Is there a cure for achilles tendinopathy?

Most achilles injuries are caused by an immobile ankle and heel. I'd recommend trying ankle distraction mobility exercises, and heel distraction exercises. There's a guy in Chandler, AZ named John Ball who is the go to guy for most pro runners and that's what he has them do when they get achilles issues. That and isometric calf raise holds. The dude took me from not being able to run for 2 weeks because of achilles tendinopathy to running in the next day, essentially pain free.

Apply 1/4 of a 0.2 mg/hour patch, apply directly over the involved area.

See any of the recent editions of the following book:

Clinical Sports Medicine

by Peter Brukner (Author), Karim Khan (Author)

I have been using on patients [along with eccentric exercise and dry needling of the plantar flexors] for 15 years with good results.

Could your problem be the paratenon instead? I couldn't tell the difference when my achilles was painful.

flagshaft wrote:

Apply 1/4 of a 0.2 mg/hour patch, apply directly over the involved area.

See any of the recent editions of the following book:

Clinical Sports Medicine

by Peter Brukner (Author), Karim Khan (Author)

I have been using on patients [along with eccentric exercise and dry needling of the plantar flexors] for 15 years with good results.

Already sent this info to the doc I saw today. Thanks.

I healed mine in 2 months running 100% mileage on grass/trails

flagshaft wrote:

Br J Sports Med. 2007 Apr; 41(4): 227–231.

doi: 10.1136/bjsm.2006.034447

PMCID: PMC2658939

PMID: 17289859

Using nitric oxide to treat tendinopathy

George A C Murrell

George is Mr. Achilles! Not only has he spent a career studying it, he used to triple jump for Achilles (the club). Now that's what I call career focus...

I’m 52 years old (former sub 15 5k runner) and have had achilles pain for almost three years. It hurts most on both sides of the tendon. If I squeeze the Achilles, it’s super painful. Like the OP, first thing out of bed I’m hobbling for 10-20 minutes, and when getting out of a car after a long drive. Pushing on the tendon itself is moderately painful, but applying pressure on both sides is more severe. I’ve tried rest (pain just returns), the night splint (moderate relief), ice (not long-term help), eccentric calf raises (caused more pain) and recently shockwave therapy. The shockwave therapy really reduced the pain noticeably, but once the five sessions were compete, the pain just returns. I can still hobble through runs and dipped under 5:00 for the mile this summer, but it’s stupid to be limping around all the time. I’m out of ideas... Heel lifts? Cortisone? Should I fly to AZ and see John Ball?

Keep me posted on here if you find anything out. Diagnosis, treatments, whatever.

Sound like a very similar problem.

I have the same pain when applying pressure. Yesterday the doc squeezed the achilles and I just about kicked him in the head. So painful!

I'm getting another MRI next week, but I'm not hopeful about anything showing up.

After that I'm seeing a foot surgeon. Not necessarily to get surgery obviously, but I'm not ruling anything out at this point.

Lamergamer js trying time continue the false belief of “glute amnesia”, trigger point and other pseudoscience. You’re very strong and there is no way you could squat and deadlift PERIOD without the work of your butt.

I have had Achilles & calf issues for the better part of 5 years. Me being old school, I never took time to research the issue as much as I should’ve but simply decided to rest.

So after months off at a time, I would return to running only to strain my Achilles again.

Here is what ultimately worked:

First — I walked a ton to Lose weight. It also strengthened by Achilles.

Second — you absolutely need to do calf raises & heel drops. I do regular cal raises, single leg raises, and then for heel drops — stand on the steps or a table with the ball or your feet on the ledge and then drop your heel, push back up into a calf raise. You should do these as often as you want (I was doing 300-400+ total). I find it’s really hard to hurt my calf & Achilles doing the exercises so I think volume is needed to really strengthen it.

I've done calf raises and eccentric calf drops, but never at that volume.

I've maybe spent 5 to 10 minutes per day doing that stuff.

I've never "strained" my achilles, so my issue might be different from yours. Not saying the strengthening won't help though.

With my achilles it's more of an aching, sore feeling that comes back every time they get a chance to rest or cool down. I definitely worry about rupturing an achilles some day, which would obviously be catastrophic, but I've yet to have an acute injury to either of them.

They are not swollen or enlarged, and I don't think there are any lumps or bumps, but I'm not exactly sure. It kind of seems as if there may be a slight swollen section right above the heel bone, but it's not extreme.

I can say this though - if I were to do a bunch of extra calf raises today, my achilles would be wrecked for tomorrow.

Sorry to hear you've struggled with this for such a long time. I've actually been through a similar thing recently and visited a very good podiatrist in the UK who explained the science behind achilles tendonitis/tendonopothy or whatever they're calling it these days. Based on his explanation and my experience of dealing with the injury it sounds to me that you're actually struggling with something different.

Let me try and break it down. The achilles gets very little blood flow. This is common knowledge. When the achilles gets hurt, the tendon sheeth which is what surrounds the tendon starts injecting fibers into tendon to try and heal it.

The sharp pain you feel in your achilles when you run/walk is those fibers pulling with each step. A good example is that these fibers start to act like scaffolding around the tendon to support it. In order for the pain to go away you need to remove the scaffolding or 'break through the fibers'. - This is where the whole 'loading' the tendon bit comes from. You want to put force through it regularly to break the fibers and allow the tendon to glide freely up and down in the sheeth.

Tonnes of research has been done on this loading method. A lot of it suggests weighted calf raises/eccentric heal drops or lifts. Or heavy leg press using your toes and pushing up through your calves. However, the podiatrist advised me that simply continuing to run would load the tendon enough to break these fibers and low and behold he was right.

