UKC

I've been running alot recently, and upping either miles or pace since the new year. I did a 10K two weeks ago which I really enjoyed, but noted afterward that I felt a wee bit sore in my Left achilles. I went to Physio who recommended the eccentric heel drops, but said to keep running, but nowt too hard. I have since done a couple of runs, and didn't feel it get much worse, or better. Then last week, I did my local 6mile route, and after that it felt really quite sore. The next w/e I didn't feel able to run so I did a few lengths and underwater running in the pool, which felt fine and did some cycling instead of running, and it felt worse still. Its now creeky as feck, and feels pretty sore doing the heel drops. I've been doing the ICE part of RICE religiously, but perhaps not enough of the R with the cross training I've been doing.

So this isn't my area, but the physio had said to keep running, and an A+E doc I spoke to said, keep using it, e.g with cycling. Other advice seems to be much much more conservative.

So, what is the experience of others with these kinds of injuries? Do you do total rest, relative rest with cross training, gentle continuation or what? Did the eccentric heel drops work for you, and how uncomfortable were they. Just interested in other's experiences and a bit of discussion.

Thanks,

Jamie

In reply to contrariousjim:

I had a bit of a revelation with an Achilles problem a bit before Christmas. It was one of a number of niggles I had, and I decided to spend the money and see a sports doctor to try to get them all sorted. For the Achilles, he had a very hands-on approach - pinch the sore bit lightly, and wiggle from side-to-side gently for a few minutes. It's agony at first, but the pain soon eases, and it does seem to work - I had three sessions of gentle wiggling, over the course of a couple of weeks, and it was cleared up completely.

At the time, I wasn't running because of other injuries, but since then, and since I've resumed running, any time I've felt an Achilles niggle, I've given it a wee wiggle and it's been fine.

In reply to contrariousjim:

In my experience, you need to rest a sore Achilles tendon......

In reply to contrariousjim:

I suffered from sore achilles for a few months, never got too bad, but just mildly annoying. I realised my running routine had changed a bit and that had been the cause - I had started running straight up a steep off road hill first thing in the morning on my way to work (the quickest way - not because I'm a masochist!) - so running on my toes with lots of strain on calves, then I would not stretch my calves or hamstrings at all and spend all day sat down and then do almost the same thing on the way home. Lots of short, steep uphill runs when cold and no stretching = tight muscles at backs of legs = sore achilles.

When I returned to running less frequently but longer/faster with appropriate warming up and stretching, it slowly got better.

I must admit I never had an issue with cycling - I switched to this to get to work and it was fine.

There might be something in what Tony said above - I found gently massaging (wiggling!) the area to be useful too. Having said that, it did take a while to go away, though once I'd stopped aggravating it with my silly little work runs, I was able to carry on running at high intensity and it never got worse. Yours might go away quicker if you take more care and follow professional advice!

Good luck with it.
Damo

In reply to Phil1919:


You're probably right, but I find resting (i.e. not running) really hard to do! Probably why it took so long to go away, though it would have come back had I not realised and dealt with the cause.

In reply to contrariousjim:

You need to find the reason. If you keep running it could get worse. I had to stop running for effectively a year to get rid.
Mine I believe was down to wrong pronation shoes and a big step up in distance (went from zero to 10K in less than 6 months)

Ignore it at your peril, and good luck....

In reply to contrariousjim:
I tweaked mine a couple of years back and five weeks before an 112k ultra, I couldn't actually run. I did manage to walk the Welsh 3000s the week after tho. Did all the stuff the physio said and made the finish line. It can still play up a bit now.

In reply to contrariousjim:

I had a similar problem last autumn (became a problem end of August). The physio advised me to stop running and climbing for a few weeks, which I did. I started swimming again for aerobic exercise and spent quite a lot of time on the fingerboard... Loads of eccentric heel drops (in excess of 200 per day) and calf stretches.

I got back into climbing about 3 weeks after that, but didn't really start running again for a couple of months. This wasn't too hard for me because running isn't really my main sport anyway. It would hurt after a long walk in the mountains or even long walk-in to the crag.

