Is there a cure for achilles tendinopathy?

Correction: tendinosis not tendonitis.

Very poor advice from your doctors. Tendons don’t respond to rest. You need to be doing heavy resistance strength training to build up the capacity of the tendon 3x week. Single leg heel raises and seated calf press to engage the soleus more. 3 sets starting at 12 rep max and over about 6-8 weeks progressing to a weight of 6 rep max. Frustrating injury but can be fixed with the appropriate management plan. All other treatments are a waste of time

Mine responded to rest. It was only when I rested that it started getting better. I had tried everything - including the heel raises which aggravated the heck out of it. I tried calf presses, other exercises in the gym. People are different. I had achilles tendonitis so this may be different and I'm certainly not giving advice but one thing I will say is for me, I was initially told not to rest, to go on walks, to do the exercises and it progressively got worse and I could not walk without pain. When I stopped all of that it started to get better. I was also advised by someone who was doing a PhD studying achilles injuries and he gave me the above advice I followed which did nothing but make it worse. Thankfully I finally said enough and just stopped... and that is when it started to heal.

Keeping it warm made a big difference too.

Not wearing socks that are tight around that area.

I am just posting this to say everyone is individual and there may not be a one size fits all.

Good luck.

I had similar issues. I started a regimen of eccentric calf raises which was a huge help. Raise up on toes of both feet then slowly down on one foot. Repeat for both feet. As it gets stronger do them on the edge of stairs so the heel can drop lower.

The other thing to explore is a technique called 'tendon scraping'. It sounds worse than it is, but it separates a lot of the scar tissue increasing blood flow which is notoriously poor in the achilles. It's a procedure you can run after immediately.

Of course, I'm not a doctor so you should consult with someone who is. A good PT can help with the eccentric excercises and you'll need to google for a local doctor who can do the second.

If it’s a tendon sheath injury (tenosynovitis) it will respond to rest but if it is a tendonopathy then rest will not fix the issue. Think of your tendon like a doughnut. The hole in the doughnut is your affected part of the tendon. The filling part of the doughnut is the healthy part. Heavy resistance training causes increases in sizes of the healthy tendon while the hole (affected part of the tendon) remains unchanged. If your tendon is strong enough it doesn’t matter if you have parts of an unhealthy tendon

If there's nothing mechanically wrong with the Achilles, you could ask about sclerosing injections. As I understand it, sometimes nerves grow into the tendon in tendinitis, which causes pain long after the damage is healed. This is NOT the same thing as a cortisone shot.

Also, Ciaran O'Lionaird described similar Achilles issues on a podcast. After years of trying everything else, his surgeon finally found some kind of anatomical issue that was causing his pain. I think it was the Citius Mag podcast if you want to listen.

Yes, I had the scraping done for many months to no avail. And the eccentric calf work was also a big part of the regimen. I still do those to help get warmed up, but it hasn't helped with the long term pain/symptoms.

It's strange how warming up hurts, but eventually once the achilles is sufficiently warmed up or has enough blood flow or whatever then things feel ok. I can even sprint decently once warmed up. Although, I think from all these years of altering my running form due to the achilles issue, I've kind of changed my running form slightly. My acceleration and explosiveness is not anywhere near where it used to be. I know a little of that is from getting older, but not all of it.

tendon wrote:

Very poor advice from your doctors. Tendons don’t respond to rest. You need to be doing heavy resistance strength training to build up the capacity of the tendon 3x week. Single leg heel raises and seated calf press to engage the soleus more. 3 sets starting at 12 rep max and over about 6-8 weeks progressing to a weight of 6 rep max. Frustrating injury but can be fixed with the appropriate management plan. All other treatments are a waste of time

Thanks.

I have done some heavy lifting over the years, although not as consistently as I should. I need to get some equipment at my house .

When I was lifting heavy, I was doing quite a bit of deadlifting, some calf work, squats, etc. I was focused on 4-6 max rep range, multiple sets.

Not exactly sure if it helped much......but that could have been due to the fact that I haven't lifted heavy for more than 3 or 4 months out of the year.

My daughter had a stubborn case.

Number one solution was eccentric weighted calf raises. Slowly, add on weight and range gradually. Control.

Get massages on soleus.

Wing and sickle. Theraband.

Releves on one foot. Fingertips to help with balance. Hold position for a bit and then down.

Ho Hum wrote:

If there's nothing mechanically wrong with the Achilles, you could ask about sclerosing injections. As I understand it, sometimes nerves grow into the tendon in tendinitis, which causes pain long after the damage is healed. This is NOT the same thing as a cortisone shot.

Also, Ciaran O'Lionaird described similar Achilles issues on a podcast. After years of trying everything else, his surgeon finally found some kind of anatomical issue that was causing his pain. I think it was the Citius Mag podcast if you want to listen.

This is a great lead. I will see if I can ask Ciaran directly, and also listen to the podcast. Thank you

tendon wrote:

If it’s a tendon sheath injury (tenosynovitis) it will respond to rest but if it is a tendonopathy then rest will not fix the issue. Think of your tendon like a doughnut. The hole in the doughnut is your affected part of the tendon. The filling part of the doughnut is the healthy part. Heavy resistance training causes increases in sizes of the healthy tendon while the hole (affected part of the tendon) remains unchanged. If your tendon is strong enough it doesn’t matter if you have parts of an unhealthy tendon

That is interesting; maybe mine was misdiagnosed and it really was tenosynovitis.

