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Hmm. I admit we all need a maximum range of movement in the ankle when healthy. The trouble with tendonitis is that there is a real threat of tendon and muscle fibres becoming shortened. Contraction such as you describe should be avoided, certainly in the beginning stages of the injury. People with bad cases of AT, such as mine, would not physically be able to do toe raises anyway. Or would compromise themselves by using the good leg.
I always used to think, heel. Use the heel. Keep the tendon warm and stretched. When walking, or sitting, think about keeping the heel placed on the ground. Stretch out the tendon at every available opportunity.
In the second half of Mar 2011 I was having a few setbacks. I noted I was feeling "sore and tired". I had managed one 16-miler, recording "a struggle 13-16" and "sharp pincer-like pain at mile 9".
My warm-up race for 2011 was the Rhayader 20 which I did, recorded "no untoward pain". I was much slower than usual due to the injury and the lack of fitness.
This turned out to be the feature of the entire year! Lack of performance, constant nagging injury, but through it all gradual improvement.
The act of running was itself part of the healing process. Although often difficult at the time, and painful immediately afterwards, a few days later came a little more relief from the pain in the area and a little more reduction in the inflammation.
Between that race and my next on 10 Apr I only did one run, which was a 24-miler. I was just about doing the very minimum to still be able to do these events.
Don't try to do a heavy training programme. I didn't.
During this run I noted that "the achilles eased from 14 miles on". My SIT was a little surprised how far I had to go before noting this easing.
I was a little apprehensive on the start line of the Connemara 39.3, Co. Galway, but managed to complete it in just under 7 hours, about 45 minutes slower than normal. In this the achilles eased at 18 miles.
Next up to think about, and to dripfeed my SIT information with, was The Highland Fling 20 days later. This was 53 offroad miles with rocks and tree roots on the West Highland Way. She tried not to look too worried but I think by now she was slowly being drawn in to my madness. But there was more that I wasn't telling her about.
While I was in Ireland running that ultra I fell into conversation with an Irish runner who told me he had been plagued with AT for I think about a year or two and decided to visit Ireland's top surgeon specialising in sports injuries. This chap injected steroids (cortisone) directly into the tendon. He told me he had been symptom free since then, a few years.
Sounded drastic to me, but over five months into my own injury I thought I'd pay a visit to my doctor to see what he thought. He said if a GP injected into the tendon like that he would risk being struck off. The practice is extremely dangerous: it masks the pain and you risk further injury e.g. rupture, or the procedure itself can actually rupture the tendon. GPs wouldn't do it for risk of litigation. SIT was dead against it as well - she thought the body should heal itself.
Whilst at the Drs of course we had a general chat about AT and he printed out some very helpful notes, some of which I've incorporated into what I've said so far.
He also said, "The thing with achilles tendonitis it comes when it feels like it, and goes when it feels like it - there's not much you can do for it". Typical doctors! But he did suggest that I should keep moving and advised me it should be OK to resume my normal level of activity. If he had known I don't think he would consider my "normal level of activity" normal!
So, GP sanction to carry on and not rest up.
Back to Scotland, then.
Always quite a logistic exercise, this ultra. I camp the night before and get my stuff moved to different places along and at the end of the course.
Set out well enough but somewhere along the shore of Loch Lomond I stubbed my toe very badly. This sent shock waves into the achilles and I suddenly felt a rush of nausea and outrageous pain. Couldn't help the involuntary yelling. I had to stop.
Was my race over?
It wasn't a good place to stop. About 20 miles in and still another 8 or so to the next check point, so I tried to hobble on, first walking, then shuffling, before finally breaking into a slow and pained run.
"Better not do that again," I thought. But I did, twice, in the next 20 miles. After the third time I realised it would be curtains if it happened any more times. It didn't, happily.
So, lesson here: be careful about foot placement - no stubbing of toes.
I soldiered on to the end of the course, at Tyndrum. I finished over 2 hours slower than I had ever done this event before, taking over 14 hours, and was nearly at the back.
Achilles was sore, but holding up.
The thing is, it wasn't over yet.
Hello, *Frodo*, you've found my thread, then! You'll know my whole life story soon. That would certainly throw up some surprises.
Are you all still with me? A long story, I know, but I should be finished in a couple of days ...
After a breather at the finish of The Highland Fling, after 53 miles, a change of clothes, and taking on board more supplies, I then carried out my long-planned "extension" - going on to the end of the West Highland Way alone and unsupported, and through the night. This was another 43 miles.
Arrived at Fort William after almost 32 hours on the trail. Achilles sore, of course, but that was only one problem amongst many by that point!
I think I told my sports injury therapist about the "extension" only when I came back.
So I can demonstrate that long distances are possible. Clearly running on all that rocky and uneven terain was difficult, but no harm was done.
The next event to prepare her for was the Housman 100, a walking event in Shropshire organised by the Long Distance Walking Association, who do allow runners. The total distance was in fact 101.2 miles.
Now this I did struggle with. I was nursing this injury, it had been a dramatic build up of distance over the Spring, and I was only able to do minimal training for these events, some would say not enough training. I was not at all fit.
