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Its over. Archilles pain. cant run no more
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Tendon injuries continue to improve even up to a year. Do you understand what tendonosis is? 6 months plus is very common, I am an example if this. I have had improvements even 3 years after injury. Often conservative treatment failure is the wrong technique.
Perhaps it is because I am in the business and I do not have much faith in orthopods. I have had orthopaedic surgery for trauma and for this they are amazing. they are exceptionally good at their bread and butter (joint replacements for arthritis). You really need to do your research on what surgery entails. Many of these techniques have a shaky evidence base and this is success versus sham surgery.
The actual surgery is very creud. I have seen a few hips, knees and k wires but at least this has a substantial evidence base. Please watch your surgery and research it. Please do your research. Orthopods get ??100k for their private practice so they always want to operate anything privately, you are their cash cows as they make a fortune from you. Also I suggest you look at the research on their preposed surgery. I remember quite an interesting trail on cartilage repair via arthroscopy which had no difference versus sham surgery. If arthroscopy evidence is so poor I have many concerns with various techniques invented. Perhaps if you knew more you would be more skeptical.
Do you research and take it from a doctor, that your private orthopods have their own agenda. You should not underestimate the implication of surgery. Also please consider the risks and read some blogs where it went wrong as you may have toive the rest of your life damaged.
Well there's my rant.
Out of interest have you tried that stretch I mentioned in an earlier post with stretching the toes using a resistance band?
I haven't tried that one yet, but I am keeping it for the future. I'm also not doing the eccentric stretches at the moment due to the current physios approach. I am just coming towards the end of 10 physio sessions where I decided to do everything that the physio told me to do, and nothing more, nothing less. I've been sceptical about the treatments, and am feeling no better off than when I started. It is through a health care scheme - I didn't get to choose the physio, but I also didn't get to pay!
We have exhausted all the physios methods now. This physio reckons I will never get back to the sort of running I want to do - so basically accept my lot, and get rehabilitated to the point where I can jog around a bit.
Last time I had it this bad I basically did nothing for several months and it magically went. I wasn't a runner at the time, more of a hiker. I did have an NHS consultant on that occasion to asses me, but he did little more than prod my achilles and tut.
Also-ran, I know you've read around this a lot, have a lot of experience and are trying to be methodical in the approach, which can only be a good thing.
However, I have no idea if it works, but I've heard on another thread that magnesium oil can help. Scroll down about half way on this for a small bit about it, where it says it can apparently help with swelling. I confess I am not usually one for this type of thing, but I've bought a bottle to give it a go.
http://drsircus.com/medicine/magnesium/uses-of-magnesium-oil
I think we need to back up a minute.
Achilles pain during running is NOT normal.
The achilles tendon is the strongest tendon in the entire body and if it is in pain it's a major warning sign from your body that something is not right. If you ignore it and keep running you are only going to end up with more problems.
But it's also important to remember that running is NOT the problem. That might sound counter intuitive as the pain comes on when you run, but our bodies are designed to run pain free. Running is only highlighting and exacerbating a problem you already have with your tendon and your body. Lots of people run and don't have achilles pain, so something within your body is causing you this pain, NOT the running.
Therefore putting on straps, or switching sports (to cycling for example), or altering your running pattern, or reducing your runs might help temporarily, but most likely, the pain is gonna return either in the same location or somewhere else, as you haven't addressed the root cause.
So what's the problem with the achilles tendon?
Something is not allowing it to work correctly and so there is extra twisting, friction and stress being placed on it which gives you inflammation and when this happens chronically you get chronic inflammation. The medical name for this is tendonitis.
You can't just accept tendonitis as a diagnosis though. Tendonitis is the symptom, the result, but what is causing this chronic inflammation? It's not the running, as correct running shouldn't do this. So what is the source?
Very often it is that there is a misalignment in your posture, and kinetic chain, so that you are not using your hips, knees, ankes and feet the way they were designed too. Basically, they are out of position so that when you run or walk the achilles tendon is becoming overworked and chronically strained. If you correct this, your pain should slowly disappear.
