Achilles tendonitis

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  • As you will have read I interspersed my runs with sessions of deep tissue massage from my sports injury therapist, with a run and a massage 3-4 days apart at the beginning, over time gradually lengthening the period between massages and fitting more runs in.  The purpose of the massage was to break down all the scar tissue and free up the tendon fibres.  She referred to 'crystals' within the tissue which needed dispersing - in fact you could hear them crackling as she worked.

    It is extremely unlikely you will have the courage to self-massage to the level required - the pain approaches 10/10 - and is best left to the expert.  My therapist spent 10-15 minutes each time on the calf first before moving to the achilles area.

    Ice after each run and massage.

    Above all, though, keep active in one way or another.  I'm afraid you are going to have to accept poor performances until the injury has completed disappeared, which it will eventually.

  • Hello, PSC.  Sliding around in mud most likely to affect thigh muscles I would have thought, especially adductors.

  • T Rex - great thread thanks. I've only just found it, but have just read it in its entirety. Some great tips in here too, which I shall definitely be trying.

    So much of what you've said rings true for me - lots of sitting and driving at work, very bad pain just walking at times, going down stairs a callenge, pain very bad first thing etc. I couldn't even contemplate self-massaging it either, due to the pain! I'll definitely try the cutting the shoe thing though - not come across that one before, thanks.

    Interested to get your thoughts on some of my experiences/symptoms too if ok? I first started having issues in Spring 2011. Probably caused by doing VLM in race shoes (Adizero Adios) - I ran a great time (for me) and had no problems during the race, but the next day both my achilles were in pieces. It was probably a good 10 days after that before I could even walk properly too, let alone run! Since then I've basically been trying to cope with it, but it affects my training quite considerably. It comes and goes I guess, but is a real problem for me when I do big mileage - so I guess an overuse injury.

    When i run it's often very painful early doors but then eases a bit. However, at the mo once I've done circa 5 miles or so it then comes back quite badly. Anything over 40 minutes or so leaves me in a lot of pain for a couple of days afterwards.

    In terms of 'treating' it. I've tried different shoes and heel inserts etc, and have even experimented with orthotics. But it always comes back. My running 'style' isn't good - poor posture, heel striker, over-pronate a bit, quite a slow cadence etc. It's the toeing off bit that seems to be an issue for me. I just wondered whether you'd consciously tweaked your style, cos you mention concentrating heel to toe - I almost feel like I can't do that, cos the toe off bit causes issues.

  • Reason I ask is I've been doing some reading on technique, barefoot stuff, drills etc. Just generally reading up on a variety of things. One thing I feel helps me (but I'm finding it difficult to incorporate into running) is to just pick my feet up instead of toeing off (if that makes sense?) I think I read it in the Chi-Running book.

    In that he has an exercise where you walk - but he gets you to imagine you have a little bar on the inside of each ankle. As you pick up your foot you have to lift it over this imaginary bar. So you're effectively picking your foot up in an exaggerated way and doing a sort of circular motion with your foot. I've found (when walking) this is completely pain-free, Now I know it's not feasible to walk like this all the time, but it got me thinking re running technique.

    I'm working really hard to try and concentrate on relaxing my ankles/lower legs when I run. They're very tense usually (my body tensing to 'protect' the damaged muscles/tendons possibly, but this actually makes it worse!) When I'm tensed the shock of landing/impact makes my achilles/ankles much worse I think - possibly why I get pain after 30-40 minutes of running.

    So I'm trying to relax, have limp lower legs and move my feet in a more circular motion when running now. Basically not toeing off, but picking my feet up, trying to run with higher knee lift and landing 'whole foot' (NOT on my toes) and then speeding up my cadence. When I do this I seem fairly pain-free when running, but I can't keep it up for very long (maybe 5-10 mins).

    Just wondered if you'd dabbled with any of this?

    My thoughts re me are I need to change something technique-wise. Otherwise I'm only ever treating the symptom, and not addressing the route cause. Think I need to be much more patient though!!

    Just interested if you'd made any changes to your form such as this, or whether persisting with the treatment but sticking to your normal style had been ok for you?

  • T Rex-thanks foryour input. My achilles doesnt feel soft and spongy more like rock hard. I cant feel a lump in it like the time before when I had problems. Its generally ok to walk on though I was limping after my 5 miler on Monday. Icing does seem to free it up too. The pain seems to be in the heel though when touching the area its ok and its the lower achilles which hurts. I dont think im as badly injured as you were but its bad enough so that everystep of a run hurts in the heel area worsening the faster i run. I think I will try different running shoes. Walking on my heel seems ok too.