A reasonable event though. Not sure I would do another one of these LDWA "hundreds" - the needs of walkers and runners are different.
Finally got to the finish line, having not long turned my headtorch on for the beginning of a second night on the trail. Time was a very disappointing almost 35 hours.
I won't bore with the remainder of my 2011 season which consisted of three road marathons, an offroad marathon, and the Ridgeway 85. I completed all these, but at a far poorer level of performance than I would normally be capable of.
That's the documentary of the year's running, to show what's possible, but more helpful might be the things I've learned from running with AT, and things that I have found are necessary to do:
This neatly brings me round to causes, which I'll give my thoughts on later.
Then I'll summarise.
Above all take heart if your AT is getting you down. You can overcome it.
I'll try to help with any feedback or questions.
F-R-C - my SIT I have to be honest was generally worried throughout, but got used to me about six months in! As I've said, I only told her about my running events one at a time, and didn't give her my whole running calendar.
During that Spring build-up (the hundred was at the end of May), I was seeing her once or twice a week and getting excellent treatment for the injury.
I want to be clear that she was not having to do extra work because I was doing additional damage. Apart from a two-week period early on, with every visit there was an improvement to the achilles: less swelling, more strength, and more ability to cope with deeper manipulation.
I consider that all the running I was doing was contributing to my recovery. It was a learning curve but I had managed to to get the balance right of doing just about the right amount, and at not too great an intensity.
As to cost, the whole course of treatment cost no more than, say, a weekend away with my wife, or a car bill. I judged it well worthwhile.
I am now clear of the injury.
What causes AT? Perhaps others would like to chip with their thoughts or experiences on this.
The standard causes include:
My GP's "it comes when it feels like it" is not satisfactory.
To this I'm adding what I feel is my reason:
I ran that Snowdonia marathon in road shoes - Brooks Adrenaline GTS (not sure what version) - but towards the end, although not too technical, there is an offroad hilly section during which I feel the back of the shoe dug into the achilles, aggravating it. They were quite new. I had done a 50-mile road race in them, but nothing offroad.
It is all I can think of. So simple a thing causing 15 months of frustration.
Advice then: choose shoes that do not have such high backs. In the meantime whilst injured, again try to choose low-backed shoes for all footwear choices. I spent a lot of my time in sandals.
I appreciate all that is a lot to wade through, but I hope it was helpful and gave you more hope about your own long-term AT. Patience is the thing most needed.
I'll try to some it all up in another post or two in due course.
In the meantime I'd be interested to hear any feedback.
Thanks for taking the time to write such a thorough post.
Achilles problems seem to be still so little understood by the professionals in whom we have to trust. I think in the past, a lot of elite athletes ended up having surgery (Gebreselassie for example), but I am not sure of the long term success rates of going with that treatment option.
Hope you have a trouble free time ahead.
Its a fantastic read. My AT is only mild, nothing compared to yours, but vthen neither is my running calender. I found stopping running had no effect so I've carried on managing it in my own way. It gets no worse or better. The advice on heat versus cold is great. I've had good success with mixed approach - heat first, ten ice it then heat again - the hobbling first thing in teh morning is often more bearable after this.
Well done on having the determination to carry on - its very easy with injury to get to the stage where you're not sur eif you can be bothered to run again. Hope your year continues injury free and thanks for the gripping read!
A great, if painful story, very well told indeed. It's good to have such input from someone who is very seasoned in running on the most challenging terrain at marathon and ultra-distances. Certainly puts my experience into perspective! But then again, that's the thing with AT - it can strike people at various stages of their running careers, right?
I hope you don't mind if I repost your thread on my blog?
I'd sooner you didn't if that's all right, qfs. I like to keep my stuff where I know where it is.
I wish you well for your future running plans. The benefits and enjoyment from running vastly outweigh the temporary set backs such as injuries, even if they last 15 months.
Glad to see you are on the mend or already mended T-Rex! What with those tiny arms I bet you could not even reach the edge of the bed!
I'm quite surprised at the lack of response from people out there with experiences like mine or who are still battling with their own long-term AT injury. And I notice at least two new threads on AT have already started since this one finished!
I can only assume others have not had this injury for as long as me which of course I am pleased about.
I'm sure this thread will remain useful as a resource in the future and if resurrected at a later point I'll probably notice and respond to any feedback.
Enjoy your running, all. And don't forget to avoid shoes with high backs! And do your calf stretches regularly! And try to avoid sitting for long periods!
Above all keep moving.
I have suffered from AT for the past six months or so, still have slight problems and not running. Last summer was hobbling around particular first thing in the morning. Physio has helped and stretching as much as possible.
In the last week or so haven't really felt any pain, although caught my achilles on a chair and nearly hit the roof.
Really miss getting out running, just an hour or so in the woods / countryside sets me up for the day. Moved workbase closer to home nearly three years ago with the intention of running to work most of the time, okay for three months and since then beset with injuries - hamstring tear, swollen ankle and then AT, although I think AT was caused by the swollen ankle ie my body compensating for the weak ankle.
Got to agree with previous comments about treatment.