Stand in front of a mirror and test your own posture using this video:
https://www.youtube.com/watch?v=DN6aQ_xx2k8
And then try these 3 exercises to bring some alignment back to your hips, knees, ankles and feet.
https://www.youtube.com/watch?v=Mv0EG-ofx8Q
Good luck and don't give up!
Ameet
I would recommend tiger balm, deep heat (gel or spray) or deep freeze (cold or spray). They are absolutely amazing
Ameet, I think you may have assumed that everyone on here is talking about the symptoms and cures and have never considered the causes. I really don't think this is the case, any many will have battled for several years to get to the cause. Maybe we are not seeing the right people.
Certainly I have had at least 4 people who work professionally in this field analyse my posture, my walking gait, and 2 of them analysed my running gait. All with a view to correcting posture / form. I know running isn't the cause as I had the problem years before I even sniffed a running shoe.
Your video is useful, but one question I have is that the lady in the video appears to have her knees locked out in her standing position. Is this good posture, bad posture or does it not matter? I've been told it matters for what it is worth
Hi Also-ran,
What do you mean by locked out?
Give the 3 exercises in the 2nd video a bash and see how you get on.
Ameet
I mean that if you look at the standing position from the side view, the legs are straight without any bend at the knee. My 'personal posture person' caught me out at this all the time to the point where I am now very conscious of it.
Regarding the exercises, I will keep them in mind for the future but not use them for now. Currently I am under a Physio and I am letting them do their thing whether I agree with it or not. I want to come to the conclusion that nothing they offered worked without muddying the waters with other things.
In a standing position we want the leg to be straight. When that happens the knee joint is close packed and stable.
I don't see it as a problem, and if anything, when the knee is flexed the muscles of the thigh and leg have to do more work, which is not ideal.
As is the way in the world, you have 2 different opinions from 2 different health professionals!
When that happens, the best thing is for you to trust your own instincts and see what makes most sense to you.
I'm gutted as I'm only just getting into running really, but really getting into it. Im also terrified I'll put all the weight back on if I stop. Don't know what to do. I have a tough race, 17k over rough terrain, 400m of ascent a month from now, and o was thinking of just walking and doing strength training (squats, corework) and then seeing how it feel on the day, but maybe it's a bad idea to be even thinking about it.
I think if you have caught it early you should hopefully be able to treat it successfully. I would suggest resting for a week with no running and minimal walking. Cycle of swim if you can to maintain fitness. Doing the squats/ core work is a good idea too
If your achilles pain is insertional. You feel it at the point of attachment at the heel then the general consecious is that eccentric heel drops may aggrivate it and doing concentric calf raises (feet flat on the floor) may be better.
New running shoes may be the answer. If you haven't had a gait test I would suggest getting one done so you can be sure you have the correct shoe.
I would also be icing it at the early stages of injury.
Good luck
Hi Also-ran, from what I have been told surgery is the last resort if all conservative methods have been tried and failed. That includes at least 3 months of the eccentric stretches and seeing no improvement.
My understanding is that once you have surgery (Which I have also been told has an 80/85% success rate. Coupled with being in a boot for approx 8 weeks) and should that be unsuccessful then all the conservative treatments would then be pretty futile.
Out of interest have you tried that stretch I mentioned in an earlier post with stretching the toes using a resistance band?
Good Luck
Are you doing the eccentrics by starting off on tip toes with both legs. Lift the good leg and lower on the injured one only. Then place both legs on the step to raise up to the starting position?
Does the achilles tendon hurt when you squeeze it between your index finger and thumb?
Where exactly is the pain felt?
I use 20KG in a ruck sack. If bodyweight causes no discomfort then you could try adding weight gradually.
Dan - Alfredson's heel drop protocol was targeted at mid portion achilles sufferers. I'm not sure if it was researched for insertional problems, or if it was I don't think it proved to have much success.
NCoa - no I'm not doing that stretch although having looked at it I think it was included in a rehabilitation program I had a few years back. I'm 100% conforming to my current physios flavour of treatment which seems to be as effective as nothing.
The pain is approx 1cm above where the heel bone finishes, parallel to the ankle joint. It hurts more on the outside, that is to say the little toe side, rather than the inside.