  • 2oldnever.  That's a bit encouraging, actually.  If it's that low and there doesn't seem to be any inflammation you might only have damage to the muscles which connect the achilles tendon to the heel bone.  Muscles heal a lot quicker than tendons which have minimal blood flow. If the pain is in the heel itself there are other injuries in that area that I don't know about.

    The answer is still going to be heel drops and other calf stretches.  If you can see a sports injury therapist, if only once, all the better.

     

    Hi, LS21.  If the pain is in toe off that makes sense because at that stage the achilles is most contracted.  What you say about running form is very interesting and sounds like would certainly help.  Not tried anything similar myself.

    In the long term running in shoes with lower heels - as in barefoot shoes - may help in that the achilles has to stretch further.  In the short term while you're managing AT pain you'd be better off with normal shoes and even putting heel inserts in so the achilles isn't aggravated too much.    When the injury has cleared up I would certainly experiment with different shoes. You're not going to be able to test new shoes in your current state!  It does sound like your existing shoes caused the injury.

    At 52 I'm not sure my body is up to the stresses of less cushioning that minimalist shoes would cause.

    At the very least all sufferers with AT should cut down the heel tab on their running shoes.  I've done it to all of mine.  Bit of a wrench on new £80 shoes!   As part of your shoe choice look at the height of the heel tab and try to find the one with the lowest.

  • I have to say since Feb 2012 I have not had even a hint of AT in my previous affected foot (left).  Often get worrying twinges in the right one but hasn't led to anything yet.

  • Excellent stuff cheers. I shall have a play round with things and see how I get on.

    And re form/shoes - it's my form I need to look at. I agree that I went down the route of racing flats (not minimalist shoes per se) but I didn't alter my form at all - and that's what triggered this off for me. Moving forwards I'm keen to look at how I land. Currently it's with a straight leg, sticking out in front of me a bit, and landing heel first. Probably how most folk run I guess. So I come crashing down on my heel and I take all the impact through my ankle joint. If I'm only doing 40 miles a week I'm ok with it. But double that for Mara training and I break down after a few weeks. I've had tendonitis in pretty much every area from my calf down.

    Hence me thinking of addressing my form. Otherwise I feel I'm only ever addressing the symptom and not the root cause. Will just see how I get on with it though, and report back on here.

  • LS21-how are you getting on with your AT? I havent run since the18th April and still have stiffness and discomfort .I am going to try a jog at the end of the week to see if there is any progress. In the meantime Ive seen my GP who prescribed strong anti-inflammatories and suggested I see a physio in a due course if things dont progress. I am now trying to stay fit swimming and easy spinning.Im also doing the eccentric heel drop exercise.Fed up to say the least.

  • So-so TBH mate. I tried messing with my gait/cadence a bit as described above - and whilst this did alleviate some of the achilles pain I started getting aches and pains elsewhere. Side of my knee in particular (well, about 2 inches below the outside of knee so don't think it's ITBS-type stuff). So I've gone back to a pair of older, much heavier but more supportive shoes (Nike Lunar Eclipse). I did a bit of running last week. Ran Wed, Thu and Sat and all seemed 'ok' - but on the Sat run I was out for about an hour. After 45ish mins achilles started to grumble a bit, so I had yesterday off and it feels ok again today - so I'll go out again later on I think.

    I've found consciously lifting my foot helps - the thing of imagining you've got to lift your foot over an imaginary metal rod on the inside of your ankle or whatever.

    I've also been standing with my foot about 6 inches or so from a wall and bending my knee - then trying to get my knee to touch the wall whilst keeping my heel in contact with the ground. Stretches the soleus and keeps things moving in the area where I get stiff.

    I've also been doig this - http://www.yinyoga.com/ys2_2.0_asanas_ankle_stretch.php

    Don't go mad with this one. but it helps me a lot. Key for me is keeping the ankle joint as flexible as poss really, so these various stretches help that.

