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Achilles Tendonitis Protocol Confusion (Read 1140 times)


tomatolover

    After about 3 weeks of calf/ankle issues that seem at first crippling when running, then sorta work their way out 1 mile into a run, I went to Doc. and was diagnosed with Achilles Tendonitis...His follow up on what I should do pretty much ran the "stop running till it feels better" route with no course of rehab action.    And so I have.  And, after about a week of NO running, it pretty much feels the same.  Tried running yesterday and gave up at the end of my driveway.

     

    The possible culprits include:

     

    1. an ill-fated speed session with new Brooks Connect Minimalists (I usually wear Launches, but I'm trying to figure out what works for me when the launch are discontinued)

     

    2. a run up a ski slope the same week as the Brooks connect run, though in Launches

     

    Where I'm at

    Those 2 occasions set the mode for the injury which I continued ot run on, including a 1/2 marathon & 5 k (duh).  I have almost NO pain (save for when i just get up) when walking around/biking and, during the times I did run, had moderate pain at the start, then almost no pain as the course rolled on.

     

    I've put a heel lift in the affected foot's shoe--- this seems to alleviate any pain i might have walking around

     

    Here's where I'm confused...everything I read is contradictory to everything else...no shoes/shoes! heat!/Cold!, stretch!/Don't Stretch, ibuprofen/No ibuprofen..

     

    Holy shit!  is there ANYT agreement on the course of action to follow so i don't know if i'm hurting/harming by stretching/icing/heating/ not running/running?Joking

     

    Frustrated much?  yes.

     

    Can someone give me the straight dope or recent experience you've had?  And/or thoughts on Achilles Tendonitis protocol?

    Thanks.

      No Ibuprofen.  You don't want to mask the pain.

       

      Do try an elliptical cross-trainer, at the same time volume as you would normally spend running.  It will help reduce the loss of fitness. 

       

      Do walk more, 1-3 miles/day.  Wean yourself off the heel lifts -- they are not a long term solution. 

       

      Go barefoot at home.  This will help keep your calves stretched but will not subject them to a lot of impact. 

       

      Try a few sessions deep tissue massage.

       

      There is no doubt that calf injuries suck.  I have had many of them, especially on the right where I tore the medial gastroc about 10 years ago skiing.  Give yourself a couple more weeks of light rehab, then start with slow, recovery jogs, in your Launches.  Hang on to the Connects, because you may use them eventually, but do that transition over the course of a month or two, starting with easy/general aerobic runs first.

      2013 H1:  7 hours/week base.  Q3: Train for goal race.  Q4:  Goal Race.

      DoppleBock


        I am not a doctor or an expert - I can only say what works for me.

         

        There is a difference in levels of achillies tendonitis injuries.  So my experience is with light to moderate acute issues (I use acute to mean linked to 1 or 2 events and not chronic)  - These I run through.  By coincidence this was the subject of my blog post today. 

         

        If you run or not - make sure you are treating.  But either way it will take a minimum of 2 weeks for the sharp pain to go, another couple weeks for dull pain to stop (in my experience).

        http://a-big-horse.blogspot.com/ 

        2013 Goals ~ Mar < 3:00, 5M < 29, 10k < 35  

         

          After about 3 weeks of calf/ankle issues that seem at first crippling when running, then sorta work their way out 1 mile into a run, I went to Doc. and was diagnosed with Achilles Tendonitis...His follow up on what I should do pretty much ran the "stop running till it feels better" route with no course of rehab action.    And so I have.  And, after about a week of NO running, it pretty much feels the same.  Tried running yesterday and gave up at the end of my driveway.

           

          The possible culprits include:

           

          1. an ill-fated speed session with new Brooks Connect Minimalists (I usually wear Launches, but I'm trying to figure out what works for me when the launch are discontinued)

           

          2. a run up a ski slope the same week as the Brooks connect run, though in Launches

           

          Where I'm at

          Those 2 occasions set the mode for the injury which I continued ot run on, including a 1/2 marathon & 5 k (duh).  I have almost NO pain (save for when i just get up) when walking around/biking and, during the times I did run, had moderate pain at the start, then almost no pain as the course rolled on.

           

          I've put a heel lift in the affected foot's shoe--- this seems to alleviate any pain i might have walking around

           

          Here's where I'm confused...everything I read is contradictory to everything else...no shoes/shoes! heat!/Cold!, stretch!/Don't Stretch, ibuprofen/No ibuprofen..

           

          Holy shit!  is there ANYT agreement on the course of action to follow so i don't know if i'm hurting/harming by stretching/icing/heating/ not running/running?Joking

           

          Frustrated much?  yes.

           

          Can someone give me the straight dope or recent experience you've had?  And/or thoughts on Achilles Tendonitis protocol?

          Thanks.

