Achilles problems, seek expert opinion

Thank God I never had one of these! My friend is 33 and he had one but he went to the pool for some time and he was ok! Everyone is different! We all heal at different times also! If you love running just be patient and wait for it to heal. It will take longer that you would like it so just hang tight! I have to be patient myself I pulled my ham last month I ran 5 times since then really easy and short! 4 miles has been my longest run! Never rush a injury!

BE PATIENT! BE PATIENT! BE PATIENT!

I had this same problem. The only chronic injury I've ever had in 20 years of running. It went on and on for 2.5 years. I'd rest for a week and then run for 2 days when the pain would return. Then I'd rest for 2 weeks and it might return on the third day of running. Grrr.

First off, how did you get this in the first place? I'm assuming it was one-time trauma/overtraining related and not some chronic biomechanical defect. If it's biomechanical (i.e. systemic) true then nothing I say here is likely to help yo much. I got my achilles injury by not resting after a long hard race when I wasn't in very good shape. I went out and trained hard the next day. And the next. And what started off as a sore calf slowly turned into a chronic achilles problem.

I don't know if this will help you, but here's what I did to finally solve it.

First I took about 8 weeks completely off from running. I can see you've done that previously but now that it is aggravated, you might need to do it again to get yourself back to the right point. The best way for me to tell when I was ready to run was the poke test:

When my achilles was injured, there was a place on the tendon that hurt acutely when I poked (or pinched) it from the side with my finger. I rested until there was not even a HINT of that pain. For me, this took 8 weeks. Oddly enough, 5 weeks into the rest it hurt more than when I started resting. But by 8 weeks, the pain was gone completely. The toughest part was making myself wait for that last week when it didn't hurt at all -- just to be sure.

Once it was healed, I (of course) need to do some serious calf/achilles stretching before every run. But I found that even before stretching - before every run, it helped immensely to soak my achilles in a bucket of very warm (almost hot) water for about 10-20 minutes. This got the blood rushing in there and made the stretching work a lot better. Do this before running. Do it after running. Hell, do it when you're just lying around, watching TV or resting. It really helps to get that blood in there. Even during the time you take off.

As for the stretching, the only stretch that really does the trick for me is the curb stretch, where you lower your heel below the level of the curb. Anything else (e.g. foot flat on the ground and leaning forward) just doesn't cut it.

And even now, on almost every run, I need to stop at around once or twice early on and stretch my achille some more. I particularly need to do an ankle rotation -- where you just lift your leg and rotate your ankle joint several times. This stretches the achilles in all directions.

Some people will contradict me on this, but I wouldn't bother with anti-inflammatories of any kind. Inflammation is there for a reason -- your body is injured. I found that for me it did nothing but mask the injury.

After all of this, I am able to do over 100 miles a week. My achilles still bothers me from time to time. About once a month I am forced to take a day off to keep it from getting injured again. And it almost always twinges a little at the start of my runs (especially morning runs). But I can run again and that's what matters.

Hope you get something useful out of this.

I agree with Average_Joe on this one. I've had the same injury and was forced to take a long time off (5 to 7 wks) and tape the arches of my feet to keep the arch in place.

With a ton of stretching, as mentioned above, (the curb stretch really works!!!) I was able to get moving again.

I was 70miles/wk before the injury and was able to get back there eventually. Patience is a virtue on this particular injury.

The only variation upon Average_Joe's post that I would suggest is to alternate ice and heat onto the affected area post-workout only. Before workout....stretch and warm up that tendon/muscle area extriemly well.

Good luck.

Vioxx has been the cure of all my running pains

But I play one on Letsrun

The link includes the exercises that worked for me... I had a minor problem that cleared up with the exercises.

DougC wrote:

The link includes the exercises that worked for me... I had a minor problem that cleared up with the exercises.

That's got to be the best article on the subject I've ever read. I wish I'd had that about 4 years ago.

Thanks for the pointers, everyone. Unfortunately, I've been through the PPOnline exercies - that was last year's effort (I even did the leg raise type thingies wearing a backpack weighing over 75lbs - 50% of my weight). I did these during the 3 months I took off completely. Sadly, they did not help, as I was reinjured again within months.

Patience is a virtue.....initial injury date was April, 2001, so well over a year now. Joe, I don't know how you stayed with it for 2.5 years.

Tex

Tex wrote:

Patience is a virtue.....initial injury date was April, 2001, so well over a year now. Joe, I don't know how you stayed with it for 2.5 years.

Tex

The first year, I didn't pay too much attention to it -- I just assumed that it was just going to heal "real soon now". Until then, I'd never had any injury that I wasn't eventually able to run through. The next year and half was the frustrating part. And then having to wait for 8 weeks after all of that was the worst.

The trick is to take the long view. Once I did that I realized how silly it was for me to think "I'll give up running". I really was about to do just that. When I decided to take the 8 weeks off I said to myself, "If this doesn't work, I guess I'll have to quit running."

But during those 8 weeks it occurred to me: Suppose I did "give up running." Well without all that pounding, then 2 or 3 or maybe 12 months down the line my achilles was eventually going to heal all the way. Whether I wanted it to or not. And there I would be, without any pain, seeing people I know run go out running the time. I would miss it terribly. Of *course* I was going to start running again. It was inevitable.

