achilles tendinopathy and eccentric calf drops

Resting never seems to help me with achilles tendonitis.

My personal protocol is to run super slow every day for 35-40 min on flat and even terrain. Super slow being 10-11min mile pace for a sub 5min miler. I concentrate on holding my best form and posture while doing these slow runs. If the achilles starts to further tighten, I walk for a bit until the tension eases, and then resume an even slower running pace. I will do this every day until the tension is gone (usually 4-7 days), then keep it slow for 3-5 days after that.

Running seems to be the only exercise for me that gets the blood flowing enough for recovery. The challenge is running slow enough to prevent further impact damage.

Edo: Good questions! I'll answer them, speaking only about my own experience.

1) No! Achilles tendinopathy does NOT go away on its own, with rest. That's because what we're usually talking about isn't tendonitis (inflammation), but tendinosis. The latter condition, my (fairly wide) reading suggest, is what might be called a disorganized or disordered tendon. In order to heal, that tendon needs to be rehabbed in a way that remodels, reorganizes, it.

2) Yes, I got 100% rid of achilles tendonosis using eccentric heel drops--the so-called "Alfredson protocol." I found a steel step near where I ran, and I did three sets of 15 heel drops every day. Every 5 drops, I'd switch sides for one drop, just give the other achilles a little bit of action. I noticed no change for the first four weeks. NONE. Nothing. I thought it wasn't working. And then, slowly, the tendon began to get better. At this point I was hooking my free foot underneath the step and actively pulling down, to stress the tendon more fully. I continued slow 30 minute jogs during the entire rehabilitation period. At this point I began to extend my slow jogs beyond three miles, but the moment I felt any returning soreness, I'd slow even further and/or walk it in. I can't remember whether it took eight weeks or twelve weeks for a full cure, but by the end of that period, I was 100% well. This all took place, as I recall, in the summer and early fall of 2013. I got a bit of patellar tendonitis on the other side after that, but eventually I cured that, too, with the help of a slant board and--crucially--meloxicam (Mobic). By January I was 100% fine. I trained normally, and hard that winter and spring. My training included once-or-twice-a-week workouts of 8.5 miles with 6 x 60 second steep hills. My achilles never once complained. I ran a few races that spring, came in second overall in one small-town one, and finished with a 20:38 5K (at age 56).

Recently, after more than 2 years of absolutely no trouble, I've felt a few faint twinges from that tendon--just enough to remind me, with surprise, that I once had trouble on that side. I've done a few heel drops. But the twinges have gone away.

I'm 100% cured.

The key thing is, mere rest did nothing. The disorganized/sore tendon stayed disorganized, frayed, troubled. But eccentric heel drops, if you stick with them long enough, WILL do the trick. I remember well that there was no change for the first month. I was despairing. I thought, "This isn't working." But it was working. It did work.

Hogwash

Rest will cure all Achilles-related problems assuming you catch it early enough. If you're in pain, listen to your body.

Edo: You've asked several times whether you should commence the heel drops while you're actively in pain. My own advice is that you should cease all running for at least two weeks, put an ice pack on the tendon for at least 15-20 minutes once or twice a day, and maybe take an anti-flammatory like Aleve. NO heel drops for at least a week. Give the tendonitis--if that's part of the problem--so quiet down. Then, and only then, start the heel drops.

There's one additional proviso. I'm quite sure that the research I've seen warns AGAINST doing heel drops if your injury is very low, right by the heel bone insertion point. I'm quite sure of that. So if that's where your bump is, I would do a lot of reading, googling "eccentric heel drops" and "achilles tendinosis" before you take our advice. My own tendon problem was, as I recall, at least 3-4 inches above the heel.

And yes, as others have said, no need to worry about the bent-knee part of this. I never did those. I just did 3 x 15 drops, and over the weeks, as the pain began to recede, I used my free foot, hooked under a step, to increase the downward force on the tendon--the same effect that wearing a daypack filled with books would have had. (I think the Alfredson protocol suggests a daypack with weights, something like that.)

injured not irreparably: You just don't know what you're talking about. Read the sportsmedicine research. Learn the difference between tendonitis and tendinosis.

hello KudzuRunner

thank you for your reply,

so far I don't see any visible bump, and it's been 20 days from my last run, I have to be precise here, I never experienced pain WHILE running, I usually felt pain the day after, especially in the morning. Except for the first week after the day I ran for 10km on my toes (now I know that was not forefoot landing) I can walk without limping,

Anyways I don't think I'll run before january, I'm taking this thing very seriously even if it's not swollen, it's been bothering me for a month or so, and that's enough to be cautious, better safe than sorry.

I am doing a lot of googling I just wanted to gather some answer from other runners that already went through this, just to have an idea of what to expect.

What KudzuRunner and SoCal Pete said.

Alfredson said in a podcast that he believes the bent knee is very helpful for successful Achilles rehab but he does not have enough data yet to prove it.

One thing that made a big difference for me was to do the heel drops barefoot. I had been doing them with running shoes and it kind of controlled the Achilles discomfort but did not completely get rid of it. I was at the Scott Simmons event in Colorado Springs and a PT guy named Fred Stoot showed all his Achilles rehab exercise slides with no shoes.

