Achilles Tendinosis - Am I done as a runner?

Go to a different Physiotherapist.

I had it.

I took 8 weeks completely off running (road my bike a tonne) while doing the necessary rehab.

This consisted mainly of isometric exercises, with a few dynamic variations, and calf raises with additional weight to strengthen my calves.

Any PT worth their salt will be able to determine which exercises will solve the issue based on the specific area of the tendon that is damaged.

You need to be incredibly disciplined though; following the exercise program to a tee - and not trying to test out the tendon with the odd run every couple of days/weeks.

I started running again in April and I haven't had a problem since.

Lots of good advice here regarding physios. A lot will depend on how disciplined you are around the rest of it though! I had a multi-year injury issue in my mid-20s, where even after 6-12 months total rest I would have pain within 5 minutes of running. I basically gave up on the idea of running and switched my focus to cycling for a few years. I eventually started doing 3x30 min easy runs a week to supplement the cycling, because it didn’t hurt. I’ve gradually built from there, although haven’t been afraid to take a week off if things hurt again. If you can do any running pain-free, do that. If running doesn’t work, do plenty of walking and get into cycling for the fitness. The biggest game changer for me in the last two years was making sure most of my volume is actually easy enough, i.e. actually keeping the majority of your running below the first lactate turning point, where you can easily converse. The increase in pace above that massively increases the load and stress on the Achilles, and cardiovascular fitness (re)gains are always faster than the tendons are capable of keeping up with, which is why tendon injuries can return apparently so easily. Most of my training now is focused on keeping the tendons and joints happy, and I’m as fast as I’ve ever been on less mileage. If you’re already a few years into this problem, come up with a very longterm game-plan, get into cycling and walking for a while, and you can possibly avoid surgery like I have up until now!

having developed haglunds deformity in both achilles in college, many yrs ago, I was able to run with the pain but eventually had surgery on both heels. recovery from each surgery was a few months, took up cycling, but was able to resume running also good as new. no doctor was able to help the medical issue, as the deformity does not go away with any treatment other than surgery

I’m a fairly competitive marathoner having run sub 2:32 in the marathon a handful of times (I’m female). Achilles issues (also on my right side) hit me hard a few years ago. I tried everything. Tried resting for months (6+) several times, tried ESWT, tons of the eccentric exercises, heel lifts, cutting the backs off my shoes, new shoes, lots of calf massage/rolling/stretching, PRP, the boot, night splints… literally everything. Saw six different physical therapists, two podiatrists, and two sports docs. As someone who regularly ran 110 mpw, dropping down to an average of 400 miles a year for three years REALLY sucked. So I get it.

My main recommendation is to really attack the issue. I had no bone growth/haglunds, so my case was a little more simple. I ended up going with tenex six months ago, and my achilles is probably at 85%. I don’t really think it’ll ever be back to 100%, but it’s nice knowing that a tear is not likely every time I go out for a jog. You’ve already spent so much time on PT/rest, so I really think you would benefit from a slightly more aggressive approach. You’re young enough now that you’ll recover well and have plenty of time to get back to full strength.

Surgery sucks and I completely understand wanting to avoid it, but if you have actual bone growth, PT, rest, stretching, eccentric exercises, strength, etc. can only do so much. I would recommend getting the surgery. While you’re out, I was able to actually gain fitness from the elliptical and bike after years of such low volume. I would also highly recommend a lot of hip/glute strength work.

Good luck. I really feel like achilles injuries are the worst injuries. I had many moments of giving up on any hope and heard many of stories of achilles injuries completely ending running careers, but if you really attack the issue, you have plenty of time to get back to the PR days/enjoying running again (whatever the goal is). Just don’t give up yet! Rooting for you

"Michigan foot doctors" on youtube has been my best sourse, has several really good treatment videos....good luck

Btw.....heel drops should not (ever) be done until pain free! Otherwise, you are contining to aggravate it (the injury). Heel raises are ok from floor level but dont create a slant angle down....(dropping your heal) ... this is very important

I had Haglunds bumps on the inside and outside of one heel and the outside of the other heel. On my left side, the side that seemed worse (and had bursitis that blew up last summer, that along with another issue in that foot, required months off) has actually had the inside bump disappear completely, and the outside bump shrunk drastically and well on its way to disappearing too. No hint of pain at all in it this year. The right heel still has a large Haglunds bump, but it also hasn't really hurt this year, just on occasional feeling a bit tight earlier in the year, and I'm hopeful that it is also not calcified and is also its way out.

In my case, there were two big issues had that I have since solved. The simple one (and universal advice) is something that I didn't learn until this summer when I came across an article on the importance of drinking water to allow hyaluronic acid to lube your muscles/fascia/tendons/bones. For the longest time, I've consumed the least amount of water of runner I know - basically I was never thirsty. After reading the article below, I started drinking a lot of water, and that helped tremendously is becoming more flexible. I don't like that I have to pee a lot more now, but it's worth it. Also, paradoxically, drinking a lot more water now has increased my thirst.

irunfar.com

The Chemistry and Timing of Mobility

Joe Uhan

Here's some good rationale for a morning mobility and hydration routine.

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The other big thing that helped me that will not be universal advice, but particular to me is that my long-term experiments trying to tweak my form by trial and error finally paid off this summer. Ever since I've started running 37 years ago, I've had a short stride for how fast I am that people notice. I've also had generally tight/short muscles that distance runners are often known for. My stride was quad and calf dominant, didn't ever feel like I was working my butt (glute) muscles, and I was always toes only/heels never get close to the ground going up steep hills. I've tried form tweaks before, and sometimes they were the wrong tweaks.