I hope the OP gets some relief. It is horrible to have it affecting your quality of life alongside running. I was in that boat too. Good luck OP.

tendon wrote:

If it’s a tendon sheath injury (tenosynovitis) it will respond to rest but if it is a tendonopathy then rest will not fix the issue. Think of your tendon like a doughnut. The hole in the doughnut is your affected part of the tendon. The filling part of the doughnut is the healthy part. Heavy resistance training causes increases in sizes of the healthy tendon while the hole (affected part of the tendon) remains unchanged. If your tendon is strong enough it doesn’t matter if you have parts of an unhealthy tendon

Thanks, I will dig more into the diagnostics between the two issues. That's part of the problem -- I haven't ever been given a specific diagnosis despite the imaging and years of treatment and dr visits.

I know nothing about this.

However, as a coach I read about training and injuries all I can.

There have been several sources that claim running/jogging/walking stadium steps help a lot. It seems counter-intuative but they claim it takes pressure off the achilles and onto the calves which haven't been doing their job, thus the achilles pain.

It might be worth a search if not having luck elsewhere.

This sounds horrible and I'm sorry to hear you have had to deal with it for so long.

I recommend going back to the heavy lifting you have done before. I have been told that building strength takes a LONG time - you would need to do (very boring) calf raises with weights for at least 6 months when it's chronic like yours to see major improvement. And then basically continue with maintenance 3 x week pretty much forever! I know that's probably not what you want to hear...but there is a fair amount of reliable literature proving the effectiveness of heaving weights.

I have had persistent tight calf muscles, especially soleus and therefore Achilles issues (not as bad as yours) and it's a constant self-management issue because I also lose motivation with the exercises. But generally I don't go a few weeks without doing them at all and it keeps the problems just about at bay. Very difficult to add speed and things without flare ups.

Check out this physio who specialises in achilles issues

https://www.pogophysio.com.au/blog/the-3-key-stages-for-achilles-tendinopathy-exercises/

Note - he says as a runner (given how much weight the calf muscles take with each step) should build the weight for straight leg raises up to 0.4 x bodyweight and for soleus bent leg raises 1.5 x bodyweight (use smith rack) !!!!

Based on your description there's a decent chance the problem is NOT with the achilles (but pain is referring to that area). This is why scans and diagnostics are not showing an achilles problem. You probably have a series of overtightened muscle trigger points in your lower half, and your form and/or biomechanics (common cause is weak glutes that cause an over-reliance on calves during push-off) are exacerbating the issue.

Check out "the trigger point therapy workbook" and consider doing glute and hip strength training (weighted squats are a good one).

I struggled with similar issues for almost 10 years, saw all the best doctors, etc. Went through the above and became (and continue to be) pain free after a few weeks.

lamergamers wrote:

Based on your description there's a decent chance the problem is NOT with the achilles (but pain is referring to that area). This is why scans and diagnostics are not showing an achilles problem. You probably have a series of overtightened muscle trigger points in your lower half, and your form and/or biomechanics (common cause is weak glutes that cause an over-reliance on calves during push-off) are exacerbating the issue.

Check out "the trigger point therapy workbook" and consider doing glute and hip strength training (weighted squats are a good one).

I struggled with similar issues for almost 10 years, saw all the best doctors, etc. Went through the above and became (and continue to be) pain free after a few weeks.

This is intriguing to me, but could I really have weak glutes? I was a sprinter in college and am fairly strong for my age and size. One of the reasons I haven't done strength training year round is because I've been told by some reputable coaches that it's not very necessary for me. I'm not dismissing you at all, I'm just wondering out loud I guess.

At 150 lbs I can squat 300+ lbs and deadlift more than that. I know that's not intimidating, but my point is just that I'm not weak muscularly. I suppose it's possible that my glutes are weak in relation to my calves. I have a sprinter's butt, so unless my muscles are misfiring it wouldn't make sense.

Also, I can still sprint pretty well. Each year since turning 40 I've been able to run a 50 or 51 second 400. Can that happen with weak glutes?

Another point, the PT spent a lot of time trying to "activate" my glutes because she wondered the same. I doubted at the time it was the issue.

NITRIC OXIDE PATCHES will increase the vascularity of the area and may help with healing.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658939/

Br J Sports Med. 2007 Apr; 41(4): 227–231.

doi: 10.1136/bjsm.2006.034447

PMCID: PMC2658939

PMID: 17289859

Using nitric oxide to treat tendinopathy

George A C Murrell

Yes, possibly right. and as the following poster pointed out, it could be weak glutes.

I'm not sure if it's lack of strength, but it wouldn't hurt (hopefully) to stick with strength training year round.

I mean, it's a crunch on time, and I've been told strength is not a limiting factor for me and I have other weaknesses I should prioritize first (endurance), but if you want to be good you just find a way to make it happen, right?

Ok, thanks for the advice.

Much appreciated from everyone.