So - long story short, each time i have had it, and i've had it be constant agony, running through it made it go away. Because running was putting the achilles through it's paces and breaking those fibers.

I've had it quite a few times and am currently going through it again. (on different legs each time) on one occasion it last 7 weeks and one day just stopped hurting and on other occasion only 3 weeks of pain. The pain is AGONY as you know but gritting my teeth and running through it made it recover. i'll add the very first time i had this injury i rested for 3 weeks. 0 running. first run back i had the pain. I'm hoping this time it hurts for closer to 3 weeks than 7 but for you to say if you've had it for so long makes me think you've either got a different type of injury or an extremely stubborn case!

I won't suggest running through it to you because you've been doing it for so long with little results. but at least this may give you the idea to explore other treatment/rehab for a different kind of injury. it could be a calf or foot issue maybe.

good luck to you, i hope you find a way of making it better. it's a b!tch of an injury but stay positive!

not just gluts ... wrote:

[quote]Lighter wrote:

[quote]lamergamers wrote:

Based on your description there's a decent chance the problem is NOT with the achilles (but pain is referring to that area). This is why scans and diagnostics are not showing an achilles problem. You probably have a series of overtightened muscle trigger points in your lower half, and your form and/or biomechanics (common cause is weak glutes that cause an over-reliance on calves during push-off) are exacerbating the issue.

Check out "the trigger point therapy workbook" and consider doing glute and hip strength training (weighted squats are a good one).

I struggled with similar issues for almost 10 years, saw all the best doctors, etc. Went through the above and became (and continue to be) pain free after a few weeks.

It is not just gluts, it's your entire core. What is is your leg extension (quads) to leg curl (hamstring) ratio? It is not simply how strong you are but how relatively strong. If your hamstrings are relatively weak in relation to your quads, your calves will over-work. If your calves have to over-work due to relatively weak hamstring muscles, your Achilles are at risk. Are your feet flat? Stuff happen simply due to wear & tear.

I do not have flat feet. Are my feet strong enough? I don't know. Like I said, I do plenty of sprinting, and I walk around barefoot, but I don't do isolated foot work. I also don't do isolated core work. I've never really done core.

I'm not saying I'm correct, but I've never liked the idea of isolated exercises. I run far and I run fast and I lift heavy things. All strenuous full body work. Seems much more natural to me, and I don't see why one particular part of my body would spontaneously get weak if I'm always active. Is this a foolish thing to say? Maybe. I could be completely wrong. Maybe I'm getting older so weaknesses are getting exposed, and so I should start isolating those weaknesses in order to keep the body all in rhythm.

I wish there were just an easy fix for this. I'm a little burnt out on the rehab. A patch that miraculously heals the problem would be great. Even a surgery to fix it would be mentally easier to handle than being told to spend 45 minutes every day for the next 40 years doing some tedious exercise.

Eccentric heel drops are what you need, bent leg + straight leg. I don't know that calf raises have been shown to do much of anything. It can take a while to notice a difference (full protocol I think is 12 weeks?), so don't just give up after a few weeks.

It's not a bad thing if the drops cause pain, but you have to use your judgement on what's OK. If your pain is closer to the heel, you might find it's helpful to not go below parallel.

This past Summer I decided to go full bore into the "running through it" method. I spend several months doing higher mileage than I've ever run in my life. I was averaging weekly mileage in the 90s for over a month, and went over 100 a couple times.

It never changed. Same pain, same issue.

As a matter of fact, it seems to be slightly worse since then. In recent weeks I've cut mileage down to the 30s and 40s due to emotional fatigue, honestly.

A few years back I took months away from running, mostly due to the achilles issue, but I don't think it felt 100% even when I wasn't running. Less pain, yes, but it was still there, and once I started up running again (partly due to my mental health not being right because I think I just need to be very active to be happy), the achilles flared right back up again.

It interesting what you said about the fibers in the achilles though. I will look into that.

Another thing my doc said was that he suspected an antibiotic from years ago could be causing the pain. That sounds crazy to me, but what do I know.

And he also said that maybe my achilles is simply my achilles heel. Maybe it's just genetic, and there's no solution. If that's the case, then fml.

You could go and visit multiple doctors and physio's who'll all give you different advice which is a shame because life would be a lot simpler if there was just an 'idiots guide to fixing injuries' and we could all follow the steps to pain free running.

Stick with it. The podiatrist i seen actually prescribed me with orthotics. I then picked his brains regularly with every niggle i had because i was able to use it as feedback from how i was getting on with the orthotics. He's always given me the best advice and i trust him more than any doctor or physio when it comes to lower leg injuries.

If you've struggled for so long on and off with this, have you thought about maybe seeing a good podiatrist to check your gait and general foot strength/health. I wouldn't be surprised if it could help. A lot of the posters above suggesting strengthening certain areas in my opinion are missing the point. if you've been managing to run 90-100 miles per week pretty regularly you're plenty strong enough so certain muscles groups not firing is nonsense .

Leptid wrote:

Eccentric heel drops are what you need, bent leg + straight leg. I don't know that calf raises have been shown to do much of anything. It can take a while to notice a difference (full protocol I think is 12 weeks?), so don't just give up after a few weeks.

It's not a bad thing if the drops cause pain, but you have to use your judgement on what's OK. If your pain is closer to the heel, you might find it's helpful to not go below parallel.

What’s the difference between eccentric heel drops and calf raises?

Calf raise is pushing yourself up, and heel drops are lowering yourself down. The eccentric loading seems to trigger the Achilles to heal in an organized way, instead of forming haphazard scar tissue. It might also shear off the painful nerve growth into the tendon area.

I'm not sure how calf raises would help, but I doubt you'd see much of an effect without weights. I mean, you're already doing some form of bodyweight calf raises all the time.