harder workout with some fast speed work. It flared up big time, but now it was in both my calfs. At the start of this year I started working on my mobility, for my whole body not just my calf/foot. This seemed to help and got me back on the road. I decided to take this further and start really stretching. Doing it every night for about an hour or so and focusing mostly on my lower body. Especially my calf, hamstrings and lower back. That's when it flared back up again. I possibly have an Anterior tilt of my pelvis as well and the stretching I had been doing actually mad it worse. So I'm into another break from running again. I'm going back to mobility work but will not be doing the stretching (with the exception of my quads). 1 thing I was able to do to help with my fitness was to skip. I started off nice and easy, focusing on how I was skipping and landing nice and easy. If my tendon showed any sign of pain I would ease off the skipping. 1 thing that I do think helped was to balance on one foot but with my eyes closed. It force's your foot area to work really hard on stability and at the beginning is very tiring on the foot and ankle

JohnMcm1 · 11-04-2021 1:03pm

lenny palmer wrote: »

I have been suffering with AT (never got an official diagnosis) since Christmas last year. It started after a bought a new pair of running shoe(I won't name any brand). I had been using the same brand for a number of years. It was in just my right foot for the most part. I ended up not running most of last year and when I did it was only for a couple of weeks at a time before it would be to sore to run. After 1 long break it all seemed fine and I was back running again. I then made the mistake of doing a harder workout with some fast speed work. It flared up big time, but now it was in both my calfs. At the start of this year I started working on my mobility, for my whole body not just my calf/foot. This seemed to help and got me back on the road. I decided to take this further and start really stretching. Doing it every night for about an hour or so and focusing mostly on my lower body. Especially my calf, hamstrings and lower back. That's when it flared back up again. I possibly have an Anterior tilt of my pelvis as well and the stretching I had been doing actually mad it worse. So I'm into another break from running again. I'm going back to mobility work but will not be doing the stretching (with the exception of my quads). 1 thing I was able to do to help with my fitness was to skip. I started off nice and easy, focusing on how I was skipping and landing nice and easy. If my tendon showed any sign of pain I would ease off the skipping. 1 thing that I do think helped was to balance on one foot but with my eyes closed. It force's your foot area to work really hard on stability and at the beginning is very tiring on the foot and ankle

Posted an evidence based hierarchy of injury prevention for runner below. You'll notice load management is most important (not increasing your training load massively week to week, managing fatigue through programmed deload weeks etc).

You'll also notice that strength and conditioning is far more impactful than stretching etc. For anyone who spends hours each week stretching I would really stress the fact that that time would be much better spent doing a very basic strength program 2x/week.

JohnMcm1 · 11-04-2021 1:03pm

lenny palmer wrote: »

I have been suffering with AT (never got an official diagnosis) since Christmas last year. It started after a bought a new pair of running shoe(I won't name any brand). I had been using the same brand for a number of years. It was in just my right foot for the most part. I ended up not running most of last year and when I did it was only for a couple of weeks at a time before it would be to sore to run. After 1 long break it all seemed fine and I was back running again. I then made the mistake of doing a harder workout with some fast speed work. It flared up big time, but now it was in both my calfs. At the start of this year I started working on my mobility, for my whole body not just my calf/foot. This seemed to help and got me back on the road. I decided to take this further and start really stretching. Doing it every night for about an hour or so and focusing mostly on my lower body. Especially my calf, hamstrings and lower back. That's when it flared back up again. I possibly have an Anterior tilt of my pelvis as well and the stretching I had been doing actually mad it worse. So I'm into another break from running again. I'm going back to mobility work but will not be doing the stretching (with the exception of my quads). 1 thing I was able to do to help with my fitness was to skip. I started off nice and easy, focusing on how I was skipping and landing nice and easy. If my tendon showed any sign of pain I would ease off the skipping. 1 thing that I do think helped was to balance on one foot but with my eyes closed. It force's your foot area to work really hard on stability and at the beginning is very tiring on the foot and ankle

Posted an evidence based hierarchy of injury prevention for runner below. You'll notice load management is most important (not increasing your training load massively week to week, managing fatigue through programmed deload weeks etc).

You'll also notice that strength and conditioning is far more impactful than stretching etc. For anyone who spends hours each week stretching I would really stress the fact that that time would be much better spent doing a very basic strength program 2x/week.