Some time around Christmas I stopped noticing any pain, phased out the heel drops, started running again. It's been fine since, but I've not increased my running mileage or intensity to the levels I was going for in August.

In reply to contrariousjim:

Get this book

http://www.amazon.co.uk/Trigger-Point-Therapy-Workbook-Self-Treatment/dp/16...

And have a look at this website

http://www.mobilitywod.com

Although since it's become a subscription site it's not as easy to find what you need without paying. I think most of the early stuff (well over a years worth of daily posts) is on youtube. Search for achillies, get a tennis ball / foam roller and work on your calf muscles.

In reply to contrariousjim:

Could be worth getting some advice about your footwear if not done already... Good Podiatrist or running sports shoe specialist.

Calf stockings help some people also.

Physios would just give you stretches and step exercises I think. Maybe therapeutic ultrasound.

Luckily, apart from my first Marathon, not something I've had issue with.

In reply to contrariousjim:
After Achilles surgery for snapping it 20 years ago I still do eccentric heel lifts every day, and a lot of foot wiggling when I wake up. I also saw a biomechanical podiatrist who did gait analysis and built foot beds. Most Achilles problems seem to have gait at route cause. Climbing is great for Achilles problems. They also had me cycling a lot in recovery but I had to give up clip ins because they were contraindicated. Swimming also great. I have only had one flare up in 20 years post op and a plan of rest, swim, cycle, heel lifts, climb and massage helped it calm down.

Good luck.

In reply to contrariousjim:

It all depends on:
1.) How low down in the tendon it is
2.) How acute it is

In my experience it isn't an injury which responds to complete rest and you have to use some common sense. Having a pro active approach is the way forward - heat before exercise and very importantly ice afterwards. If mine is bad i usually whack a few ibruprofen before sleeping which helps. After a particularly hard session sessioni will use a cross trainer the next day since it is good for overall fitness and gets blood flowing around the general area without being impact based. I also wear sorbothane in my everyday shoes to lift and support the achilles, but never run with this in.

The massaging is good (although can be excruciatingly painful). You have to be pragmatic and if really hurting for a prolonged period look at overall bio- mechanics and seeing a specialist - perhaps an osteopath who will look at the whole system.

Good luck and as my old coach would say "manage the injury rather than letting the injury manage you!"

In reply to contrariousjim:

These helped me after a period of 1 month off running youtube.com/watch?v=PJPfzTHpbAM&

In reply to bowls et al:

Thanks all. An interesting range of views, which seems to reflect the range of views on the internet. I'm off to the physio this pm so will ask a bit more.

I know I've got underlying issues that need addressed:
- previously fractured right ankle with reduced range of motion (knee wants to move to mid-line rather than over the line of the foot which just will not go)
- over-pronation, particularly bad on the right (this injury is on the left) with flat feet
- weak abductors about the hip
- morton's neuroma on left

I've had running assessments done before partic with respect to the over pronation and the road shoes I use reflect that. The morton's neuroma is painful, but I don't want the surgery because of the risk of recurrence, and the likely loss of toe feeling that is so useful in climbing. I'm actively doing strengthening work on abductors. And with respect to the calf and achilles, I'm already very flexible there, so while I have this achilles injury, it doesn't appear to be due to tight calfs.

I've been doing some self cross fibre massage over the last two days, which seems to help reduce the crepitus, I've been taking Ibuprofen for the pain and continuing with RICE and its better enough that I can now carefully do the eccentric heel drop on the sore side today, which was too sore the last two days. The eccentric heel drops with knees bent are much much worse than the eccentric knee drop with leg straight. This is clearly an acute event, its swollen, painful with crepitus, and appears concentrated on the lateral / outside aspect of the left achilles tendon about 1.5inch above the top of the heel. Though there may well be some b/g chronicity.

I'm finding this all quite difficult because I really need the exercise for the good of my mental health, and not getting out running and biking is not helping my mood at all. I can get in the pool, but it's just not as mindful as running and cycling, and also, I'm a crap swimmer who is self taught with nay technique.

