Achilles tendonitis

Hi.

I appreciate there are other threads on this most dreaded of running injuries but my particular experiences - especially the length of time I had this injury - I feel warrant a thread of their own.  In particular I want to help or encourage other runners who are facing long term AT, especially if you're wondering how on earth much longer have you got to put up with it and what's the best way to help recovery.

I haven't done everything right but I have learned a lot.

My idea was to document my history and thoughts here as a kind of blog.  With the benefit of hindsight I can try to make it informative and constructive. It many take several days to set everything out - there may be quite a few posts!

In the meantime if you want to chip in, feel free.  I may respond to your points straight away or more likely wait until the end.  I may cover your point in later post!

So, to begin ..

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  • My background is mainly in marathons and ultras.  Over the last few years I have done more and more offroad running, and virtually none of my training is on tarmac roads.  I've been running about 14 years and apart from a catalogue of injuries, mainly minor, when I first started I had been largely injury-free for many years.

    So finishing the Snowdonia marathon Oct 2010 with pain and swelling at the back of the left ankle was an unusual experience.  What didn't help was the next day I went for a walk in the mountains (covering three 3000-ers) by the end of which my ankle was in severe pain.

    My usual philosophy with any injury was complete rest, so with this I rested for 16 days - it seemed to need it -  before feeling well enough to go out on a short, but very hilly and stony climb and descent of my local hill (1500').  I tore down the hill at full speed as was becoming my wont.  Although OK on the run, later in the evening the ankle swelled up like a balloon with incredible pain.  I could scarcely walk or drive.

    Icing it was useless. Immersing it in a bucket of cold water was better but the achilles tendon area stayed swollen and spongy, extremely sore to touch.  Flexing the foot was difficult (especially away from you as you would do when standing on tip-toes).

  • Over the next few weeks the area stayed spongy and walking was gradually getting harder and harder - I couldn't do the proper gait cycle with the foot and limped badly.  Running was out of the question.  Trying to stand on tip toe (aside from the pain of trying) was impossible - I didn't seem to have a muscle that did that movement.

    What seemed to make it worse was long periods of inactivity - I spend a lot of time either at  a PC or driving.  Trying to walk after sitting down for a long time was pitiful to watch.  At work it got to the point where I had psyche myself up to walk the 50m to a storeroom.

    I was trying to reduce the swelling by long sessions with the bucket of cold water.

    Clearly something had to be done, but what?

  • T Rex - Thanks for the post. I will follow the thread with interest

  • Doing some research I soon discovered it was achilles tendonitis.  The tendon wasn't ruptured since I would be in more pain, walking would be virtually impossible, and I would have known exactly when it happened - there would have been an episode of acute pain.  But this was something that came on more slowly, during that marathon and afterwards.

    About early Dec 2010 - so after about 5-6 weeks -  I had the recommendation from a friend of a sports injury therapist in my area.  I made an appointment and went.  First time ever in my running career that I was seeking sports-injury-related professional help.

    What I learned from her  - I won't divulge her name on a public forum - on that first appointment, and from all the sessions I had with her over the next 12 (yes, twelve?!) months has been vital and key to my recovery.

    I'm not sure there are any other ways by which chronic achilles tendonitis can be made to heal except for a regular programme of deep tissue manipulation from a specialist - such as I endured week in, week out all that time.  Well, there is one other way I found out about but more on that later.

  • Paco thanks for that.  Read on! 

    I would strongly urge not taking the surgical route, unless you know the tendon has ruptured or come away from the heel bone.

  • I am not medically trained so the description that follows may not be absolutely accurate and may be cringe inducing to those that are.

    The achilles tendon is the largest tendon in the human body which conects the muscles of the heel bone to the lower calf.  It is flexible but only to a certain extent - it relies on the flexibility of the attached muscles - and has little or no blood supply to it, hence why it takes so long to heal.

    The -itis is when the outer covering of the tendon become inflamed because it has been aggravated by some cause.  (I'll try to look at causes at some point.)

    The achilles tendon moves within a sheaf of muscles surrounding it, so when the tendon is inflamed this movement becomes very restricted and left to its own devices all sorts of scar tissue can build up which may permanently restrict the tendon's movement.  Unless you can perhaps do something with super-stretching the calf muscles your running career could be in danger.  Aside from the almost permanent, if usually low-grade, pain you have to put up with.

  • This was where my sports injury therapist (SIT) came in.

    So, after a full examination, and about six weeks after the injury and with my upper ankle about twice the size it used to be normally, she set to work with deep tissue manipulation. On each occasion firstly of the calf, which had also become very tight (too sore to stretch) and then into the area of the tendon itself.  Mainly to both sides of the tendon before rounding off with a full frontal assault on the ridge of the tendon itself.