  • LS21- looks like you can still run a bit. Whenever I try and that includes pool running today,I get searing pain into the back of my heel. The Achilles whilst tender and sensitive doesn't seem to be a problem itself. I'm beginning to wonder if there's some extra complication which needs identifying . I'm speaking o a physio tomorrow. I've tried a variant of the yoga stretch...sitting on my knees though I need to put cushions under my knees and feet. This provides relief but again it makes no difference to the help pain from running impact . Will just have to keep plugging at it 

  • Oh dear sorry to hear image

    Yes I think mine is more of an overuse thing, caused by poor shoe choice. Sounds like yours is a bit more serious. Hopefully the physio can shed some light on it tomorrow. Fingers crossed for you. Good luck!

  • Thanks for this thread. I read it with great interest.

    I'm still yet to run, last time I tried was back in May, but had a niggle, so haven't done anything since, then on a recent cycle to work, felt it go again, but this time  it went further up into my lower calf, which was then stiff for days afterwards.. I'm gonna keep re -trying and take some of your tips.. I'm dying to get back out there, especially now winter is not so far off.. image

  • Gosh not posted for a while but want to say a big Thanks T Rex - have read your story too with  interest and will get my shoes sorted, low backs to shoes ...yes and yes why have I not twigged  it before?

    Unfortunately have spent some good money recently on sturdy walking shoes as am walking the miles instead of running them these days.   I eased off running these last twelve months on and off  as have mild AT (though I don't think this in the mornings) and am doing all the stretches sports therapist advised.

    Trouble is living where I live the hills here are killers and it's since moving here I think is when the trouble began. 

    Will try some heel pads for my all of my shoes

    all the best

  • Great Thread. I've also suffered for the last 12 months with varying degress of pain.

    Visited a physio for 6 weeks and it improves. Stop visiting and it gets worse.

    Have decided on "manning up and self help" - lots of stretching / ice and foam roller plus trying to gently run through it. Seems to be slowly working.

    On the plus side I am still able to exercise 6-8hrs a week on my mountain bike with no pain image

  • Thankyou for this thread you have helped me make the decision to run I have a recent injury 6 weeks  I still have the dull ache and its still swollen not nearly as bad as it was I want to try a gentle run but am scared I have Snowden looming so I need to know what I can do 

  • Thanks for this thread TRex, if you're still about. I've been having a niggle in my ankle/Achilles area for a while now and saw an NHS physio after GP referral. He gave me some exercises to do, but didn't attribute it specifically to my Achilles. They seemed to do the trick, but I stopped doing them once they had. (Probably a mistake in retrospect.)

    During a recent walking holiday (I thought it would be good cross-training) the pain returned. I think this was brought on by the hills - there were a lot - and the fact I was in walking boots, i.e. high backs. I cut the holiday short and went to a private physio on return. She diagnosed a mild Achilles tendinopathy and gave me some exercises; heel drops, proprioception, calf stretches, clams, etc. She also said to take it easy on running but not to stop altogether.

    I'm currently a few weeks away from the GNR, which I don't want to miss, and - soon after that - my first ultra, a 30-miler. My physio seemed to think I might be OK for GNR but wrinkled her nose over the 30-miler, mainly (I think) because the injury has meant/will mean a reduction in the training required to complete 30 miles.

    I'm due to see her in a few weeks, between those two races. Any advice on how much I should/can train now would be appreciated. I ran a few miles a couple of nights ago and felt OK. I want to carry on, but I have to confess to a certain degree of paranoia now about doing too much and making it worse. My confidence is shot a little bit.

  • I last posted in April . My left achilles gradually recovered over the summer with some false dawns and the help of extra corporeal shock wave therapy and recently I managed a 43ish 10k and a 90min HM but then out of the blue my right achilles went and I'm back to square one with no running. I doing eccentric stretches spinning swimMing icing when necessary but now expect another three month slog. I'm hoping to see my consultant again for more ecswt and hopefully it will work again. So fed up and worried I won't be ready to start spring marathon training 

  • Great to see my old thread resurrected and that it has been of help.  I'll have to re-read it and see if I still agree with it all 18 months on!

    2oldnever - unfortunately we have two achilles and there may be unresolved issues that threaten the other one.  My right achilles often gets a bit sore and gives me concern, but not so much as a niggle from the left (the previously badly injured) one.

    If affected go for deep tissue massages and keep running but at very low intensity on flat and smooth surfaces.

    Daniel C - thanks for your professional input but I would consider rest not to be a main component of recovery, except at the very beginning of the acute phase when you haven't really got much option.

    Calf stretches are very important, and icing if swollen.

    I also choose the brand of shoe with the lowest back when buying new shoes now.

    Might be wise to avoid walking boots?  These prevent movement of the achilles which is the opposite of what you want.

