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Achilles Tendonitis

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    #32
    JohnMcm1
    Banned (with Prison Access) Posts: 79 ✭✭JohnMcm1


    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.


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    #33
    Ceepo
    Registered Users Posts: 2,510 ✭✭✭Ceepo


    [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.


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    #34
    Ceepo
    Registered Users Posts: 2,510 ✭✭✭Ceepo


    [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.


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    #35
    davegilly
    Registered Users Posts: 680 ✭✭✭davegilly


    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?


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    #36
    JohnMcm1
    Banned (with Prison Access) Posts: 79 ✭✭JohnMcm1


    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.


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    #37
    [Deleted User]
    Posts: 0 ✭ [Deleted User]


    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


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    #38
    Marty Bird
    Registered Users Posts: 1,871 ✭✭✭Marty Bird


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


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    #39
    Ceepo
    Registered Users Posts: 2,510 ✭✭✭Ceepo


    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


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    #40
    JohnMcm1
    Banned (with Prison Access) Posts: 79 ✭✭JohnMcm1


    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.


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    #41
    Ceepo
    Registered Users Posts: 2,510 ✭✭✭Ceepo


    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?


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    #42
    ariana`
    Registered Users Posts: 4,291 ✭✭✭ariana`


    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.


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    #43
    davegilly
    Registered Users Posts: 680 ✭✭✭davegilly


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


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    #44
    Ceepo
    Registered Users Posts: 2,510 ✭✭✭Ceepo


    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


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    #45
    Ceepo
    Registered Users Posts: 2,510 ✭✭✭Ceepo


    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 :)


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    #46
    Marty Bird
    Registered Users Posts: 1,871 ✭✭✭Marty Bird


    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 ?


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    #47
    [Deleted User]
    Posts: 0 ✭ [Deleted User]


    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


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    #48
    Ceepo
    Registered Users Posts: 2,510 ✭✭✭Ceepo


    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?


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    #49
    Ceepo
    Registered Users Posts: 2,510 ✭✭✭Ceepo


    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.


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    #50
    Marty Bird
    Registered Users Posts: 1,871 ✭✭✭Marty Bird


    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.


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    #51
    [Deleted User]
    Posts: 0 ✭ [Deleted User]


    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.


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    #52
    daydorunrun
    Registered Users Posts: 784 ✭✭✭daydorunrun


    I struggled with this for 5 months two years ago. Ended up getting shockwave therapy on it. Expensive and painful but did the job. Here’s where I went-

    https://www.sportssurgeryclinic.com/wp-content/uploads/2016/10/Shockwave-Therapy-WEB.pdf

    I have since bought one of these

    https://nordicprostore.com/products/hyperice-hypervolt-massage-gun?gclid=EAIaIQobChMIsKzBhev77wIVh7PtCh3_zw18EAQYASABEgLwZPD_BwE

    And regularly treat the area with it, works a treat.

    “You tried your best and you failed miserably. The lesson is, never try.” Homer.



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    #53
    Ceepo
    Registered Users Posts: 2,510 ✭✭✭Ceepo


    HungryRepair54 wrote: »
    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.

    Yeah, that's how all injuries are pick up. :)


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    #54
    Unknownability
    Registered Users Posts: 918 ✭✭✭Unknownability


    daydorunrun wrote: »
    I struggled with this for 5 months two years ago. Ended up getting shockwave therapy on it. Expensive and painful but did the job. Here’s where I went-

    https://www.sportssurgeryclinic.com/wp-content/uploads/2016/10/Shockwave-Therapy-WEB.pdf

    I have since bought one of these

    https://nordicprostore.com/products/hyperice-hypervolt-massage-gun?gclid=EAIaIQobChMIsKzBhev77wIVh7PtCh3_zw18EAQYASABEgLwZPD_BwE

    And regularly treat the area with it, works a treat.

    Do you mind me asking the approximate cost?


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    #55
    [Deleted User]
    Posts: 0 ✭ [Deleted User]


    Marty Bird wrote: »
    Anyone suffer from insertional tendonitis were the Achilles goes into the calcaneus anyone any tips for this?