My point is you really don't need some sort of "final decision" on the matter. I had run for many years so I KNEW that my body could handle the stresses of it once it was healed properly. And you've run for a few so yours probably can too.

You just need a little Zen, I guess. Not that I know what Zen is...

everybody else wrote so damn much that i didn't finish it all. i just wanted to tell Tex what worked for me. i just suffered through intense ice massages and scrapping devices applied directly to the achillies. this was always preceded by hot tub and light stretching...but it worked.

you've probably done that already though, it's the first thing i did.

Patience,

I agree with average on this one. Patience.

I've basically missed the entire last year due to my own achilles problem. Since last Oct.

I've tried everything so far - those PPO exercises, podiatrits, hartmann in ireland, rest etc.

I now starting week 6 of at least 6 weeks of now running (maybe 8). I basically took 3 months off (oct. -January) when it first started but it wasn't complete rest. I'd take 3 weeks off and then test it, take 3 weeeks off. The pain only went away when I didn't do those PPO drills (which i actually do now). I started running and the pain came back. However, I was running about 45 miles a week in pain from Feb-May. I saw Hartmann in Ireland, nothing better.

The most recent developmetn is that they can do surgery where they scrape the scar tissue off. I talked to a friend of mine who 'retired' from running and didn't do a track workout in 2 years. She 'unretired' or tried to this spring and her achilles was killing her on her veyr first workout. SO i figured, heck, it can be so bad that nothing will help it but surgery.

The scraping surgery supposedly is very minor (but expensive). Howver, my guy won't touch me unless I take at least 6 weeks off. Which I'm doing now.

The pain is totally gone so i'm hopefully that with some more rest I'll be fine. Maybe I won't need it. I never did give it tons of time off before as I was impatient (naturally). I mean the first week I missed drove me nuts. Now i'm so frustrated, i really don't care.

We'll see. I had no pain before for a short while and it came back when i started running a lot so we'll see.

PATIENCE, patience, patience, patience and then retire or surgery.

One more thing. The guy who may do my surgery if I need it has written the following about tendinits.

He's operated on more sub 4 milers than anyone in the world.

http://www.straws.com/s_achil.htm

He's also done 65 surgeries on the achilles according to his website and has a 90% success rate. Details can be found here:

http://www.straws.com/sax4feet.htm

After my 6 weeks off, he has told me to "Go ahead & start jogging 15-20 min everyother day for a couple of times & then increase by 10-15 min. everyother time you run. Don't let up w the stretching, strengthening & icing. Try to stay on level dirt. If it gets worse as you run over the next 2-4 wks then I would consider surgery, which would allow you to run in 3 wks."

Do calcifications of the achilles area show up on x-rays? I've had ultrasound to break up scar tissue, as well as having a thin metal tool run up and down the achilles to break up scar tissue. X-rays showed nothing. The papers at the site you mentioned are interesting - albeit a little too technical for me to understand completely.

I'd be pretty hesitant to undergo surgery. I love to run, but I'm far from an elite athlete. Even if I run today, and am limping tomorrow, I will be able to walk normally within a few days (though I still can't run). Surgery seems so risky, even if there is a 90% success rate. My nightmare would be a reduction in mobility, which might hinder other things I do (swimming, cylcing, hiking, etc). Is it worth the risk?

Your post does present some new information that I can arm myself with, if what we're doing now doesn't work. Most of the rest of this thread I've been through, with no results. I'm hoping that what my PT is saying is correct - that I have a muscle imbalance that is messing up my gait. We'll see, in time.

Tex

I just finished reading Marty Liquori's book "Real Running". In it he claims that the higher, built up heels or modern running shoes have caused an outbreak of achilles problems. In my case, I am much more comfortable in a racing flat type shoe (Tiger Paw or Wave Spacer) which does not have a high heel. What do you guys think about this theory? Nike and New Balance seem to have very substantial heels, whereas Adidas and Asics (in general) have less... Any thoughts?

Hi Doug,

Just as an example, I wore the Nike Structure Triax for 3-4 years prior to my injury (and was wearing the 2000 version when I had to stop running).

I'm now in the Adidas Supernova and haven't had any relief, as my previous posts indicate.

Tex

I never got an xray but nothing would show up there.

I got an MRI and the first guy said it didn't show anything but Dr. Saxena said it did show symptoms consistent with paratendonosis.

Basically, behind the achilles it was all very white when it shouldn't have been.

-Robert

PS. I don't necessarily think it was the shoes. The supernova is a great show. That being said, one doctor did tell me that i probably should wear a little more motion control shoe. For some people, it's the pronation that stresses the calf/achilles.

I had chronic tendonitis for years. I couldn't hardly walk in the morning. I finally had mine operated on. I had surgery on both back in 1986 and and one done again in 1994 and haven't had a problem since. I haved raced on it competitively and logged a lot of miles on them.

What had happened to me was scar tissue build-up which caused the tendon to stick to the sheath (sp?). The doctor released the tendon from the sheath in a 30 minute surgery. I was back running in 3 months, no pain.

I don't wear spikes any more and put a small lift in my training and racing flats. I make sure to keep my calves strong and stretch them after every workout.

It is obviously a last resort, but it worked.