JohnMcm1 · 11-04-2021 1:05pm

lenny palmer wrote: »

I have been suffering with AT (never got an official diagnosis) since Christmas last year. It started after a bought a new pair of running shoe(I won't name any brand). I had been using the same brand for a number of years. It was in just my right foot for the most part. I ended up not running most of last year and when I did it was only for a couple of weeks at a time before it would be to sore to run. After 1 long break it all seemed fine and I was back running again. I then made the mistake of doing a harder workout with some fast speed work. It flared up big time, but now it was in both my calfs. At the start of this year I started working on my mobility, for my whole body not just my calf/foot. This seemed to help and got me back on the road. I decided to take this further and start really stretching. Doing it every night for about an hour or so and focusing mostly on my lower body. Especially my calf, hamstrings and lower back. That's when it flared back up again. I possibly have an Anterior tilt of my pelvis as well and the stretching I had been doing actually mad it worse. So I'm into another break from running again. I'm going back to mobility work but will not be doing the stretching (with the exception of my quads). 1 thing I was able to do to help with my fitness was to skip. I started off nice and easy, focusing on how I was skipping and landing nice and easy. If my tendon showed any sign of pain I would ease off the skipping. 1 thing that I do think helped was to balance on one foot but with my eyes closed. It force's your foot area to work really hard on stability and at the beginning is very tiring on the foot and ankle

Posted an evidence based hierarchy of injury prevention for runner below. You'll notice load management is most important (not increasing your training load massively week to week, managing fatigue through programmed deload weeks etc).

You'll also notice that strength and conditioning is far more impactful than stretching etc. For anyone who spends hours each week stretching I would really stress the fact that that time would be much better spent doing a very basic strength program 2x/week.

JohnMcm1 · 11-04-2021 1:06pm

lenny palmer wrote: »

I have been suffering with AT (never got an official diagnosis) since Christmas last year. It started after a bought a new pair of running shoe(I won't name any brand). I had been using the same brand for a number of years. It was in just my right foot for the most part. I ended up not running most of last year and when I did it was only for a couple of weeks at a time before it would be to sore to run. After 1 long break it all seemed fine and I was back running again. I then made the mistake of doing a harder workout with some fast speed work. It flared up big time, but now it was in both my calfs. At the start of this year I started working on my mobility, for my whole body not just my calf/foot. This seemed to help and got me back on the road. I decided to take this further and start really stretching. Doing it every night for about an hour or so and focusing mostly on my lower body. Especially my calf, hamstrings and lower back. That's when it flared back up again. I possibly have an Anterior tilt of my pelvis as well and the stretching I had been doing actually mad it worse. So I'm into another break from running again. I'm going back to mobility work but will not be doing the stretching (with the exception of my quads). 1 thing I was able to do to help with my fitness was to skip. I started off nice and easy, focusing on how I was skipping and landing nice and easy. If my tendon showed any sign of pain I would ease off the skipping. 1 thing that I do think helped was to balance on one foot but with my eyes closed. It force's your foot area to work really hard on stability and at the beginning is very tiring on the foot and ankle

Posted an evidence based hierarchy of injury prevention for runner below. You'll notice load management is most important (not increasing your training load massively week to week, managing fatigue through programmed deload weeks etc).

You'll also notice that strength and conditioning is far more impactful than stretching etc. For anyone who spends hours each week stretching I would really stress the fact that that time would be much better spent doing a very basic strength program 2x/week.

11-04-2021 1:07pm

davegilly wrote: »

Anyone suffer from this? Had it last year, wasn't sure what it was but it was reasonably mild and I'd only suffer from it at the start of a run and it would disappear a k or two into the run. No pain afterwards. Bit of soreness in the mornings again but would disappear again 15 mins after getting up.

About 6 or 7 weeks ago it flared up again after a hard run. Not as mild this time and was bothering me during the day as well. Pain would ease and return throughout the day so I decided to stop running for a while. Iced it every evening for the first week and lots of heel raises. No real improvement. Been doing concentric heel drops for the next three weeks. Lots of improvement since but Its still tender when I wake in the morning. 30 mins later its all fine again.

