Tendonitis treatment

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If I can extend your question, how does one know when he/she is ready to start running again? I'm just starting to run again after 4.5 weeks off with peroneal tendonitis. Is it normal to have a little "awareness" of the general area when I'm not running? It doesn't hurt at all like it did a month ago, but there is from time to time a little dull sensation down there.

Could that be just scar tissue being worked out?

Yes, it is hard to find what you are looking for.

I wrote an article on this exact conundrum a while ago.

http://www.runningwritings.com/2012/12/how-to-find-good-doctor-or-physical.html

Short version is to do your research BEFOREHAND, because as you've discovered, you can waste a lot of money and time on docs who just do not know their stuff, or don't understand the sport. Find someone who is a team doctor for a college team or works with elite/high level runners on a regular basis, and specializes in the area you've injured.

As for Achilles tendonitis in particular, you might find this helpful too:

http://www.runningwritings.com/2013/11/achilles-tendonitis-in-runners.html

in.same.boat wrote:

Bump

If I can extend your question, how does one know when he/she is ready to start running again? I'm just starting to run again after 4.5 weeks off with peroneal tendonitis. Is it normal to have a little "awareness" of the general area when I'm not running? It doesn't hurt at all like it did a month ago, but there is from time to time a little dull sensation down there.

Could that be just scar tissue being worked out?

This is timely...i'm icing my peroneal tendon as i type. i quit running 8 days ago but had to drop my mileage substantially for a month or so before that. i just got to the point where it wasn't getting any better and i was hobbling around my office.

I've read the goal is to make sure you aren't doing anything to irritate it. one thread i found here said to use a walking boot if you can't walk without feeling it. i decided that i won't run again until i can walk without knowing that i even have a peroneal tendon. I think that is the only way to know it's gone for good.

Do you have any exercises you've been doing that strengthen and stretch the calfs and feet without engaging the peroneal tendon? i want to start doing these but most of them make me realize my peronal tendon exists.

Also, i don't think it's scar tissue you are feeling. i think that the tendon is still rubbing the sheath around it meaning it is not yet healed, which is what you are feeling.

Thanks for your thought, man.

I've been sitting on floor and using an elastic band twice a day, doing 2 sets of 20 for four different exercises:

a) extending toe (like pointing your toe)

b) pulling toes to my right

c) pulling toes to my left

d) pulling toes toward my body

a is easy -- you just hold onto the ends of the band with your hands and wrap the middle around the back of your foot

for b, i wrap the band around my right (uninjured) foot and then loop it around my left (injured) foot so that i'm pulling the band at a perpendicular angle to my outstretched legs

for c, i cross my uninjured leg over my injured leg and do the same thing as "b"

for "d," i wrap the band around a solid object (my apartment's heater) before wrapping it around my injured foot, so that the tension comes when i pull my toes toward my body

other than that, lots of stretching of calves, icing morning and night, and general frustration...

i didn't get a boot, but my PT has been taping my injured foot every few days

Thanks in.same.boat! I'd read about some exercises but having someone in the same boat who actually went to PT for this gives me some confidence that i'm on the right track.

4.5 weeks? ugh! i was hoping a week off would do it but i can still feel it walking. i can walk in a way to not make it hurt but it looks goofy.

do you find that it's worse after sitting?

hey in same boat...

are you able to run now? i'm at almost 4 weeks off. i just slammed 800 mgs of ibuprofen for the past 4 days and i still feel it a bit walking but i don't have to limp. i want to try and run for 15 minutes tomorrow. I'm wondering what your status is.

thanks

I found doing toe raises and drops several times during the day to be very effective, along with various calf and ankles strengthening routines. The main thing is to ice IMMEDIATELY after a workout. No babying around here, get a bucket large and deep enough to get ice water up to your calf muscle and ice it for 10 minutes. Let it come up to body temp before walking on it afterward.

ZERO speed work and only very easy maintenance running, 10 days off is better while you get into the routine.

Did these make it hurt more after? Were you doing them when still hobbling around?

It seems like every time i try to do some sort of PT exericse, it gets worse.

Not surprised that some are frustrated with tendon injury care. The best science is not often practiced clinically, instead focusing on contradictory passive treatments, e.g., ultrasound, soft tissue work, which are all BS.

Yes, the best evidence is for loading the tendon: slow, heavy weight. Some pain during the exercise tells you that you are loading the tendon enough. Pain 24 hrs after tells you the load was too much. Do the exercises no more than every 36 hours (tendon takes 36-48 hrs to recover). If that is too much load, then do long hold isometrics (do a heel raise to midrange and hold for 30 seconds, repeat to fatigue).

Other adjuncts: a mild rocker bottom shoe reduces the load on Achilles and peroneals. Some Pearl izumi shoes have just enough a rocker. I think there are others out there as well e.g., Scott

For peroneal tendinopathy, check the amount of medial posting you shoe has. Too much post puts you into too much supination, which compresses the tendon (bad). Also, too tight of a shoe compresses the tendon. Same goes for Achilles: too little shoe drop or too tight of a shoe compresses the tendon.

Patience and caution with respect to returning to running in addition to time off, when needed. Slow return to hills and lots of calf stretching. Be prepared for 4-6 months of recovery.