Achilles Tendinosis - Am I done as a runner?

and if PT is working to the level that is OK for you or you don't have major issues like a haglund's that's great. I don't mean to be dismissive. If the OP really hasn't gotten any benefit from PT they need more than PT and will be running the sooner they get good help from an experienced medical team.

The posts in that thread from Ciaran O'Lionaird are gold. He took the time to put together a hugely valuable protocol. It's well-rooted in a blend of solid art and science.

Try the rowing machine. It took about a month of rowing without running. It's been a year now and the Achilles tendonitis hasn't come back.

I'd strongly recommend getting an X-ray in case to see if it is a bone spur issue. After a year and a half of PT etc. and little/no improvement in my ability to run, I went to a different doctor and she suggested the x-ray. Her reaction on seeing it was, "Oh that is a sweet bone spur. No PT in the world is gonna cure that". I could have saved myself 18 months if I'd had the x-ray to begin with. Also, if there is some kind of bone spur, it is slowly abrading the tendon and it will eventually tear it, and the healthier the tendon is when they remove the spur the quicker the recovery.

Do not have surgery. First advice.

I would pursue doing ultra sound on the heel, with there likely being a surplus of bone/bone spur. That will help treat the source. Ultra sound is honestly the only safe way to deal with bone spurs and can break up break spurs with time and consistency (and done properly).

next is graston’ing the entire calf routinely and properly.

my man, ultrasound does not break up bone. if ultrasound dissolved bone, there wouldn't be millions of people having ultrasounds for injuries and pregnancy screening. ultrasound can help with the healing of scar tissue. extracorporeal shockwave lithotripsy can help really break up persistent scare tissue and realign tendon fibers (varying levels of evidence in some peer reviewed studies).

Saying that ultrasound is the only safe way to deal with bone spurs is completely false.

I am shocked not one of you tried something as simple and effective as icing. I just read about 50 posts of trying everything under the sun and at best with limited results and at worst mostly dead ends.

I too tried all that crap, and it failed or was limited or temporary success, then just icing 10 minutes immediately after each run, then wait and hour and ice again. I am not cured, but I can run as much as I like with no pain or limitations the past 15 years.

Just squeeze the inflammation out and don't let it get back in there, by icing. Don't give me any crap about tendonitis vs tendinosis, I have had the condition for 45 years and have small lumps on the side of my achilles, so I have what you hair splitters would call
tendinosis. It will work for whatever you want to call it.

I iced my Achilles for 15 mins post run and 15 mins before bed every day for years. it did not help a thing. Icing constantly still led to not being able to walk at the age of 33.

You may need to realized that there are varying degrees of severity to an injury and your injury simply isn't that serious if icing is a successful solution.

Achilles tendinosis is a degenerative condition, not an inflammatory one.

Sorry for your injury. The folks posting who say the Haglund's surgery must be done may be right.

Alfredson recommends injections with polidocanol. This is to kill the new nerves and blood vessels that are the body's attempt to heal the Achilles. The new nerves and blood vessels are bad and must be destroyed! The injections are guided by ultrasound so they are put in the exact spot where they are needed.

I have had injections with concentrated dextrose ("poor man's polidocanol") for my Achilles pain and they have been miraculous! Where do you live? The guy that did my injections (and also had some very helpful suggestions regarding orthotics) is Dr. Paul Tortland in Glastonbury, Connecticut.

Good luck with your injury and running!

OP here bumping this thread two years later. After being stuck with this problem for over five years, I made a few key changes which finally helped me get over this injury.

Here is a list of changes I made, from what I considered to be the most important to least
important. This is my personal experience, but I sincerely hope it can help
anybody else dealing with this very frustrating problem.

1) I modified my pace so that my aerobic, easy runs were actually easy. There is a difference between "easy" and "not hard". Frankly, I was not being honest with myself about effort level. Faster running stresses the Achilles much more than truly easy running.

I gave HR training a shot. It is extremely humbling plodding along at 9+ minute miles. But, without unnecessary speed, running no longer kills my Achilles. I feel that this base training approach has strengthened my tendons and made me much more durable.

2) I identified and addressed personal muscle imbalances I had. Instead of doing stereotypical "Gym Bro" activities in the gym (heavy squats, deadlifts, bench) I spend my time in the gym doing much more focused running work. Lots of single leg activities (single leg calf raises, single leg deadlifts, single leg split squats).

The single leg split squats actually made me aware of a Glute Medius weakness on my right side. This is the same side as the injured Achilles. My hip would tilt in, and my body would look super lopsided in the mirror when I performed this exercise on my right side (even with just body weight).

Despite my PT telling me my hips are strong overall, I still had a severe muscle imbalance with this muscle. I spent lots of time working on this hip. I did lots of of lying leg lateral raises, banded walks, clamshells, fire hydrants, etc.