My first ~22 years running was basically injury free, with youth apparently covering the big imperfections in my form. In the past 15 years, I've had cycles of Achilles issues (midpoint, then insertional, then Haglunds). I've mostly been able to run through by doing the standard recommended things like eccentric work and stretches, but I've always still been tight until this summer.

I finally figured out (by trial and error) that the key issue underlying all this for me was poor posture. I habitually slouch in chairs, and in cars preferred no lumbar support (slouching = negative lumbar support) I also ran this way until this summer. Suddenly, running with my back neutral (=feels arched from where I came from) caused all kind of changes. My backside muscles in the legs all had to lengthen and free up to be able to get my legs forward and especially up hills. I got that new range of motion with both stretching and working that range of motion during runs (with the first supporting the second). My heels now come down even on pretty steep uphills. I also feel my glutes working now, and that is more dominant feeling than my quads and calves. The glutes felt weak and easily fatigued at first, but now I'm up to 70 mile weeks again as they are coming around. I did a lot of stretching this past spring and summer, but the backside chain of muscles in my legs stay limber even when I don't stretch now, so I've mostly stopped stretching too. I also used to have a very short and slow walking stride. Within a few weeks of fixing my bad posture, my walking stride has also lengthened a lot as I worked the tight muscles away. It's unlikely that others have the same form issues I had, but it's my case study of one that shows it's at least fixable in some cases. Form is admittedly tricky to fix (taken me 37 years) because there's not always universal agreement on what good form is.

You need to go talk with a sports medicine physician and a foot-ankle surgeon who has a history of working with haglunds athletes.

if you have the trifecta - tendonosis, bursitis, haglunds - then the main cause is likely the haglund structure interfering with normal achilles function after your history of activity.

once things go south with that biney structure in the way, it may not be possible to alleviate your injury without the haglund’s being gone.

i struggled with it from 2011-2018. The only thing that has gotten me to pain free running, or any rehab activities, is having the haglunds itself removed.

good doctors who deal with this can help determine course of care from process of elimination.

if anti inflamatories and tendon rehab do not

1. Relax the tendon for full range of morion

2 eliminate bursitis

then you are likely dealing with structural interference from the haglund’s and not a purely tendonitis issue.

also, the longer you go chronically irritating the are, the harder the surgical recovery will be.

I once had a bad case of Achilles T it took me like 7 months to recover like your case I didn’t pay attention to initial symptoms and I kept getting re-injured till it was a serious problem. I had to stop running completely and had therapy for months it was very frustrating but eventually I fully recovered. Your case might sound complex given the issue with the deformity you have I saw once a case of the woman runner with similar problem her Orthopedist was recommending surgery because she hasn’t improved with conservative management for years, but also she runs and stops etc. Who knows how bad your deformity is but gotta keep in mind that you might require surgery. Best of luck…

- Magnesium Glycinate supplement

- Anti-inflammatory diet (google, and tailor to your preferences)

- Acupuncture (get a recommendation for a good practitioner)

- Don't overtrain/don't build volume too fast

There is lots of solid PT advice in this thread, the above items helped me get better. I've suffered several bouts of Achilles Tendonitis, and always came back to train and race more. It is insanely frustrating.

Biking and swimming are great, but they are not running. I did buy a Specialized brand trail bike that is huge fun, but it still ain't great like running.

For whatever it's worth I've had achilles tendinosis for almost 10 years, first thing in the morning I can barely get down the stairs, I have to go sideways and slowly. Runs start off very slow because they wont let me go any faster, but gradually they loosen up and after 5 or 6km they're semi normal. After speed sessions or races I can barely walk but again they loosen up a bit gradually. Morning after speed work they're actually usually a bit better. Everyone's different etc etc but they can take a lot of punishment. I'm very wary of spikes though

If you want to run you can run.

My running career was blighted by recurrent achilles problems for about 55 years of my running life of some 70 years (I'm 82) and I completely overcame the problem around a decade ago when I met Dr. Bill Grace. A seasoned competitive runner-physician, he prescribed heel drops on stairs, for a couple minutes after every run. On each full drop, I count to thirty slowly, around a second a digit. I now do them faithfully ("on and off" doesn't count). I have not incurred achilles problems since, while winning age group national championships on the roads and hills.

I've suffered through the Tendinosis/Bursitis/Haglund's trifecta and what ultimately ended up solving my issues was finding a shoe with a heel cup that didn't irritate the Haglund's. The bursitis went away first, then the tendinosis.

FWIW, ASICS seemed to work best, then Nike.

I was told to do the eccentrics with progressively increasing weight, and that made a big difference compared to BW.

So I had a similar surgery as someone mentioned here.

I ran a 2:34 when I noticed it, and never got better, just progressively worth. PT, time off, etc, didn't really help. Eventually I had surgery where the achilles was detached, some bone, and some damaged (some meaning quite a bit) tendon was removed, then reanchored. It took me a while (I'm 3 years post surgery, late 30's now), and am back in the 2:40's. My mileage still hasn't recovered fully, but I'm basically pain free and enjoying it again.

I used to get this a lot and lot and lots and lots of eccentric calf raises solved the problem for me. The reason this kept happening to me was because the Arch support in my shoes was worn out...it's hard to tell over time, but as soon as I got a new pair, it was easy to feel the difference.

I Suggest changing your shoes more frequently and get on those eccentric calf raises

No you are not done.
step one: eccentric heel drops

step two: read Klaas Lok’s Easy interval method. and do what it says

Pain free in a few weeks

I do this every day. Feel like it especially helps after the run:

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raynersmale.com

Treatment of Achilles tendinopathy with combined loading programs — Rayner & Smale

Sian Smale

Eccentric muscle strengthening has become the primary conservative management approach for Achilles tendinopathy and popularized by the Alfredson program, however up to 45% of patients do not respond to this approach. Other l...

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