Yes, it's tender when squeezed between thumb and index finger. When it hurts most though, is for about five minutes after icing, when I can feel its noticeably contracted and it aches.
I've been doing concentrics rather than eccentrics, it seeming to be low down on the tendon. Not using any added weight.
Please may I have some advice on this issue too? I have never had any Achilles problems at all until last week when I did a XC race that was a lot hillier than I am used to running (and a lot hillier than I expected!). Finished with a slight pain in my left Achilles, iced it, felt fine the following day. Took a week off running to be on the safe side and last night ran a very easy, flat 3 miles. Achilles began to hurt about 3/4 of the way through so I came home, stretched, iced it all night and this morning it is very sore and about twice the diameter of the other one.
I assume this is an acute injury so different from a lot of the above which seem to be chronic as a result of running style or a weakness somewhere else in the leg. Therefore ice, NSAIDs (systemic and local?) and obviously rest should be helpful for me? I have it tubigripped-up today, which helps a little. Is there anything physio can do at the acute stage and does anyone know roughly how much rest I should be looking at. Weeks? Months? Mine is slightly above the level of the ankle bone so quite high up.
I know a lot about tendon injuries in horses, but very little about people!
You're probably looking at at least a month's rest, I would say, probably more, based on my experience - if it's the first time you've done it, I'm guessing it may heal quicker than a re-occurrence of a previous condition. The key thing is, when you do run again, if it still hurts, and particularly if it's stiffened up the next morning, then it's time to stop again and give it a longer rest.
I've just done two runs again, after resting my achilles for nearly two months and doing lots of gym work, and I was completely fine the next morning both times, so I will continue to run, but not go overboard. Previously, I would run, then be a bit stiff the next morning, leave it a day or two, run again, and then be stiff again. I know not do do that any more.
Probably best not to stretch it for a short while, give it a bit of a rest and then gradually do some light stretching.
Judging from this thread and my own experience, the achilles tendon is the runner's achilles heel (pardon the bad pun).
I have to say that after 4 years of enfaced rest and almost every possible therapy under rain or sun, my own achilles insertion problem hasn't gone away.
Having said that, it is pretty much under control now. I have learned to adapt my running gait to a forefoot strike (which feels much more natural) and a more supportive shoe.
However, it is amazing the difference shoes make. I bought the wrong shoes a month ago and my left foot (the one with the worst achilles problem) was probably pronating too much. This caused a lower posterior shin splint after a 8 km run and my left ankle has been swollen (though not painful) for 4 weeks now.
I went for my first run yesterday and my left achilles gave me a couple of twangs, the b*stard thing. This passed, though, and no issues today - fingers crossed. Giving it a day's rest before I go for another short jog tomorrow.
No inflammation anywhere now, just the old injury internal scars near the heel bone, rubbing and complaining when there is too much pull, I reckon.
I agree, changing shoes can help with achilles problems - if someone already has a pre-existing achilles problem, using the wrong shoes could make the problem worse or at least prevent the problem from getting better. It's always worth trying a different shoes just to see if it helps in any way.
In my experience, a combination of strengthening my legs and using a lighter, less structured shoe, with just a touch of support and a different heel-to-toe drop, means I now land more mid-foot than heel, and feel like I'm spending less time in contact with the ground, which can only be a good thing.
Here's my experience. 2009: averaged over 40 miles per week - 2200 miles. February 2010 got discomfort in both achilles. Rested for a couple of months. Seemed ok with slow jogging. My big mistake was running a 10 mile race in July which set me back a long way.
Tried running again at the start of 2011 (walking ok by then) but had to give it up after a couple of months ever though I was only running a couple of slow miles. Tried again in October 2011 with more success. Managed a year and a bit of fairly slow running. Less than 20 miles per week, no races. Initially running faster caused problems but the achilles problems gradually improved. The main problem was pulled muscles, presumably because of lack of condition.
Skiing accident in January 2013, started running again in July (could have started earlier but lack of motivation). Gave up running again in January 2014 for three months. Since then running a bit more, maybe 25 miles per week, even a few races. Doing 21 something for 5k rather than 18 something. Currently 5 kg heavy than I was 5 years ago.
Only thing I've really done for my achilles is to rest it. No other treatment. Seems ok now but being cautious.