Anyway, rant over. Thanks for the discussion, and any other input / ideas appreciated!

In reply to contrariousjim:

Wow, ok, quite a complex situation with your underlying issues!

My only other advice is if you were planning to go on holiday some time this year (with your family), do it soon to take your mind off the injury. If the sort of holidays with your family are like mine, they just involve pottering about doing stuff with the kids - should give you time to recover a bit and you won't be quite so depressed about not getting out running!

Anyway, good luck with it all.
Damo

In reply to contrariousjim:

I had the same type of problem last november.

Three things helped me:

- Cut out the speed training/hill training for a while
- Regularly take ibuprofen for a couple of weeks (helps with swelling as well as pain)
- Stretch as much as you can afford to in a day, use a foam roller on your calves gently if you can!

It'll get better, don't push it and listen to your body.

Hope for a speedy recovery!

In reply to contrariousjim:

I guess that we are all made differently and our running dynamics rather bespoke.
I had a niggling Achilles problem a year or so ago. Basically it used to ache like buggery after exercise and almost impossible to touch afterwards. A trip to the osteo and an over tight calf muscle was the root cause.
Definitely worth seeing a sports specialist for their opinion.

In reply to contrariousjim: I'd second the use of a foam roller on your calves. Any tightness here will put more pressure onto your achilles. I think active rest is what you need to encourage blood flow to the tendon which gets very little. In the past I have tried the "Dave Mac" finger tendon injury treatment on my achilles but that seemed to make it worse. It takes a while to go but I've found you can run with it and even do sessions on it if its not too bad and this is where its difficult to give exact advice over the internet!

In reply to contrariousjim:
But i think he's already stated that he doesn't have tights calves though it was immediately what sprang to my mind.

I don't like messing around with achilles injuries and pain much, and it was one thing i wouldn't run thro'. Given the background here id start with shoes (what do you have and how did you select them?) and work my way up

In reply to contrariousjim:

I run a lot and had a problem with my achilles a year or so ago.

It was painful but just seemed to ache early in the run and afterwards without getting worse.

Like yourself hate resting but tried that - the problem came back. New shoes and extra calf stretching and no improvement.

The thing that fixed it for me was Kinesio tape. I was very sceptical about trying this as I presumed it was just a gimmick. I put some on my calf & achilles for a few days, it cured itself pretty quickly and has never come back. I am still not totally convinced and could have just been coincidence or placebo but it did work for me so would say worth a try.

In reply to Rourke:

Thanks for all the input! The pain is much reduced. I managed a couple of cycles and no running last week, along with painfully doing the eccentric heel drops two footed. Then my brakes bust on my bike, so that was the biking out and rest enforced over the w/e. Interestingly, while I've never had tight calfs and the physio has commented on their good flexibility, the base of the calf is getting tighter day by day while this goes on. Anyway, the crepitus is still present, but the pain much better, and yesterday managed a full set of eccentric heel drops on one leg. The very top of the movement (before dropping slowly) appears to have become particularly weak, but the rest of the movement I can do very slow and controlled. So it seems to be getting better. Hoping to get out on the bike later this week! The physio also but some of that stretchy tape on to pull the skin away from the tendon, and I have to say, I do think that has helped, as has putting temporary wedges under my heel in my work shoes. All this reminds me of the frustration of tearing a tendon back in 1997 climbing, and having to not climb for a couple of months....

In reply to contrariousjim:

I had AT on both feet after I started hill running without building up gradually. That was about two years ago and I still get flare ups occasionally.

The things that worked for me were self massage of the calfs (to reduce tension). Baby oil and make sure you are massaging in straight lines towards the tendon rather than away.

Re eccentric heel drops - they are definitely the thing that will fix the problem. But if your injury is currently quite acute then I suggest doing them on the flat ( so that your tendon isn't extended so far ).

Then as your condition improves buildup to dropping your heels a little bit, and progress gradually to full heel drops.

Worked for me.

Oh and I got some insoles to correct my over pronation..

