Achilles tendonitis



  • Trex Heel striking seemed to hurt me so naturally seemed to be the thing to do to avoid that pain. this is before the current barefoot running push came in last few years. As you said with yours, my pace went way down when the AT was bad at this point, very slow, lucky to run once a week 6 miles, bit of football on astro turf, some spinning classes.

    Achilles like concrete, hard bony, sore getting up in morning till the blood had been flowing for awhile standing.

    Just proving there is no wrong answer and everyone different, of your list of do & don't..Im the opposite view on some of these.
    I wouldn't exaggerate the movement, very light footed , and force the heel down
    Ditto stairs heel first, I'd go toes/ ball, and avoided shoes/ boots with heels.
    I wouldnt stand on tip toes, but certainly have done exercises on stairs on tip toes and then down through past the stair level and below..
    As for sitting/ standing still this was actually a clue for me ,something else sore,legs, hips, whatever. Did some Alexander technique lessons, some interesting things, exercises.

    Found my achilles loosen on holiday a few times after swimming in cold sea water, plus resting it sun bathing. Also wearing sandals but you forget this. Later found some cold sprays with menthol loosened it up got in deep and helped a lot.. £1 from a local shop.

    Chiropractor spotted that my left hip was 15mm shorter than right. Hence the AT.
  • T RexT Rex ✭✭✭

    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.

  • T RexT Rex ✭✭✭

    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.

  • Something in that (range of movement comment), I tend to sleep with toes alternating between heel straight & stretched out, .. when horse riding the instructor always laughs since Im moving between heel down & heel up., just habit I guess to avoid the pain

    Hard to work how bad a case like mine was, certainly Achilles like bone, very sore in mornings, limping badly till blood flowing.

    Chiropractor could see my problem within 1 minute examination. Best £20 spent ever with groupon offer for 2 visits. Fixed within 4-5 sessions over 2 months and allowed me to run a marathon within 3 months for first time.
  • T RexT Rex ✭✭✭

    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.

  • T RexT Rex ✭✭✭
    F-R-C - so it wasn't all inflamed and spongy, then?  I expect that marathon was a pleasing experience.
  • Blood red, spongy at times, often totally hard, bulging out quite a lot

    Sub 4 Marathon first time was lovely with all the effort, ph in half and 10k both by nearly 4 mins soon after
  • T RexT Rex ✭✭✭

    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.

  • T RexT Rex ✭✭✭

    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?

  • T RexT Rex ✭✭✭

    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.

  • *pulls up sofa*

    Fascinating stuff, TRex. Especially having followed your races on the SNOD threads last year, this really puts what you were going through in context image
  • T RexT Rex ✭✭✭

    Hello, *Frodo*, you've found my thread, then! You'll know my whole life story soon.  That would certainly throw up some surprises.

  • T RexT Rex ✭✭✭

    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.

  • T RexT Rex ✭✭✭

    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.

  • Jez Trex.. I'd be dead with no Achilles left after doing this.

    How was your physio you doing all this advice wise?

    Apart from being rich image
  • T RexT Rex ✭✭✭

    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:

    • accept your performance will be low, mainly through the inabilty to train very hard, if hardly at all.  You're nursing an injury.
    • be VERY careful when going downhill.  This action contracts the tendon and again it is very advisable to go down heel first, taking it easy, with very small steps.  No mad, fellrunning type descents.  That one I did so soon after the injury was folly in the extreme.  In offroad events I found this frustrating, but necessary. I was as slow going downhill as uphill, in many places in long ultras I was only running on the level bits, and walking the rest.
    • make adjustments to your shoe:
    1. have the laces loose to prevent excessive pressure and don't do the "butterfly" lacing method which tightens the shoe around the ankle.  If offroad running this allows all kinds of crap to get in your shoes, so I invested in some good running shoe gaiters to stop this.
    2. Consider heel raise inserts.  Controversial when considering the arguments of the barefoot/minimal shoe brigade.
    3. This takes guts, especially if you have new shoes, but I have done this on my shoes.  Using a sharp knife, cut slits down the back of your shoes, in effect extending the v-notch at the back of the shoe. This enables the ankle to articulate at a steeper angle without digging into the achilles tendon.

    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.

  • T RexT Rex ✭✭✭

    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.

  • T RexT Rex ✭✭✭

    What causes AT?  Perhaps others would like to chip with their thoughts or experiences on this.

    The standard causes include:

    • sudden changes in activity level
    • running infrequently
    • beginning running for the first time
    • too much time in high heels, then running

    My GP's "it comes when it feels like it" is not satisfactory.

    To this I'm adding what I feel is my reason:

    • Type of running shoes.  Specifically those that seem to have high back or only a shallow v-notch. 

    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.

  • T RexT Rex ✭✭✭

    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.

    T Rex

  • 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!

  • TRex,

    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?

  • TRex,

    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?

     Cheers,  QFS

  • T RexT Rex ✭✭✭

    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!

  • T RexT Rex ✭✭✭
    Thanks, cragchick.  No Fling this year - after four consecutive years (two with extensions image) I'm doing other things this year.  I couldn't have improved on my logistics of last year and that sunny weather was fantastic and probably a little unusual!  It was only the injury letting me down.  So I've decided to stop while the going was good!  In late April and May I'll be doing three shorter ultras - two local in S Wales and one in Exmoor.
  • T RexT Rex ✭✭✭

    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.

    T Rex

  • 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.

  • Must admit, I've only just come across this thread, and wish I'd found it earlier. Currently resting an AT issue that I've had for three months, and has made a dent in my training, and early year race plans. However, ice, heat, stretching and rest and fingers crossed it's back on the mend.

    Interesting to read about trying to walk with proper form which is what I've done throughout, but at times (working on construction site), heavy site boots, caked in mud, made walking extremely difficult, and did set me back a few times.
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