Just to throw in my recent experience and how I recovered, i damaged my right achilles in August last year. I had a few more races to run so cut back the training and turned up and ran anyway. I felt fine once I got going, I just hurt in the morning. I'd already decided that come October I'd rest until the new year ready to go again.
The pain improved, but I still had stiffness and discomfort in the morning. It lessened little by little each day but wasn't going. I still couldn't run without aggravating it.
I found that I still had some weakness there, which was easy to test - stand on one foot and lift yourself onto your toes, compare with the healthy side. It wasn't until March that this weakness fully resolved.
But I still had pain, I went to a physio (not my normal one) and we started doing some heel drops. I could have done hundreds of these without any weakness or pain but all that happened was after a few days my achilles was more painful although not weak.
I visited my usual (more expensive physio) a few weeks later and we started on some more basic exercises and again everything was ok, but the pain was still there. But it was something else we discussed that got me thinking and seemed to improve my condition.
Apparently the tissue around the injury can get into a cycle of inflammation and it can be hard to break, so I was asked to massage the area to break down the inflammation and break this cycle. You pinch the area tight and move your fingers up and down the achilles. I used some voltarol gel to aid this and reduce the inflammation and voila in a few days the pain had gone.
I started running, just a mile and still no problem. I went back to the physio and explained what had happened and that I felt it was just the aggravated tissues as opposed to an actual injury and it was agreed I start running again.
In training for half marathon for the first time in a year now
P.S. Really important that I say, this isn't some miracle cure, but that you need to find out whether the achilles is healed and strong or whether it is just a bit angry from swelling and inflammation. If it is still weak it needs rest.
I have had Achilles insert pain slightly when I walk. I developed it 5 weeks ago after a training run the following morning. I carried on running but cut my mileage a lot but no improvement, as it would be fine for a run then the following morning sore slightly. I haven't run for three weeks and stopped cycling as that also makes it sore. So I after some advice please as physio Said its minor but its not improving,p and don't know what to do.? I have stopped squats and leg work outs to.
Yiannis If simple leg squats are enough to irritate your achilles insertion I think complete rest for a few weeks and ice on the heels might be appropriate. Also, you should talk to your GP in case you have a fracture in your calcaneus.
It doesn't hurt when I do the squats but is sore the next day
After suffering for over 5 years with achilles problems, I have found there is no magic bullet. The approach that has worked best for me is in the short term, total leg rest (swimming and upper body exercises being the only exception) and deep massage of the calves. In the longer term I have retrained my running gait to a mid-forefoot strike as, in my case, heel striking exacerbates my injury within seconds. I did have a hairline fracture in my left calcaneus, I didn't have it checked and I struggled with constant pain (even from walking) for nearly 4 years. I'd advise anyone not to muck about, have your injury checked as soon as possible and rest your injured leg for at least a month before you start running on it again. It not a pleasant prospect, but better than hobbling your way about life for half a decade.
Hi, I would like to post an update and also thank Six Physio for looking up and recommending Richard Norris at The Physiotherapy Centre in Liverpool.
You can see from my earlier post that this has been a debilitating and frustrating injury for me to shake and get good help and guidance for.
My progress this year has been difficult but after having chronic achilles tendon pain for a few years and not being able to run at all without immediate pain I am happy with how far I have come. It is thanks to the above mentioned Physiotherapist and hard work. I am now running anywhere between 7 to 8 miles 3 to 4 times a week with very little discomfort during the run and minimal aggravation the following day.That is immense to me and I am extremely happy. Especially after being told I would need to be operated on and that I may never run again by an Orthopaedic surgeon earlier i the year.
Richard had me following the silbernagel achilles program which focuses on the concentric phase as well as the eccentric which is all I had done previously (Alfredson technique). I think the concentric phase has been the eureka moment with it providing strength conditioning to my gastroc and soleus muscles which unbeknown to me must have been week.
So if like me you have been suffering a long time and all you have tried is the eccentric stretches it may help you to try the silbernagel program. Under the guidance of a physio for best results and professional guidance etc.
Thanks again Six Phyiso for your recommendations.
Neil
Good Skills NCoa