Doing them barefoot exposed a weakness in the arch of the foot that had the Achilles pain. After a few sessions of barefoot heel drops, the arch strengthened, and the Achilles got 100% better. I find a step with carpet on it to be most comfortable for barefoot heel drops.

It's good as a rehab and a prefab. After many years of left Achilles pain, I ended up with right Achilles pain one season while my left was OK. I rehabbed the right but did the exercises for the left also. Both sides have stayed healthy.

Yes. I can claim this. And I didn't have to stop running. They've worked again and again. But combine with bass drum pedal style exercises to avoid shin splints as your calf muscles hypertrophy from the eccentric calf drops.

go slowly--that is the key to the drops. I would not do more than ten on one leg at a time. You alternate legs with ten, so doing 3x10. And you can do that 3 times per day, but then I'd take a rest day between. When I do more than ten on one leg at a time, my heel starts to get worse, not better. And there was a page on the web about doing eversions with these, basically going a bit to one side or the other as well as straight down, to work different muscles.

hey kudzu

did you ever do more that 3 x 15 drops in one day? the protocol says to do this x 3? i tried following that and just limped around.

But maybe i'll just start working on 3 sets.

I injured my left achilles a few weeks after running the Comrades Marathon back in June 2013. 6 months of no running, a further 12 months of slightly painful running

The most important thing I learned was that an injured achilles won't heal itself through ice and rest; that's too little blood flow to the area. Never had much luck with heel drops as well. You need the opposite of rest. You have to increase the flow of blood throughout your body. That's why the pain was most severe first thing in the morning or after resting for too long. Not enough blood flow. The minute I warmed up and got some blood flowing, the pain left

Three or four times a day, I'd fill a bucket with warm water (similar to the temp of bath water), submerge my entire foot in the bucket for 5 - 10 minutes, and gone was the pain. I'd head out immediately for a short run after doing this.

Active recovery is what will heal that injury

hello,

thank you for sharing your experience,

I keep reading about the blood flow problem with achilles, I read that contrary to other tendons the bloodflow is rather scarse in this area and that's why anti inflammatory drugs aren't usually efficient in treating achille's tendinopathy. I never thought that could explain why it does hurt more in the morning, good stuff.

moanswers wrote:

hey kudzu

did you ever do more that 3 x 15 drops in one day? the protocol says to do this x 3? i tried following that and just limped around.

But maybe i'll just start working on 3 sets.

No, I never did. I get bored easily, and I just felt that 3 x 15 at the end of my daily slow jog was enough. But I did try to follow the part of the protocol that said "Work them harder as you begin to improve." Thus the opposite foot hooked under the step, helping pull me down--and helping stretch and work the troubled tendon.

I know a high-level runner who has had good response to Graston technique.

As said above- in the acute stage of the injury, it needs some rest. But for long term, rest alone will not heal it. You need to strengthen.

Question for those doing heel drops- at what velocity do you do them? Do you lower down mind-numbingly slow, or do you just lower down at a casual speed?

I do 1 every 6 seconds. So about 5 seconds down and 1 second to get back into position for the next rep.

yeahyeahyay wrote:

I know a high-level runner who has had good response to Graston technique.

Four years ago I developed Achilles tendinitis (or whatever) on my right side. I had about 7 Graston sessions over several weeks which completely cleared it up. I was a happy man.

Fast forward to today and I've been sidelined for almost 5 months because of my left Achilles. Again I have been having Graston treatments, but this one is much slower to respond. Ice and rest have helped to improve things, but I'm still not able to jog much more than a mile every few days. I'm not so happy.

I'm paying close attention to this thread. Thanks for all of the good information.

TomBradysHairCut wrote:

Going through the same thing - I don't think it ever goes away. Doing Alfredson now. Don't think it actually helps. I tried an ART massage and I thought I got something out of it.

How long have you done it?

Are doing the exact protocol or some Bro Science version of it?

I'm finding this thread very interesting and relevant. I had an Achilles tendon flare up on July 5, 2015, apparently as a result of doing a 22-mile run in zero-drop shoes which I had worn for many shorter runs but never for a really long run. I quit running completely for about a month, then started back very carefully and had worked back to a half-marathon by February. By March I was running normal mileage but still had mild pain and a good-sized bump on the back of the heel. In May 2016, after running in quick succession a hard half-marathon, several runs with short but very steep hills, and a 5K race, it blew up again and I took another several weeks off (cycling only), then began running again very carefully, 5-10 miles per week.

The idea of stretching an injured tendon scared me to death (tendons aren't supposed to stretch, right?) but I kept reading about the eccentric heel drops and finally started doing them, carefully and with no added weight, in July. I am now doing 30 mpw of easy jogging (no pace and absolutely no hills) and I am continuing to improve. Mine is insertional (self-diagnosed and confirmed by the orthopedist I saw, who insisted I needed surgery) and I'm doing the drops on a step, going well below floor level. But I don't add weight to my 115 lbs and I stop at a point of relatively mild pain. One set of three long stretches, approximately every day.

I intend to start doing more drops to a set and perhaps twice a day, and hope that improvement continues.

The problem is that since everyone is a sample size of one, you have no way of knowing whether what you're doing is working or whether it would have gotten better anyway on its own.