    The idea of this is to break down all the scar tissue - she called it "crystals" - that was causing muscle and tendon fibres to fuse together.  Separating out the fibres again, with the eventual aim of freeing the tendon completely.

    I have to be quite frank here.  Although I absolutely recommend deep tissue manipulation - it bears no resemblance to therapeutic massage.  During the sessions with my SIT I can honestly say I had to endure the worst pain I have ever experienced in my life (51 years).  And this voluntarily!!

    There were times I was gripping the couch so hard I thought it would actually break and there were huge dents in my biceps!  Sometimes I would be moaning and banging my head up and down on the couch.  Sometimes loud yelling.  Always heavy and laboured breathing. 

    But in 12 months only once did I have to ask her to stop because I thought I was actually going to pass out.

    She never bruised me once, nor even made the treatment area red.

  • What made this so painful of course, especially during the first few months, was that the area was so swollen with sponginess and water, or whatever it is that's in there, making it very difficult to isolate muscles and tendons. And pressing swellings hard does hurt.

    As time went on and the swelling reduced, the sessions became more effective and less painful, although she had the tendency then to rack up the intensity because she could feel herself getting somewhere!

    At first I could only put up with one of these sessions a week - typically I would have appointments 6-8 days apart.  It took several days for the additional soreness of those sessions to subside.  Later on I was able to stomach two a week.  Later still I tailed them off until only one a month, finishing them altogether in Dec 2011, a year after I'd started them.  The SIT didn't think any further treatment would be beneficial, or necessary.

  • That'll do for now.

    To come:

    • what training and racing I was able to do during 2011 (this might surprise you)
    • other treatment I investigated and other advice I received - including from just the one visit to my GP
    • self help ideas and things to avoid during recovery
    • causes
    • preventive measures
    • etc

    Some of what I have to say might be considered as unconventional.  So many emphasise rest, rest, and more rest.  I want to suggest an alternative approach.

    See you later.

  • Loving reading this - I've been nursing AT issues since August last year, looking forward to reading more.
  • Hi T Rex

    Great story.

    but, I bet you'll break down...sorry image

  • Waiting for the next post ...... I'm sure I'm not alone!!  I'm at that point - six months in and wondering how much longer I have got to put up with it before the pain goes and I can start running again.

  • Some kindred spirits here image.

    Paco - you seem to have lost most of your post, but I did read it all.

    Hard to know how to document 15 months worth of stuff in a sensible order but I'll keep going ...

  • The sports injury therapist (SIT) I was seeing Dec 10 - Dec 11had had experience with AT but not on someone who ran longer distances and had never come across an example of the condition as stubborn as mine.  Most people's AT cleared up after only about six weeks!  And most of the threads on this forum seem to be about AT seem to be this mild version

    But, apart from one two-week period about three months into the treatment when it looked as if we were going backwards and the injury was getting worse again (morale was low at that point for both of us), I can say that with each visit there was improvement afterwards, if sometimes only very small. 

    At the beginning of treatment, although I felt good straight afterwards with the tendon really loosened up, the pain from the experience lasted several days.  It was some time before I was physically capable of having two sessions a week.

    The sessions gradually took effect and the swelling started to disperse.  I'm afraid this was only after several months.  With less swelling the SIT was able to get much deeper and manipulate tendon tissue and finally get it back to looking like normal.

    Because I am back to normal.  The reason I have started posting now was because in my last long run which was yesterday, for the first time I could feel nothing wrong with the achilles either during or after the run.  In fact I had forgotten I'd had the injury!!  What a great feeling.

  • That's the treatment aspect.

    A big mistake I made was not seeking it much sooner after doing the injury.  Because I left it a long time (about six weeks) all sorts of tightening and fusing of fibres had taken place and additional swelling.

    I've always been averse to professional help, prefering to "listen to my body", etc but this episode has re-educated me!  Of course it was expensive as well, but I judge it worth it.

  • Great read, look forward to the rest!!!
  • cragchick - I doubt you'd have the courage to massage yourself hard enough to be really effective, but if you are special forces or Antarctic explorer calibre you might be able to!  Think Ranulph Fiennes sawing his own frostbitten finger tips off!
  • As well as the 30-40 minute sessions on the couch, I was given advice on things to do at home.  This consisted mainly of:

    if the achilles is swollen, ice it.  I have found the easiest way of doing this is to soak the whole foot and ankle in a bucket of cold water for about 15 minutes.  Put ice in as well if you like.  I didn't.

    if the achilles is not so swollen, keep it warm and stretched.  The SIT emphasised frequent stretching using exercises similar to those used to stretch the calf.  This is fine because the calf is tight as well.  The best exercise is putting the balls of your feet up a wall and gradually leaning towards it pivoting on your heel, and holding it for about 30s.  This is a very powerful stretch and should be done very gently.  Do not do it if you suspect the tendon is partially (or fully) torn.  Incidentally you need to stretch both legs to ensure no imbalances.

