eccentric training regimine increases collagen synthesis in injured achilles tendons

I just thought I would post a progress update here and ask for some advice. It’s been 5 ½ weeks since starting the eccentric program, 7 weeks off of running. It seems when I started I had an increase in pain and since then it seems I’ve gone through cycles of it improving and then getting worse. At this point the tendon does feel stronger than at first, but there is still pain. Pain is only in the morning as it was to start with. There seems to be some fluid around the tendon and a lump. I can massage them out in about 5 mins. I’m up to about 20lbs in the backpack.

This last week I’ve started taking some aleve before bed every night and icing 2-3 times per day. This has seemed to help but it’s still painful in the mornings, especially during eccentrics. I’ve been stretching massaging quite a bit and doing a lot of biking for cross training which I’ve always been able to do pain free.

I’m thinking of giving the eccentric program one more week and then stopping for a few weeks to see if that helps. Am I doing something wrong? Any suggestions?

I know this is months later, but if you are still there, allyson:

How much time elapsed between taking the antibiotic and injury? I took two rounds of Cipro(and I hated that doc before I ever found out about the tendonosis connection), but started with injuries about two years later. Is such a delayed reaction possible, particularly because I was only doing 3-4 mi, so it might not show up as readily?

Thanks if you have any answers. Feel free to email.

Regarding insertional tendinosis--limiting drop to floor level. For me this made a huge difference as I was not getting results with full dorsiflexion.

http://www.ncbi.nlm.nih.gov/pubmed/18184750?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

BACKGROUND: Chronic painful insertional Achilles tendinopathy is seen in both physically active and non-active individuals. Painful eccentric training, where the patients load the Achilles tendon into full dorsiflexion, has shown good results in patients with mid-portion Achilles tendinosis. However, only 32% of patients with insertional Achilles tendinopathy had good clinical results with that type of eccentric training regimen. AIM: To investigate whether a new model of painful eccentric training had an effect on chronic painful insertional Achilles tendinopathy. Patients and METHODS: 27 patients (12 men, 15 women, mean age 53 years) with a total of 34 painful Achilles tendons with a long duration of pain (mean 26 months), diagnosed as insertional Achilles tendinopathy, were included. The patients performed a new model of painful eccentric training regimen without loading into dorsiflexion. This was done as 3x15 reps, twice a day, 7 days/week, for 12 weeks. Pain during Achilles-tendon-loading activity (VAS) and patient's satisfaction (back to previous activity) were evaluated. RESULTS: At follow-up (mean 4 months) 18 patients (67%, 23/34 tendons) were satisfied and back to their previous tendon-loading activity. Their mean VAS had decreased from 69.9 (SD 18.9) to 21 (SD 20.6) (p<0.001). Nine patients (11 tendons) were not satisfied with the treatment, although their VAS was significantly reduced from 77.5 (8.6) to 58.1 (14.8) (p<0.01). CONCLUSION: In this short-term pilot study this new model of painful eccentric calf-muscle training showed promising clinical results in 67% of the patients.

I had terrible achilles problems near the insertion point for years. The eccentric calf exercises kind of worked, but using the seated calf machine at the gym worked very well. I would give that a try.

I've had insertional achilles tendinosis for several years now, and actually had a PRP injection at the insertion point recently. I'm in a boot for a few weeks and wanted to see if anyone else has had a PRP injection done for insertional achilles tendinosis, and also what kind of rehab you did following it (eccentric raises and otherwise).

Thanks for any and all help.

What is a PRP injection?

hmmmmmm wrote:

What is a PRP injection?

The doctor drew a sample of my blood, spun it in a centrifuge and separated out a platelet rich plasma (PRP). He then injected that plasma in and around the insertion point of my achilles.

I'm interested in starting one of these eccentric training programs to see if it helps with my current achillies problem, but I can't seem to see anywhere where someone has mentioned what these eccentric exercises are?

Could someone give me more details on the different exercises involved and possibly direct me to a training/exercise program?

Thanks!

I've had good luck with a combination of eccentric heel drops and strengthening of the tibialis anterior.

The latter seems to address a bad strength imbalance I have between the plantarflexors and dorsiflexors. I use a tib machine when available, but manually assisted repetitive dorsiflexion while seated seems to work too (a PT prescribed the last).

What is a manually assisted repetitive dorsiflexion? How do I do it?

coffee wrote:

What is a manually assisted repetitive dorsiflexion? How do I do it?

By that I just mean:

1) While sitting on the floor with one knee drawn up to your chest, dorsiflex that foot as far as possible.

2) At the point where you can dorsiflex the foot no further just by contracting the tibialis anterior, place your fingers under the ball of the foot and gently assist the foot in dorsiflexing as far as it can. Continue to contract tibialis anterior maximally, though; just use your hands to assist. Hold the foot in the maximally dorsiflexed position for 10 seconds.

3) Repeat above 5 times for that foot.

4) Repeat above 5 times for the other foot.

5) Repeat again 5 times for the first foot

6) Repeat again 5 times for other foot.

You might be surprised how fatigued this makes your tibs get if they're weak. My whole leg begins to shake after a while.

I noticed that as my tibs get stronger, my forefoot doesn't slap the ground as hard when I'm running. My foot plant is gentler.

Good luck.

Would it be good to do this using a thera band?

Has anyone had any success with a Strassburg sock?

Wogger, how did things go with the PRP? I am looking at having this done. How long after the injections can you begin to run?

I'm still in a walking boot, but begin PT next week. I believe that my time in the boot has been much longer than what's usually prescribed for PRP injections, but since I've had achilles problems for so long, my doc decided to go conservative with things.

I don't have any pain walking around in the boot, but even the small amount of poking around that I've down on my heel has been pretty painful. We'll see how PT goes...

I'm mostly pain free, I just can't get over that hump to pain free running. It's been months. My Dr says two weeks from injection time to start running, but I'm skeptical. After PRP how did the tendon feel just walking around in the boot? Painful to stretch?

Does anyone do these right away in the morning? They seem extra painful then, but I have to get them in before work if I'm going to do them 2x day. They are pain free for the most part in the afternoon for me, but painful right away in the morning. Think this routine is ok?

Could stuff like eccentric single leg squats/hamstrings do the same thing for gluteal tendinopathy?

ScriptedConnection wrote:

Could stuff like eccentric single leg squats/hamstrings do the same thing for gluteal tendinopathy?

Yes, but you need to be very careful that the motion you focus on is actually eccentric. You would need to know the specific repetitive motion that caused injury in your specific glute before you can isolate the reverse motion for that exact glute. If you aren't 100% confident you have isolated the correct things to do in reverse motions, then you risk further injury.

Shoebacca wrote:

ScriptedConnection wrote:

Could stuff like eccentric single leg squats/hamstrings do the same thing for gluteal tendinopathy?

Yes, but you need to be very careful that the motion you focus on is actually eccentric. You would need to know the specific repetitive motion that caused injury in your specific glute before you can isolate the reverse motion for that exact glute. If you aren't 100% confident you have isolated the correct things to do in reverse motions, then you risk further injury.

Also, keep in mind that the current research on this only "suggests" this may be an effective treatment path. It certainly is far from "proven" to any degree at this point. There is enough research suggesting it may work combined with a relatively low risk of it causing harm that it is a reasonable path to follow, but it certainly isn't clear yet that it absolutely is effective.