I know it's not healed because if I squeeze the tendon it's still a little tender but apart from the first 30 mins in the morning all is good. So my question or two questions are:
1. How long does this take to clear up fully? It's been 4 weeks now of icing and heel raises/drops. Been cycling only since.
2. I haven't run in a month and I miss it. Now that there is a good bit of improvement - still some mild discomfort in the morning - would it be ok to start running again? Maybe some short slow distances for a while?

What do you think? All ok to.run again?

Doctor and scan, as soon as you can.
I "treated" mine the same way you're doing, as told by GP and physio etc. 6 months later I had a complete rupture, all calf muscle was retracted to my knee.

By far the most painful thing I've ever experienced. Bad enough that things were going fuzzy and I was close to passing out.

If you've insurance (or can afford) get the scan, a referral to an ortho, and take their advice

JohnMcm1 · 11-04-2021 1:15pm

JohnMcm1 wrote: »

Posted an evidence based hierarchy of injury prevention for runner below. You'll notice load management is most important (not increasing your training load massively week to week, managing fatigue through programmed deload weeks etc).

You'll also notice that strength and conditioning is far more impactful than stretching etc. For anyone who spends hours each week stretching I would really stress the fact that that time would be much better spent doing a very basic strength program 2x/week.

I'm not demonising stretching btw. If your particularly "tight" /sore in certain muscle groups and you find static stretching provides some relief then happy days. I would just question why anyone would spend hours each week using an intervention that has shown to be ineffective at reducing injury rates when there are proven interventions that do work (strength training). That's before we even discuss the other benefits of strength training regarding general health.

Also, my final point ensuring you are sleeping appropriately, eating a healthy diet and minimising life stress (not always possibly unfortunately) will do far more for your recovery than massage, foam rolling or stretching.

Ceepo · 11-04-2021 1:31pm

[Deleted User] wrote: »

Ceepo, what would you say are the best 2 or 3 stretches that you have found most useful for the hip/ lower back area that help to rebalance and most influence the Achilles tendon ?
I use lying spinal twists at the moment.

Its not as simply as that I'm afraid, there are a lot of factors that need to be taken into account.
You would need do some assessments first.

Things like the lack of dorsi flexion for example can have a impact, as can tight calves.? Then we need to ask why are the calves getting tight.? Are they overworked?, if so what are they compensating for.?

When you start to look at the hip complex, are you able to get hip extension on both side? If not, why not. Does one side of the hip rotated instead of extending?

It may or may not come as a surprise to some here, but I'm not the biggest fan of stretching.
You mentioned side lying twist, what are you doing it for, what do you feel that does, and how long does it last for?.
Again I maybe some what controversial here, when I say stretching rarely solves anything long term, and usually will need some type of a strengthening program to go along with it.

My philosophy is to get people moving better ALL of the time, not just when they do there stretches.

The problem with doing some stretching like this is, you're using the ground as platform to stabilise the none moving part, similar to doing seated trunk rotations.
As a test try doing it standing up, rotate the trunk and trunk only to the side without letting the hip's move. (this is usually hard than most people think)
By doing the exercise like this, you're developing the ability to rotate and stabilise at the same time.
Now this movement can be incorporated into daily task like reaching for the tea bags, getting something from a desk etc etc. And will have long term benefits.

Ceepo · 11-04-2021 4:29pm

[quote="JohnMcm1;116855556"
I would just question why anyone would spend hours each week using an intervention that has shown to be ineffective at reducing injury rates
.[/quote]

Because we are consistently told by Physiotherapist, s&c trainers, coaches, and most running magazines articles that it is need to prevent injuries.

davegilly · 11-04-2021 5:04pm

lenny palmer wrote: »

I have been suffering with AT (never got an official diagnosis) since Christmas last year.

Went for a 12K walk today and mine has flared up again now as well after yesterday's run

I think I'm going to have to pack in the running completely for a while - was fine this morning but it's pretty sore now again. Cycling and S&C isy plan for the next two months and see how it is after that. Everyone seems to have a different answer to what works for them so I suppose between the rest and everything else it will hopefully clear up.

On that, those of you who have recovered from this - has it cleared up completely or cleared up to the point where there is slight discomfort but manageable when running?

