Please Help!! Insertional Achilles Tendonitis Not Going Away

This. My PT expressly told me to run even if it was painful, but just to be mindful of different kinds of pain (we all kind of know the pain we can run through, and the kind we can't). She said that the wisdom on this has been changing (at least in her circles), with activity and exercises being preferred over RICE (as you can see by all the therapy recommendations in this thread), to the extent you can be active (even if it's taking it easy for a while, like walking/jogging, but not totally off).

Golden State Warriors team P.T. told Kevin Durant it was okay to play through a calf strain. K.D. suffered complete Achilles rupture. Anyone telling you to train through Achilles strain is a fool.

Calf raises helped mine. Took quite a while, but it worked.

IAT took me out for about 8 months in fall 2020. I did all the exercises, shockwave, various soft tissue treatments. I think at first significant rest and the shockwave were beneficial but what finally brought me back was running through it and keeping my calves loose. Also, wearing open heel shoes as much as possible helped manage the pain. I started seeing a new PT that said you need to really stress (but not overstress) the tendon in order for it to heal.

I built mileage very slowly to like 45 miles per week over maybe 2-3 months until it got to a point where it didn't bother me. I can definitely still feel it and have flare ups on occasion. It will probably never go away completely, but I've been running normal mileage and workouts without any real issues since last spring. If your starting point was 90 mi per week, it will take a lot of stress in order for the tendon to react. Don't be afraid to run through some pain, just go very slowly and make sure it's not getting worse in the long term. Even if it gets worse in a week, you really only care about the long term trend. You'll have good days and bad days along the way. Find a PT or Sports Chiro who understands this injury and understand competitive running and have them advise you through it.

At this point, what do you have to lose by running through it? Good luck! IAT is a tough one.

What does a basketball player with a calf strain have to do with a runner experiencing insertional achilles tendonosis...? Apples to oranges.

kevin durant isn't a runner. your average runner isn't doing explosive jumps 500 times a day. completely different sport with different use of the achilles muscle.

This video advice helped me a lot

Go light on stretching when it hurts, but try to loosen the calves with massage. Take magnesium, because it will help with muscle knots. Wear shoes with soft heel counters when running and don't have anything touching the back of the heel when going about your day. Try natural anti inflammatories like turmeric and ginger. This is a frustrating injury but it WILL get better!

Try adding a 20-30 minute rowing session a few times a week. It helped me manage a 20 year care of Achilles tendinitis. I now run without pain, even in the mornings.

In regards to the conversation regarding resting vs running keep in mind that tendons need load so resting 100% is not the best course of action.

a good rule of thumb my physio gave me was that if running is making the pain worse then take a week off whilst maintaining the rehab routine. If the pain doesn’t get worse from running then it should be okay to run.

another good protocol that I use is if you can’t do drills pain free then you can’t run. Drills for me are atleast dribbles, ABC skips, straight legs and karaokes. This is also a good way to reintroduce dynamic load to the tendon. I’ll start off at walking speed and if that’s pain free then I go to half speed then full speed

You may also want to find a good sports medicine doctor and not a podiatrist. I had problems that progressed to haglunds surgery. I started at a sports medicine physician that diagnosed problems via ultrasound imaging. This may be very helpful to you to see the state of your achilles (tendonitis, tendinosis, intrasubstance tear) this information can help inform your rehab protocol and tell you if some sort of intervention is needed. with no noticeable haglunds on x-ray, it would be very good to check the tendon health.

try eating some eggs!

The best LR resource for all things Achilles is from Ciarán Ó Lionáird:

Before I dive in: What follows is for insertional Achilles tendinopathy, not a true injury to the tendon itself. In other words, the tendon is not ruptured or damaged. It just ... hurts. The former requires surgical intervention most of the time. My advice is for the latter kind of problem.

I struggled with the same injury for about a year. The "aha" moment was when I learned that the fibers in the tendon are disordered -- not injured. Obviously this is not a clinical explanation, but ... the tissues get all messed up and are not able to heal properly from load. So they get stiff, send pain signals to your brain, etc.

To fix it you have to reorder the tissue (and, if possible) make everything stronger.

The Smith machine at the gym should be your new best friend. Do eccentrics on that three times a week: two feet up, then down slowly on the injured leg. When I started I could barely do the bar. Four months later I was doing 200+ pounds, and my tissue was strong enough to handle regular running.

My achilles isn't perfect -- it is still stiff as sh*t in the morning and gives me occasional pain. But thanks to all that work it is strong enough to handle 80-mile weeks.

One other thing ... a lot of this is in your head. Your body/brain connection are trained to believe something is wrong in that tissue. You have to train it to fire properly, to work properly. Your body/brain have to relearn how to fire the right way. Which is a long way of explaining why rest doesn't work for sh*t. It isn't retraining anything. You have to progressively load the tissue to fix the tissue.

Finally, there is an Aussie PT with amazing resources on insertional Achilles issues. Great advice on how to do what I describe above (with much better explanations.)

pogophysio.com.au

3 Steps to Rehabilitate your Achilles Tendinopathy | POGO Physio Gold Coast

Brad Beer

Alec Lablache POGO Physiotherapist shares around 3 Steps to Rehabilitate your Achilles Tendinopathy

Open link

pogophysio.com.au

The 3 key stages for Achilles Tendinopathy exercises | POGO Physio Gold Coast

Pogo Physio

Achilles tendon injuries are one of the most common running injuries. The 3 key stages for Achilles Tendinopathy exercises

Open link

I was told by both my doctor and sports chiro that you want there to be a little pain when you do them. The key is to do them on a flat surface and not drop the heel below the ground (like you would do in non-insertional). Once you can do those with minimal pain, you need to add weight. However you can- hold a weight in one hand, wear a weighted vest, use a backpack with weights.

I put heel lifts in my running shoes so it would turn a 10mm shoe into a 14mm shoe - that is really helpful.

The smith machine worked for me. The more weight the better. And my sports chiropractor described it in the exact same way.

I had insertional achilles after college. Took two years, but I eventually started to perform alternating days of HEAVY isometric heel loading underneath a barbell or with heavy free weights. No movement, just hold the load for up to 30 seconds, 3-5 sets per foot. Keep running as tolerated. STRONG STUFF HURTS LESS. DO NOT GIVE UP.

I've been dealing/not dealing with this for 10+ years. It has challenged my self-identity and made for some pretty depressing times (pun intended). I appreciate the guidance in this thread and being reminded that I'm not alone.

12 years and counting, same thing.

The BEST management for me after seeing my 5th physical therapist that finally addressed my hips and lower back. Even yourself out at your core and it stops pulling. IE my left hip was rotated which was pulling my right hamstring and achilles. I saw some of the best doctors in Vail and searched everything and it came down to my hips. At first it was a weekly visit and now I see her every ~6 weeks for maintenance.

I still feel it every single day though but can run 50 mpw.

Again, I really can’t stress how much I appreciate every single one of these replies. I respect all of your thoughts and advice so much. I never expected to receive this much help on here. Honestly, I have been feeling exhausted and just really down/hopeless with this injury (almost at the point of throwing in the towel), but you all have given me hope with different ways to fix/manage this, and I really can’t even begin to express my appreciation. Not trying to sound dramatic haha but still huge thank you to each and every one of you.

And I'm so sorry to those who are still struggling with it. I really do hope it gets better for you guys. I feel bad complaining about mine since it has only been seven months. I'm seeing a sports med doc and PT next week and will update this thread if they suggest anything new so that this thread can continue to be a good resource for others who are struggling.

Again, huge thank you!