  • I'll mention here things to do and things to avoid during the recovery.  Some of these ideas were from the SIT, some I learned myself by trial and error.

    DO

    • really exaggerate the correct foot movement when walking, i.e. proper heel placement.  It will hurt, because it is easier to limp.
    • walk down stairs heel first

    The more swollen your achilles is the harder it is to do these things but persevere!

    DO NOT DO

    • stand on tip toes (ladies no high heels)
    • limp
    • sit still for long periods - instead keep moving

    The aim always is to stretch the tendon and attaching muscles, not contract them.  Keep them warm and in use. 

    I expect there are other ideas.  I'll give them as and when I remember them.

  • At this rate I'm going to be looking at causes last ...

    ... because I am sure what you really want to know is what running can be done (if any) while you are recovering?

  • keep on typing T Rex... good read.  And it makes sense.
  • Thanks for that.  Even to a pirate?
  • OK, running.  Or not?  This is the question.  Do you "run through" this injury, or rest up until all symptoms have gone?

    This is where I've had to go out on a limb.  I'd set myself some running goals and had race entries in.  Generally speaking I'm not all keen at pulling out of things. 

    I could find no real good advice anywhere as to how far I should be thinking about running.  The SIT could find no reference point for the distances I was contemplating.  She was not used to long-distance runners and their mindset - and she didn't know me and wasn't able, at least initially, to judge whether I was being foolish or not.  Obviously she wouldn't want her work undoing so I dripfed her with information about my events one at a time in order not to cause alarm. 

    We were both on a learning curve together here, I think.

    My first runs had to be in the middle between therapy sessions.  A few days after to recover from the session, but also a few days before the next one because those first runs caused some aggravation and there was no way I was going to let anyone near that tendon.

  • Good read TRex

    Took me a good 18 months or more to sort out my AT, bits of sports massage but not as heavy as yours it sounds. Lots of ice buckets. Cold sprays. Switched away from striking with heel to front of foot.

    Chiropractor finally sorted mine out, manipulating my hip
  • Ignoring that stupid hill run I did on 16 Nov 2010 which in all of the last 15 months was my worst mistake by far -and I'll talk a bit more about it later - my first run since Snowdonia marathon 30 Oct 2010 was a tentative 4 miles on 16 Jan 2011.

    Well, I had to be a DNS at my first race for 2011, a 50K a week later.  Even I could see the sense in that!!

    My SIT was happy about resuming running and was listening to my feedback closely.  Her expectation was that it would be sore to start off with, but the tendon should loosen up after a couple of miles and the pain ease off.

    It did nothing of the sort - it was moderately painful throughout,  with no easing off.  By the evening of that day the pain was extreme and swelling huge.  The next day though it was back to how it was before the run.

    My next run was 11 days later, 8 miles.  Again moderate pain until mile 8 when it got much stronger and I finished the run, as I put it in my log, with "loss of form".  I also noted I was in "great pain for 36h".

  • Interesting point Fit-Running-Cat.  I would have said forefoot stiking would have made the AT worse, unless you really were transmitting a lot of shock through the heel?  Looks like yours was a slightly different and more complex issue.
  • T Rex

    Great Read and very interesting. I have had a mild version of AT twice over the last couple of years. Since Christmas I have had it again

    I have used some of the stretches you describe and especially heel drops Been to a sports therapist a couple of times for massaging.

    My current dilemma is to run or not to run. Currently holding off as the last two short runs I did (5k) aggravated it and left me hobbling for a few days so trying to keep fit at the gym spinning and on the turbo trainer both of which seems to ease and loosen the tendon.

    Keep posting its an interesting read. Thanks
  • I won't bore you with the details of all the runs, except for these initial ones. 

    Seven days later I was out again for 8 miles.  This time "painful during miles 7-8, but no loss of form".

    Ten days after that (13 Feb 2011) I was up to 10 miles, when for the first time I noticed the pain eased during miles 3-6.

    By the end of February I was up to two runs a week, one short and one gradually getting longer.  My first serious target event was 19 Mar so I was really working hard at getting the balance right between running and treatment, and focusing on what was creating improvement.  My racing calendar for 2011 was driving me.

    So I was doing these things alternately: a run then a torture session, each about two or three days apart. 

    On 27 Feb I managed 12 miles: "OK 2-7, getting painful 8-9, eased 10-12".

    This "easing" was starting to happen, and post-race discomfort was getting less.

    Something I was beginning to notice was that a day or two after each run the achilles was feeling really good, better than before the run. 

    Running was actually helping it.

    [To be continued]

  • Sprint ST - yes, heel drops are very useful.

    Before I go, something I haven't said is that these intial runs were at a vastly reduced pace to normal.  I tried to concentrate on form and a proper gait.

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