JohnMcm1 · 11-04-2021 5:28pm

Ceepo wrote: »

Because we are consistently told by Physiotherapist, s&c trainers, coaches, and most running magazines articles that it is need to prevent injuries.

Yes by bad ones who are spouting nonsense. I do agree though.

11-04-2021 6:11pm

davegilly wrote: »

Went for a 12K walk today and mine has flared up again now as well after yesterday's run

I think I'm going to have to pack in the running completely for a while - was fine this morning but it's pretty sore now again. Cycling and S&C isy plan for the next two months and see how it is after that. Everyone seems to have a different answer to what works for them so I suppose between the rest and everything else it will hopefully clear up.

On that, those of you who have recovered from this - has it cleared up completely or cleared up to the point where there is slight discomfort but manageable when running?

I had it on both sides. Got back playing with the rugby senior squad after the long lay off. The repaired tendon has been perfect for 12 years now, the left tendon always has some discomfort and it's what finally made me have to pack in any sports requiring explosive speed or direction changes, anything straight line and consistent if fine. Even light trail running

Marty Bird · 11-04-2021 6:20pm

Anyone suffer from insertional tendonitis were the Achilles goes into the calcaneus anyone any tips for this?

Ceepo · 11-04-2021 6:55pm

JohnMcm1 wrote: »

Yes by bad ones who are spouting nonsense. I do agree though.

Irish Society of Chartered Physio recommend static stretches to prevent injury, prevent onset of muscle soreness and to increase muscle length!!

sseairtricitydublinmarathon.ie/wp-content/uploads/2015/04/Injury-Prevention-2015.pdf

Would this fit into a false narrative category.

As to the best of my knowledge they're no evidence to support this. In fact they're is evidence that it doesn't

JohnMcm1 · 11-04-2021 7:08pm

Ceepo wrote: »

Irish Society of Chartered Physio recommend static stretches to prevent injury, prevent onset of muscle soreness and to increase muscle length!!

sseairtricitydublinmarathon.ie/wp-content/uploads/2015/04/Injury-Prevention-2015.pdf

Would this fit into a false narrative category.

As to the best of my knowledge they're no evidence to support this. In fact they're is evidence that it doesn't

I've clearly stated three times that I don't think static stretching is any use, I've posted evidence based recommendations for runner who want to reduce their risk of injury.

What exactly do you want me to do say?

Btw you were spouting a load of ****e about biomechanics etc yourself not that many posts ago.

Ceepo · 11-04-2021 7:25pm

JohnMcm1 wrote: »

I've clearly stated three times that I don't think static stretching is any use, I've posted evidence based recommendations for runner who want to reduce their risk of injury.

What exactly do you want me to do say?

Btw you were spouting a load of ****e about biomechanics etc yourself not that many posts ago.

woah slow down there buddy, no need to throw the dummy out, I was just asking your opinion,

I agreed with you about static stretching. you mentioned that "bad ones were spouting rubbish", I was simply pointing out that the ICSP still advocated for doing it...

And the evidence based recommendations you linked included gait analysis and gait retraining, which correct me if I'm wrong is biomechanics.

BTW I never ask, what are your own qualifications?

ariana` · 12-04-2021 9:25am

This seems to be quite a common injury. I'm about 7-8 weeks into the Alfredson Protocol which I've stuck to very religiously and it's working for me. Mine was never so bad that i had to stop running so I've been lucky that way. For me it was stiffness in the morning that would go away once i was up and moving about and also some manageable pain or stiffness during tough sessions or long runs. So it was manageable but at the same time it was getting to the point where I had tightness in the PF and other parts of the calf & foot also and I was starting to catastrophise about the whole of that calf/ankle/foot. The morning stiffness is almost all gone now and I rarely feel any pain or tightness at all, on a recent strength test the injured Achilles actually scored higher than my other Achilles. I feel I'm 90-95% there now so hopefully the next few weeks will get me to 100%. I'm aware that there are so called non-responders but just sharing my experience of the Alfredson protocol. Unfortunately it seems to be a case of trial and error with this injury.

davegilly · 12-04-2021 2:07pm

I'm 46. Would age have anything to do with the speed of recovery?

Ceepo · 12-04-2021 3:56pm

davegilly wrote: »

I'm 46. Would age have anything to do with the speed of recovery?