          I'm not a doctor; but a self-claimed expert!! ;o)  I suffered from Achilles tendonitis for about 5 years to the point where I seriously thought about either giving up running all together or surgery.  Here are some things I've found out:

           

          I saw at least 3 doctors on this.  They all told me to stop running till it goes away.  Well, it didn't really go away so I thought the hell with it and ran.  But what I've noticed is; though sometimes it hurt like hell, running actually helped.  Apparently, there's no circulation in the tendon itself so the more you can increase the circulation around the area, the better.  Icing helped.  Walking--in VERY thin sole shoes--helped.  Slowing down definitely helped.  I took Advil to mask the pain because it helped cope with it, though, I agree, it's not the best strategy.  Again, contrary to what many would say, minimalist shoes helped too.  I tried heel lift but didn't help.  It may have been because I'm a forefoot runner to begin with and it hurts most when you just land.  So any amount of heel lift didn't help.  But STRETCHING IT OUT actually did help; hence minimalist shoes.  I actually swore by it.  When I saw the marked improvement was when I incorporated trail running in minimalist shoes.

           

          Other things that helped immensely was eccentric exercise.  Here's the article: http://www.pponline.co.uk/encyc/achilles-tendon-injuries-a-full-guide-to-causes-symptoms-prevention-techniques-and-treatments-41361  Make sure you do the same exercise on the leg that doesn't have the issue--I did so much of this on my left leg that I noticed, when my Achilles problem was gone, that my left leg got too strong compared to my right!!  I'm now battling with the imbalance...!  But, seriously, you CAN overcome it.  Be sensible about it.  Listen to YOUR own body; not anybody else's suggestion or even doctor's suggestion.  Don't be too afraid of pain.  It's just pain.  But whatever you're doing is actually making the pain worse, stop.  Otherwise, continue.  Again, you WILL overcome it.  Be patient and preserver.  

          DoppleBock


            My tendonitis is usually acute - Related to 1 physical effort - Usually not running related, but to tennis, racketball, volleyball ... some explosive court sport outing.

             

            But I am with Nobby - The only difference is I like the Icey water 5 gallon bucket / the steamy hot water 5 gallon bucket instead of just applying ice.  5 minutes in one then 5 minutes in other - Repeat 3-6 times (depending on time you have).  The cold forces blood away from the injured area surrounding achillies tendon and the heat draws knew blood into the area.  I usually try and gets the calves well massaged 1st.

             

            Strengthening is always a good idea for prevention - But even more critical when it is from a chronic issue than an acute issue. 

            http://a-big-horse.blogspot.com/ 

            2013 Goals ~ Mar < 3:00, 5M < 29, 10k < 35  

             

              My tendonitis is usually acute - Related to 1 physical effort - Usually not running related, but to tennis, racketball, volleyball ... some explosive court sport outing.

               

              But I am with Nobby - The only difference is I like the Icey water 5 gallon bucket / the steamy hot water 5 gallon bucket instead of just applying ice.  5 minutes in one then 5 minutes in other - Repeat 3-6 times (depending on time you have).  The cold forces blood away from the injured area surrounding achillies tendon and the heat draws knew blood into the area.  I usually try and gets the calves well massaged 1st.

               

              Strengthening is always a good idea for prevention - But even more critical when it is from a chronic issue than an acute issue. 

              Bock:

               

              Surely, what you described would be a better approach.  I was just too lazy to go through that routine couple of times a day!! ;o)  

                These are the threads that make me appreciate RunningAhead. I've read 50 achilles articles in the last two weeks and virtually zero reliable advice.

                 

                To add one observation, I switched from relatively minimalist shoes to the more conventional bulky ones a couple weeks ago after an achilles episode.  By last Saturday, my hip was starting to act up -- just as it always does when I start clomping around in the big galoshes.  I went back to my old shoes yesterday.  The achilles was very tight for about 1-1/2 miles and it hurt all the way up my leg.  I was feeling pretty stupid.  But then it loosened up and felt great.  It's still good today.  Long live the minimalist shoe. 


                tomatolover

                  thank you all and I completely concur with Cheevers on why RA rocks...I really appreciate all your inputs as well as your experiences and I'm thankful that you've shared them.  I'll be trying the hot/cold technique this week & the eccentric exercise.....went to see my chiro yesterday on an unrelated matter and asked her what she thought...

                   

                  She's a runner & so understands the compulsion (???)  to run & the fear of doing damage whillst running.  She said I had low arches with serious pronation when standing still and recommended a heal cup until the pain checks out, then working back to neutrals and eventually to more minimal shoes, once the feet/ankles are strengthened.  She also slapped some kineseo tape on my ankle and told me that when I do start running, run just to my threshold & stop when i reach it.  Finally she said it will probably go away on its own if sit my ass for 4 weeks, or gradually  work itself out over the course of 3-4 months if I do the threshold technique.  As a runner, she knew which of the 2 I'd be heading for.

                   

                  Thanks again for your responses

                  DoppleBock


                    Intersting - I usually can make it go away in 4-6 weeks if I run.  I have no experience with the other option.

                    http://a-big-horse.blogspot.com/ 

                    2013 Goals ~ Mar < 3:00, 5M < 29, 10k < 35  

                     

                      I had acute achilles issues back in 2008 and it still hurts a little, but really it has almost cured itself. Here are some thoughts that helped:

                       

                      1) Running SLOW is better than time off. While the achilles is injured, stay away from long hills and moderate running. The best thing I did for my achilles was run about 3 min/mile slower than MP around a flat grass loop. (Boring, yes.)