    My OH has this for years..
    Haglands deformity is the medical term I believe.
    One ankle he needed surgery it was unbearable, he tried orthotics, ice, rehab, steroid injections etc the works first. Never had any bother since that surgery.
    Now the other ankle has flared up Alot over the last few weeks, was always bothersome but unbearable now. Hes trying ice, orthotics, splints, physio, and went for extracorporeal shockwave therapy recently, too early to say if that will make a difference, if not it's surgery next. We've heard PRP might be an option too
    It's a tough one this one
    Have you tried a night splint? It might help,


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    #56
    Reg'stoy
    Registered Users Posts: 1,571 ✭✭✭Reg'stoy


    daydorunrun wrote: »
    I struggled with this for 5 months two years ago. Ended up getting shockwave therapy on it. Expensive and painful but did the job. Here’s where I went-

    https://www.sportssurgeryclinic.com/wp-content/uploads/2016/10/Shockwave-Therapy-WEB.pdf

    I have since bought one of these

    https://nordicprostore.com/products/hyperice-hypervolt-massage-gun?gclid=EAIaIQobChMIsKzBhev77wIVh7PtCh3_zw18EAQYASABEgLwZPD_BwE

    And regularly treat the area with it, works a treat.

    Have a very similar massage gun, which attachment do you use and how exactly do you massage the area?


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    #57
    Marty Bird
    Registered Users Posts: 1,871 ✭✭✭Marty Bird


    [Deleted User] wrote: »
    My OH has this for years..
    Haglands deformity is the medical term I believe.
    One ankle he needed surgery it was unbearable, he tried orthotics, ice, rehab, steroid injections etc the works first. Never had any bother since that surgery.
    Now the other ankle has flared up Alot over the last few weeks, was always bothersome but unbearable now. Hes trying ice, orthotics, splints, physio, and went for extracorporeal shockwave therapy recently, too early to say if that will make a difference, if not it's surgery next. We've heard PRP might be an option too
    It's a tough one this one
    Have you tried a night splint? It might help,

    Yes I’ve tried the night splint no difference, physio did recommend orthotics again no different. Mine can get really painful when I run on consecutive days.


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    #58
    [Deleted User]
    Posts: 0 ✭ [Deleted User]


    Marty Bird wrote: »
    Yes I’ve tried the night splint no difference, physio did recommend orthotics again no different. Mine can get really painful when I run on consecutive days.

    I think the night splint needs to be used for 2 months at least to see some difference.
    Have you looked into shockwave therapy? Oh has only has 2 sessions and has had Alot of pain after, so hopefully this is an inflammatory response, it's worth a shot before surgery, apparently it has a success rate of about 77%.


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    #59
    pauloYYC
    Registered Users Posts: 2 ✭pauloYYC


    https://www.boards.ie/discussion/comment/116883614#Comment_116883614

    Hi - would you mind sharing what the ballpark cost of the surgery was?

    I had two small tears in my achilles confirmed by scan just before Christmas, steroids, anti inflammatories, then nearly 5 months of physio, strengthening & orthotics later. All have helped, from not being able to walk down to stairs to running 3 times a week, but the pain / nagging discomfort is still there most days, more severe after prolonged exercise. Haven't dared to go back playing football since COV regulations allowed because I can nearly already tell that the sprints & twisting are going to cause real trouble.

    I'm nearly at wits end & have always thought of surgery as a last resort, but I'm sick of my bloody heel being the first thing I think about with that first step out of bed in the morning.



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    #60
    Ceepo
    Registered Users Posts: 2,510 ✭✭✭Ceepo



    This might be an interesting read for people on this thread.

    https://www.painscience.com/tutorials/achilles-tendinitis.php



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    #61
    davegilly
    Registered Users Posts: 680 ✭✭✭davegilly


    As the OP, I'll give a quick update on how it's been going.

    Achilles flared up in January 2021 and I stepped back from running a bit until early March when I stopped completely due to Achilles pain. It's now 7 months from initial pain and 5 months from when I stopped running and the pain in the morning has disappeared for about the last 10 days or so. Achilles is still a little tender to touch but there is no longer any daily pain or discomfort thankfully. Apart from a 15 minute test run last week I haven't done any running for 5 months. Been cycling and swimming over those months to keep myself sane.

    So what worked? No idea. I did hundreds if not thousands of heel drops. Heel raises. Calf stretches. Icing. Rest. NSAIDs, bouts of physio/shockwave therapy. Maybe it all contributed or none of it did. I've a feeling most of the recovery was simply down to time and not much else.

    Was going to start running again, gently, week of August 16 as a 6 week lead up to one of the Quest Adventure races. However I've had a bit of a setback last week and tore a shoulder muscle messing with the kids so looks like I'm out of action again for a month or so with that. Maybe it's no harm, gives the Achilles a few extra weeks to fully repair itself. Looks like 2021 is finished now for any events and onwards and upwards to 2022.

    So, long story short - Achilles Tendonitis takes a looooong time to recover from, there is absolutely no quick fix for this plus I'm not even sure I've fully recovered yet. I'll update again in a few weeks when hopefully I get back running again with hopefully no pain.



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