Achilles Tendinosis - Am I done as a runner?

Check out jake tuura's youtube. He mostly deals with the patellar tendon but I believe much of what he covers is applicable to the achilles tendon. seems that the best way to start tendon recovery is heavily loading the tendon isometrically. eccentrics are good but the tendon needs to be loaded. Not sure how this would interact with your haglunds and everything else though. Good luck.

Have you tried doing calf raises (rather than just heel drops)? I haven't seen one exact rehab protocol described as the gold standard, but all the latest research I've read says the best approach is some kind of progressive rehab where you build up the strength of the calf and achilles over time with calf raises (starting with body weight and progressing to adding more weight in a backpack or smith machine). It seems like the thinking is if you're someone who's had achilles problems you're probably always going to susceptible to them, but you can still increase the strength of the calf/achilles so it can withstand the load you place it under when running. There are some researchers that are active on twitter and podcasts talking about their research, if you google Seth O'Neill I found interviews with him and his twitter feed helpful. Here are two articles I found helpful too: https://www.lasselempainen.fi/wp-content/uploads/2021/11/FC_BARCELONA_TENDON_GUIDE_2021-web.pdf

https://www.sciencedirect.com/science/article/pii/S1836955322000893

The last thing I'll add that seems to be consistent with my experience and the research is that just taking time off isn't likely to help things. It may be necessary at first to let the pain calm down, but then while you're taking time off your achilles is just getting weaker when really you need to work on making it stronger. And tendons get weaker very quickly but take a long time to get stronger, so you have to build up slowly when getting back into it.

This is solid advice.
I agree that you have to do more than just heel drops. Stack up a smith machine and do some isometric calf raises with some heavy (I’m talking +200lb) single leg calf raises (build up to it).

besides that I’d also look at your running program. Often times injuries occur when we load the tendon too much, too soon and/or too often. Take your easy days easy, and slowly build up into workouts/mileage. If the Achilles doesn’t hurt, that doesn’t mean you’ve got the green light to up the intensity.

lastly, I’d look at adding a 1/3-2/3 heel lifts into your running shoes. It takes stress of the Achilles (and places it on your knees). If your hips and quads are strong your knees should be able to take it.

Everyone and their mom knows eccentric calf raises.

I'd argue that they do not place *enough* stress on the achilles to prepare it for running. You're only moving your body weight. The amount of load the achilles receives while running is anywhere between 5x-11x your body weight per step.

https://journals.sagepub.com/doi/abs/10.1177/0363546515584760?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

Here's an interesting small study comparing both eccentric and heavy slow calf raises. Both worked, however the heavy slow calf raises had a higher satisfaction rate.

Here is an interesting study I found on twitter the other day. Different exercises and how much they load the achilles:

https://twitter.com/RodWhiteley/status/1585522129885429761/photo/2

Might help with exercise selection

If you were over 30y old the prognosis would be poorer. But with no major or complete tear, you likely have a chance, depending much on the quality of your coach and PT.

Have you tried loosening up the fascia? More than likely this issue, broadly speaking, is linked to either compartment pressure in the calf or scar tissue (fascia or muscle/ adhesions).

You also have nutrition contribution, glycation reaction (linked to blood sugar elevations and if applicable, alcohol use or possibly earl metabolic syndrome). Dehydration and inflammation due to diminished sleep quality, low nutrient density diet or animal foods all lined to chronic inflammation.

Stay away from low drop shoes. 8mm plus are your new friends, like forever.

could be a candidate for surgery, maybe a graft or whatever they do. I would figure that out sooner rather than later.

I am a top 10 age group competitor over age 70. I have been working around achilles tendinosis since my late 50s. I have calcium deposits in the lower tendon and bone growth at the attachment point that is not quite large enough to be defined as Haglund's. I have religiously been doing heel drops and calf raises since the problem started. I have managed to control the problem enough to keep running about 50 mpw. Each year I get a little closer to needing surgery to clean it up and correct it. At my age surgery is likely going to require closer to 12 months rehab than 6 months rehab.

Your physiology is not going to magically improve this condition over time. There are exercises and stretching you can do to minimize the problem, but ultimately it will require a surgical solution. You just have to decide when it affects your running too much to put off surgery.

I am very close to that point now.

Good luck with your decision.

I am recovering right now from my second achilles surgery for bone spurs/Haglands, this time on my right foot. Tried PT for 18months on the left foot, but it didn't get better so I eventually opted for surgery. Surgeon took the Achilles off, shaved the bone spurs/Haglands, then anchored the achilles back on. No weight for 5-6 weeks, light jogging at 3-4 months, then full strength in 9-10 months. The left one is perfect now, so when the right foot started hurting 6 years later I didn't even hesitate to get the surgery done on it. 6 weeks on crutches sucks but not being able to run sucks worse. Surgeon said it was inevitable for me - Haglands and high arches + exercise = achilles bone spur issues.

I am in my 50's so you may have a quicker recovery than I did if you opt to get surgery. It was well worth it.

Kind of curious what PT looked like?

I had a similar experience. Haglunds on both sides, had surgery when I could no longer manage the situation. but I’m old too so I wasn’t returning to anything close to “elite” running. In most surgeries only a portion of the Achilles is detached. if you’re lucky they can leave the sides anchored, this will speed recovery and outcome. it’s a tough balance, the longer you wait to have surgery likely the more extensive it will have to be. can they tell from the MRI how extensive the detachment has to be? good luck.

James Robinson recovered from an Achilles (non contact) in 8 months

Mine took about a year. From forefoot striking whilst barefoot.

Wear big heels and cushioned shoes. Keep running unless pain is bad. Midfoot strike.

You're an idiot

why?

In my mid 40s I picked up Achilles tendonosis/MRI confirmed, about 50% of the tendon was damaged/inflamed about 2.5" up from the heel

After about 3-4 yrs of mostly off/3-4 mpw I finally seem To tolerate 12 now or so w/o regression. No surgery, no treatments, but tried PT and eccentrics and heel drops and anything any of these threads crowd source recommend. Everything contraindicated and made it worse.

Queue 3-4 yrs of mostly off or around 3-4 now and fits and starts at coming back and finally I'm a typical hobby jogger. YMMV

Oh forgot to add, and this may just be coincidence, but I didn't truly start to recover until i strung a bunch of 20-25 mile day hikes together in a row, eg Yosemite high country, Whitney, JMT, Tahoe, etc

Early in my injury I day hiked halfdome and that sucked. I just wasn't ready injury wise, major inflammation and regression. Three years later, the hikes seemed to trigger a fix. Who knows

Sorry to hear about your Achilles tendon problems.

Here are some helpful resources:

clickphysiotherapy.com.au

Achilles tendon pain (tendinopathy) - Your ultimate guide for 2021

Check out this E-book covering everything you need to know about Achilles Tendon Pain. Anatomy, treatment, rehabilitation and even some secret content..

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clickphysiotherapy.com.au

Braces, night splints, walking boots for Achilles Tendonitis - do they work?

Click Physiotherapy

Braces for Achilles Tendonitis are a common prescription to help with pain, as are night splints and walking boots. Research suggests they..

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The only idiot here is you.