                       

                      2) The problem with your achilles is likely located somewhere else. For me, it was (and is) tight hamstrings and hips that were fatigued from running consistent high mileage. The long term solution is strengthening hips and core and trying not to get so drained in training that these weaknesses affect my form.

                       

                      3) Yes, to eccentric calf raises. I also had success, somewhat counter intuitively, with short steep hill blasts. These seemed to dynamically stretch the backs of my legs and lined everything up.

                       

                      4) Your non-running shoes. I had success going with dress shoes with an elevated heel in my work shoes (something like cowboy boots.) Some recommend going more minimal, but I think if you are going to run through the injury, you also need to figure out how to take stress off of it during the day. This really helped me. I would resist the temptation to think about healing as "elongating the achilles" as I am not really sure how that would happen. Your achilles will heal whenever the pressure that is tweaking it out of line is relieved.

                       

                      5) Anti-inflammatories: be your own best judge here. When I was training through the injury towards a marathon, during my highest mileage periods, I would take an Alleve a day, and this helped the symptoms from developing out of control and further damaging the tendon. 

                       

                      6) If you have chronic achilles tendinitis, healing may not mean totally relieving all pain. I can run anyway I want on my achilles now, but it still gets stiff in the morning, and if I am training extra hard, it can become painful to the touch. It is much better now than it was even two years ago!

                        I had acute achilles issues back in 2008 and it still hurts a little, but really it has almost cured itself. Here are some thoughts that helped:

                         

                        1) Running SLOW is better than time off. While the achilles is injured, stay away from long hills and moderate running. The best thing I did for my achilles was run about 3 min/mile slower than MP around a flat grass loop. (Boring, yes.)

                         

                        2) The problem with your achilles is likely located somewhere else. For me, it was (and is) tight hamstrings and hips that were fatigued from running consistent high mileage. The long term solution is strengthening hips and core and trying not to get so drained in training that these weaknesses affect my form.

                         

                        3) Yes, to eccentric calf raises. I also had success, somewhat counter intuitively, with short steep hill blasts. These seemed to dynamically stretch the backs of my legs and lined everything up.

                         

                        4) Your non-running shoes. I had success going with dress shoes with an elevated heel in my work shoes (something like cowboy boots.) Some recommend going more minimal, but I think if you are going to run through the injury, you also need to figure out how to take stress off of it during the day. This really helped me. I would resist the temptation to think about healing as "elongating the achilles" as I am not really sure how that would happen. Your achilles will heal whenever the pressure that is tweaking it out of line is relieved.

                         

                        5) Anti-inflammatories: be your own best judge here. When I was training through the injury towards a marathon, during my highest mileage periods, I would take an Alleve a day, and this helped the symptoms from developing out of control and further damaging the tendon. 

                         

                        6) If you have chronic achilles tendinitis, healing may not mean totally relieving all pain. I can run anyway I want on my achilles now, but it still gets stiff in the morning, and if I am training extra hard, it can become painful to the touch. It is much better now than it was even two years ago!

                        This is interesting, though I think we're basically saying the same thing...in most parts.

                         

                        I think for (4), I believe I saw Spaniel saying a similar thing--I think he was wearing heavy-duty boots or something when not running.  I went the opposite direction; I wore these when not running to stretch out my Achilles and I think it really worked/helped:

                         

                         

                        Perhaps it's what stage we were--beginning of the tendonitis or toward the end of it???

                         

                        For (3), it was too painful for me to do any hill at all (maybe I was being sissy...???) but we were heading for a Hill Training Phase of a training cycle for a girl I was coaching.  But I noticed I can fairly comfortably do step running because the angle of my ankle wasn't too deep.  

                         

                        For (5), I did use quite a bit of Advil because I didn't want the pain to alter my running form.  One time I noticed I was running "sitting in a bucket" and it was very uncomfortable and afraid I might hurt my lower back if I continued running that way.  I shifted my Center of Gravity and, though it hurt crap out of me, the ride was much more smooth and comfortable from there on.

                         

                        As for (1), totally agreed--I would go to St. Paul Science Museum where we did step running 20-minutes earlier and I would do warm-up before our warm-up at VERY slow speed.  It helped alleviate the pain even further.

                          I too have had a rough patch with my Achilles, so bad I couldn't walk for a while there, never mind run.  I had to take some time off.

                           

                          As far as treating it, I'm with Jeff that the culprit is at least partially somewhere else (for me, it was my hips).  Something else that helped me was using one of those elastic physical therapy bands to strengthen the other muscles in my foot and to religiously ice it and stretch it.  

                           

                          I'm finally back to running regularly and I'm happy to say so far its been pain free, but I lost an awful lot of fitness along the way. 

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                          www.miloandthecalf.com

                           

                            Time wounds all heels.

                            runnerdave67


                              I occasionally get Achilles pain in my right foot, and pains that hurt on the right side when I flex against gravity or run up hills. Taking time off

                              does absolutely nothing for it, so I'm tempted to believe that running/strengthening is necessary to heal in this case...it's definitely frustrating, though. 

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