  • Great thread,

    I'm currently training for a couple of half marathons (one in 3 weeks at Worksop) and another 3 weeks later at Rother Valley.  My plan was to treat Worksop as a training run (aiming for around 2 hours 15) and then tapering until Rother Valley when I'm aiming for nearer 2 hours.

    My current longest run is 10.1 miles at 1 hour 40 mins.  I get a slight achilles discomfort after my early morning long runs (not during) but nothing that had been causing me any great concern - I regulalry do calf streches, heeld drops and heel raises as in the past I've been prone to calf tears (physio was shocked at how tight my calfs were).

    Recently joined a running club and have started hill interval sessions on a Monday night (my long runs are on Sunday mornings).

    After last night's session, both achilles were sore to touch (noticed this about an hour after the session, after sitting down to food) and were tight.

    This morning saw me hobbling like an old man, taking my girls to nursery was painful - if it wasn't for their puschair for me to hang on to I doubt I'd have made it!

    I've been making sure I get up from my desk and walk around at work every 20mins or so, but even raising my toes whilst sat at my desk is painful today.  5 mins of walking around eases the tightness.

    I'm hoping I've not done any major damage and will see how I get on during the next few days - I've ditched tonight's gym session (leg night after a 5k treadmill run) and will probably switched my scheduled hill session on Wednesday for something flatter on the grass.

  • Hi Gravitas. Sounds like very tight calves - but uphill work is good for that!  Take enormous care coming back down - no fell-running type descents.

    You might have upped the intensity of your training too quickly which can cause an injury to come on.  It's hard to avoid competitive urges when you join a club which you might not have had if you used to do all your training on your own.

    Take it steady.  And lots of calf stretches (when warm).

  • thanks T Rex,

    No pain today and can walk around fine with no hobbling image but still feel a little tightness, foam roller session on my calfs tonight alongwith my usual stretches, easy 5k on treadmill tomorrowimage

  • I've had AT for, oh, around 3-4 years now, on and off.  Worse, I have been unable to run.  These days I manage to run what I want to, but have to put up with soreness, one slightly lumpy foot with scar tissue, and one tender side.   I put in around 50K of training a week, equaling to 5 runs a week including all the basic speedwork, tempo, long run, and some hills.  I ice, stretch, massage it, probably not enough though.

     

    Question is how to actually get it all better?  It is always niggling me at the back of my mind that I have to be careful, warm up and cool down well, must do drills etc. and post / pre-run care.  The lump has been there for ages, and no amount of massage seems to get rid of it - it is quite painful and stiff.  The tender side is worse some days and better others.  Even after a hard run it is not necessarily bad (probably good blood flow?).  VERY ANNOYING!  

     

    I occasionally visit a physio who massages it, I have had acupuncture, ultrasound, cupping (I live in Hong Kong, so this is common), and stick special Phiten tape on my feet, but nothing has "cured" my injury.  And physios are so very expensive and time consuming.  Age does not help I suppose, I am 46 yrs.  But am very competitive here in HK and have been able to get many placements in my age group (happy about that).  Start of race season now.

    Any advice please?  How to get a complete cure....!

  • There might be hope for the tender side.  You need deep tissue massage from a proper sports injurt therapist immediately, probably twice a week to start with.  Is there someone who deals with top athletes in your area?  You need to free the tendon within its sheath of muscle and break down any scar tissue beginning to build up.

    After 3 or 4 years of scar tissue in the other foot I am not sure much can be done now.  Worth a try though!

    Rigorous regime of calf stretches, and making sure the backs of none of your shoes aggravate the tendon.  No high heels.

    I've had a complete cure after 15 months in my one foot.  I'm 52 btw.

    Glad you're enjoying your running and you're doing yourself a great favour generally doing those drills and taking extra care, etc.

  • TRex.- an update to keep your useful thread going. Since I last posted I hadn't run until Friday making do with lots of swims and spinning. I saw my consultant on Friday and had a session of extra corporeal shock wave therapy on my right achilles as I had previously on my left.  Since then I managed 1k Friday ,5.5k yesterday and 6.2 miles today. On each occasion there was discomfort but no pain and no limping afterwards. Looking at things more positively now but will take it carefully. Terrified this will be a bit of a false dawn but fingers are crossed anyway. I don't know if it was the ecswt that did the trick or the rest or both but both Achilles seemed to turn the corner after the ecswt .

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