In reply to maxsmith:

Just a wee update for everyone who has kindly contributed advice.

My L achilles is still inflammed, but marginally better. I stopped running completely, but it got so painful I had no choice but to rest it. I couldn't even do two feet eccentrics heel drops due to the pain associated with the grinding between the tendon and paratenon, particularly on the upper limit of plantar flexion. Indeed eccentrics seemed to exacerbate things at least in the immediate aftermath of sets. Adding to the general swelling over the tendon which is at least double the width of the other side. However, I've continued with the physio who added in some foot stabilisation work: specifically one leg flat foot dips off a large step. Almost immediately this seemed to improve things to a point of being able to do eccentric heel drops and add back in some cycling. I've also added in more soleus orientated stretching rather than more generic calf stretches, and that also seems to be helping. I do some active release massage, and cross tendon massage over the most swollen painful areas, which also seems to help in the immediate after period. I'm keeping it elevated when I can, including overnight, but in general am taking the keep using it rather than resting it approach. I'm managing the twice daily 10m cycle commute, and did a 50m on the last w/e which didn't make things any worse, iceing after any significant exercise. I've been avoiding Ibuprofen after reading the evidence for improvement seems entirely orientated toward symptom relief and not at heeling wherein there is some evidence it is actually detrimental.

It's very interesting that the leg dips / foot stabilisation exercise seemed to help so much, but it definitely has.

It has to be said, it is a most frustrating injury!

In reply to contrariousjim:

A bit late now, but have you seen the article by Denise Park in the spring Fellrunner magazine? A good 3 page article on Achilles problems and some suggestions for cure. Worth getting hold of a copy if you can, Denise is a top physio for world class fell and mountain runners.

In reply to contrariousjim:

Hi, I have just joined the site and saw your post. Oh achilles injuries.. About four years ago I partially ruptured my left achilles. The final thing which caused the injury was a podiatrist who, because of my long and skinny feet, gave me some 5 mm heel raises as he was correcting the mechanics of my feet.. Then when walking to the train station... ping... pain.. lots of pain..

The short version of this tale is that my achilles doesn't even begin to heal for a year, a year of lots of pain and straining my other achilles as I over compensated. The docs up my way are rather useless with sport injuries so I started to research a way to recover and this led me to zero drop shoes. This was because my achilles only really felt 'normal' the closer to bare foot I went. This led me to realise that I had significant bio-mechanical issues. Poor range of movement in my ankles and hips. This was what was causing me to put way too much pressure through my forefoot. and overloading my achilles. Working to correct these underlying issues is what has helped me to heal. It took years. I have been relatively pain free for the past year. And I am running further, I feel stronger.

If I can recommend a course of action, you may have some underlying bio-mechanical issue, have a look at calf stretches to help take the tension out of your calf muscles. If you can, then this will help to take the pressure off your achilles and may help it to heal.

Achilles issues can be caused by tension in the calves, hamstrings, glutes, lower back etc. You say you are a keen cycler, cycling, loads these structures massively so you need to counter the tension put in. I would recommend rest, stretching all of these muscle structures, have you tried Yoga? It is very useful and has helped me immensely.

Lots of hot baths with epsom salts to help the muscles ease. stretch (yoga). Then when you are not as sore, not in pain, then start heal raises and gentle running. It can be a long process. but it is worth taking your time. You will come through this stronger.

Forgive the long post, I wish you well on your recovery.

Regards,

In reply to contrariousjim:

I had chronic problems with eccentric stretching making little difference and recurrence also after resting until a wise man explained that most chronic Achilles problems are secondary to abnormal loading with the most common cause being over pronation. Additionally poor stretching of the back of the leg increases tension on the tendon as hamstrings, gluteals, calf, Achilles and plantar foot fascia are essentially one long band and if tight the weakest point causes problems first. I saw a good podiatrist who fitted me with orthotics and I probably don't stretch as much as I should but I can run as much as I want now with no Achilles pain. Seems like a miracle but actually it makes perfect sense when you think about it. Hope it gets better soon.