Unfortunately it can do.

But you certainly can help it out a bit by eating good quality food, (non inflammatory) and getting good quality sleep.

Edit,, oh and hydrate well

Ceepo · 12-04-2021 4:53pm

Marty Bird wrote: »

Anyone suffer from insertional tendonitis were the Achilles goes into the calcaneus anyone any tips for this?

Similar rehab protocol really.
Deload, so ease back on the training.
Deep tissue massage and maybe dry needling.
You can try doing eccentric heal drops.
Maybe temporarily use a heal raise if you are running, to take some of the pressure of it, if its is still in acute phase.
Personally I'm not a fan of using ice. Inflammation is there to heal it.
Not a fan of stretching either, but that said there's a stretching component to eccentric heal drop.
Foam roll calves, staying on any sore spots not continuous rolling up and down.
I would also factor in getting your biomechanics looked at if it persist.
Id also do some walking in barefoot, as this will bring the foot through range of motion.

Of course not everyone will agree with the above. But hey, there you go

Marty Bird · 12-04-2021 10:57pm

Ceepo wrote: »

Similar rehab protocol really.
Deload, so ease back on the training.
Deep tissue massage and maybe dry needling.
You can try doing eccentric heal drops.
Maybe temporarily use a heal raise if you are running, to take some of the pressure of it, if its is still in acute phase.
Personally I'm not a fan of using ice. Inflammation is there to heal it.
Not a fan of stretching either, but that said there's a stretching component to eccentric heal drop.
Foam roll calves, staying on any sore spots not continuous rolling up and down.
I would also factor in getting your biomechanics looked at if it persist.
Id also do some walking in barefoot, as this will bring the foot through range of motion.

Of course not everyone will agree with the above. But hey, there you go

Thanks I’ve been out for a few months and only went back last week, it’s starting to flare up I’ve stopped the heal drops as it drives the bone into the insertional part.

When you say biomechanics any recommendations for that ?

12-04-2021 11:13pm

Marty Bird wrote: »

Thanks I’ve been out for a few months and only went back last week, it’s starting to flare up I’ve stopped the heal drops as it drives the bone into the insertional part.

When you say biomechanics any recommendations for that ?

Personal I'm a big fan of the technique that Eric Orton talks about, he has many other useful videos on his YouTube channel.

https://youtu.be/XaYQwq6TnXY

Ceepo · 12-04-2021 11:35pm

Marty Bird wrote: »

Thanks I’ve been out for a few months and only went back last week, it’s starting to flare up I’ve stopped the heal drops as it drives the bone into the insertional part.

When you say biomechanics any recommendations for that ?

So I take it you have done the vast majority of the protocol I listed and haven't seen much improvement?

Ceepo · 13-04-2021 12:03am

Deleted User wrote: »

Personal I'm a big fan of the technique that Eric Orton talks about, he has many other useful videos on his YouTube channel.

https://youtu.be/XaYQwq6TnXY

Just had a quick look there, hadn't heard of him before,
Some of what he says is sound advice, few things I'd disagree with thought,
"Squeezing the glute at the top" this achieves nothing really in the context of moving as you won't do it as you walk or run, in fact you probably couldn't walk or run if were to do that.
He mentions that "thing's start at the feet and work its way up". The reality is we have small muscles in our feet and big ones in our hip, if the big ones are doing what they're suppose to then there's a good chance the small ones will do the same, however the same can't be said if it's the other way around,(example: left hip rotates instead of extending, the foot can't change that, foot over pronation can be change at the hip) and they certainly won't help to fire the glutes or help tight hip flexor.
The starting point of corrections should be the hip,

Not tryin to take away from the video, just my thoughts on it.

Marty Bird · 13-04-2021 9:37am

Ceepo wrote: »

So I take it you have done the vast majority of the protocol I listed and haven't seen much improvement?

I have been get some relief from the heel raises, I haven’t got any needling done, I normally roll the legs daily but I’ll try what you suggested when rolling thanks.

13-04-2021 6:25pm

I read this thread a couple of days back out of interest.

Had a sore achilles y'day after my run, woke up this morning with it stiff.

Currently cycling between compression and ice.

I'm blaming this thread for it happening.

Achilles Tendonitis

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