Achilles Tendinopathy

Darola

I've had AT for about 3 months now, with around 8 weeks of proper rehabilitation. I've been able to use the Elliptical trainer without any issues so have maintained atleast some level of fitness. When it first occurred (that feeling of soreness and tightness) I followed the eccentric stretching protocol with no running for around 4 weeks and then, largely out of frustration, I raced on it. Big mistake! Afterwards my achillies was sore and quite swollen. I couldn't walk on it the next day and it took a week for the swelling to reduce.

From this point on I've been a bit more religious in my recovery. Plenty of eccentric stretches, including with weights the last 3 to 4 week, and no running. I'm at the point now where it's slightly stiff in the morning and after it's warmed up (5 minutes of walking is all it needs) I can't feel any pain or discomfort at all. If I really try to test it, e.g hop on it, I'm aware of it; but not in a painful or uncomfortable way. I can also now do 5x30 eccentric drops and not feel it at all.

My question is to others that have recovered from this, and had to do the weeks of eccentric drops - at what point did you return to running? Don't want to rush in to it after last time, but equally don't want to wrap myself in cotton wool unnecessarily.

Pre AT I was running circa 32mpw over 5 sessions a week. 1long, 1 tempo, 1 speed (e.g 6x800), 2 steady.

HA77

I'm just getting over an achilles problem now. I'd always had a bit of an issue that I could run through and manage but it really flared up when I tried to do too much too soon, rookie mistake. I tried to get through it over then next few weeks by taking days off here and there and easing up on speed work but it didn't get any better. Eventually I took a week off and it seems to have done the job. I'm making sure I do the eccentric exercises and stretches every day. I've been back running now for 3 weeks (including speed sessions and racing a half marathon) and it feels pretty good. It's still a bit sore to palpate and there is some mild stiffness in the morning. 

I guess the thing is that everyone is different and you can't always expect your recovery to be the same. Maybe you should see a physio for guidance and to check if there are any other issues contributing to it. Good luck.

T Rex

Hi Darola.  I've had two bouts of the dreaded AT - left foot 2010-12 and right foot 2015-present.  This is a notoriously difficult injury to get rid of.  The fact that my left foot eventually cleared up and I have had five years free of trouble from it gives me hope for my other foot.

You've got to nurse this injury carefully but the good news is that you can, and in fact should, keep running, although at much lower intensity than normal. Cut out ALL intense sessions such as speed work and hills (especially fast downhill running).  I'd cut out short-distance or fast racing as well.  

If you can, find level and smooth surfaces and articulate that ankle - no limping or shuffling. 

By keeping yourself moving, this increases blood flow to and from the area. And also helps prevent the tendon fibres shortening.  

You will probably find the tendon stiff and sore for a few miles but then ease up completely and be practically pain free.  If you get to a point where pain starts to return, especially if sharp or acute, that is the time to stop.

After every run it will be important to ice the area to reduce any swelling and afterward keep the area warm.  Do normal calf stretching exercises (when warm).

T Rex

The eccentric heel dips (NB: NOT raises) are very important for rehab, and usually take 12 weeks.  You may find them very sore to do and may give pain for 24 hours afterwards, but after that, there is a definite improvement.  I think you are supposed to do a series of them every 36 hours.

Other things you could do:

• avoid shoes with a high heel tab which digs into the tendon
• consider heel inserts, but this should only be a temporary measure in the acute phase
• avoid long periods of sitting or driving.  Have frequent breaks to move around.
• avoid movements such as going on tip-toes, ladder climbing, (and hopping!!)
• no high heels
• do get deep tissue massage from a sports injury therapist - very, very beneficial and worth the cost.  I was going once a week to mine, and now once a fortnight.  I envisage phasing him out altogether in the next two or three months as my injury finally looks like it's clearing up.

MsE

There is excellent advice here but what I would add is that it is worth identifying the root cause of the injury.  Often we can see we tried too much too soon, but it is also the case that if we are stronger with good functional strength, it shouldn't be such a problem.  That way, as well as following protocol for alleviating the symptoms, you are working on eliminating the original cause.  Typically this involves something deficient higher up the kinetic chain, e.g. tight calves, weak glutes.  I reckon weak glutes / tight hips are probably at the root of 75% of lower leg running injuries!  Good luck.  I have dealt with it on both sides and managed to eliminate the problem completely.  Bear in mind that damaged tendon tissue won't ever be quite the same however and it is worth being vigilant at the first signs of irritation in the future.

Footmech

We deal with this condition a lot in our clinic. 
Its is a complex problem in that ere are multiple factors involved. 
1) flexibility routines are important, however there are a number of techniques that may work better than others. 
2) foot function....check if there is sufficient ankle joint mobility, and if here is change to foot posture.
3) gluteal deficiency...cross training may be needed to fire gluts.
4) deep tissue massage and fascist release 
5) Neuro Muscular Electricsl stimulation, to aid local blood flow, pain relief and as a adjunct to eccentrics exercises.
6) pelvic malalignments and leg length discrepancies.
7) footwear choices and foot strike

the Protocol you were doing sounds good, but as I have just stated there are multiple factors to look at. 
Foot mobilisation may help free up foot joints and ankle range. 

Some clinics advocate shockwave therapy, acupuncture, taping .

orthotics may be necessary too. 

Harry1996a

I have had patella tendinopathy for a while now and had a similar problem when returning to running. I found as long as I do stretches and eccentric exercises alongside shorter runs it eventually gets better!

Darola

Still little progress, and have just had a spell where I feel it regressed, so have knocked all activity on the head for a while (now have to walk past the cakes!).

Im seeing a new Physio on Friday for a new perspective. I'll report back on what she says.

T Rex

Yes, it's not a nice injury.  Deep tissue massage from a sports injury therapist is very beneficial.  

Keep up the movement, but nothing high impact.  Persist with the eccentric heel dips.