I also spend some time addressing other weaknesses in my body caused by dumb injuries in my youth. (3 X Sprained Ankle / 1 X Dislocated Shoulder, if anybody is curious). I also do much more core work. This has made me more balanced and durable.

3) I do heavy calf raises. In the past, I would do light weight, but high reps at the advice of my PT. They definitely helped me initially! But once I progressed to truly heavy weight, I felt that my healing rate increased significantly. Something like 3-5 sets of 3-5 reps, where I am going slow and in control. When I do these, I get a crazy pump to my calves, hamstrings, and even my core. I never, ever had this sensation with the higher reps of calf raises.

4) This contrasts 1, but I started throwing in a small amount of faster running. I used to only do easy runs because I was injured all the time and scared to overload the tendon.

Just doing some strides + a light tempo or fartlek every week has subtly changed my
form and made me stronger. I notice when I run a cooldown after a workout, my
core is more engaged, and my hip position is different. I believe that running
faster (once I built up enough easy running) has strengthened my body.

5) Idk if this actually helps, but I wear more minimal shoes when I am not running. I wear zero drop shoes at work or when I go out. These don't have a lot of cushion. I would
/ could never run or walk a lot in these. However, I suspect that walking in them day to day has made my feet stronger. I wear the Altra Escalante for work, and the Xero Glenn for more formal occasions (occasionally for work, but the Xero shoe requires A LOT of foot strength to wear). I still run in traditional shoes for 100% of my mileage.

That's pretty much it! I am sorry to write so much, but this is a complex injury. It took a lot of attention and concentrated effort to get under control.

I am slow compared to most here, but I am now running a consistent 40 MPW including a workout, and more importantly, very minimal Achilles pain. This is in contrast to me getting
up to 20 MPW, hurting myself, restarting from 0, and inevitably repeating the cycle.

I suspect my right Achilles will never be the same it was before the injury. Sometimes, it still
is a little sore / stiff in the morning. But it rarely hurts while running, and it is improving despite me increasing running volume. It's good enough for me. Maybe one day I will need surgery, but for the first time in a while, I am comfortably increasing my volume and running consistently.

I hope this helps somebody out there. It was frustrating not being able to train properly in my mid to late 20's. But this experience has fundamentally changed how I view
training and overall athleticism. I think I will be a stronger runner for it.

Peace and happy running.

Sorry for the janky formatting. I knew I had a lot to say, so I wrote this out in OneNote first. I thought I fixed the indentations, but I guess not.

Cole Hocker had it in both in 2022 or 2023.

I was a long-time Achilles Tendonosis sufferer. I had problems off and on for many decades. The first thing you should do is find a decent physical therapist and they are not all the same. They do not have to be a runner but must be patient with you.

Many runners are grinders, it is the nature of what we do. The best thing that you can do to heal the injury and keep from re-injuring it is to do heel exerises on the stairway. (You probably think I am crazy at this point! But it is true and hopefully you will find that out, no matter what anyone else says.)

***What you do is get on a stair and practice lowering from high to low. Then step off and repeat that action. Do not do heel raises at first! Several physical therapists had me do heel raises from day 1 and I could not walk out to my car! So, I do not think you want to do that at first if you are still injured! {One valuable thing I learned recently is that you can lower both heels form high to low more easily than any other way.} Some trainers will try to get you to do one at a time. That is difficult and hard to motivate oneself!***

Beyond that the Physical Therapist should be able to help you further with balance, stretching, and other protocols.

Thank you for writing what you wrote! We all can learn more about running and life, that never stops!

When I first injured my achilles we had a national champion gymnastics coach at our college who told me that once you injure a body part it will never be 100% again. It might be 99.9% but of course you will lose something, so I hope you never decide to have surgery, I do not think you will need it or benefit from it. But of course I am not always right! No one is.

Hopefully you already know this, but the heel lowering exercises should be done SLOW! You lower the heels slowly to work muscles eccentrically. Your muscles can handle a lot more weight with eccentric contractions. (If you did heel raises with a quick rhythm up and down on a stairway that might be a good change of pace.) --What most people hate to do most is warmup--

Step across your other leg before doing the single leg calf exercises, body weight or machines. Don't only do them straight gait position.

I agree and I'll take it a step further. For some people (like me), even slow drops don't help but what I found did help was isometric holds of about 45 seconds. Just stand on the edge of a stair. Don't let your heel drop all the way down. Pick a degree of flexion and hold it there for 30-45 seconds. I did 6:sets on each side twice daily for a few months as rehab and I haven't had any Achilles problems for a year now. 3 sets with straight knee, 3 with bent knee.

You are correct, but many physical therapists know a ton more than they knew in the 1970s when I first began having problems. Heck, we did not even have a physical therapist in the city I lived in. Isometrics, like one person said on here is something we rarely think about when we are injured. But therapists will use that along with massage, balance, and many other exercises. There are many factors, but eccentric calve raises are very universal for that injury.