Achilles Tendinitis

Experience From - Jeff Wold , Jay Hodde#1 , Cary ? , Karl King , Dale Perry , Dan T. , Tom Duket#1 , Jay Hodde , Tom Duket#2 , Rich Schick , Daniel Temianka , Grant Hickey , Rick , Ray Krolewicz , Alex Feldman ,

Dale Perry wrote:

"Does anyone have any treatment for Achilles Tendinitis?"

There were two "breakthroughs" in my recovery.

1. I stopped icing and ibuprofen, and applied a heat pad a couple of times a day. This helped, but the pain still lingered.

2. Around late February, I followed Karl's advice and took the following supplements: L-lysine, L-glycine, and glucosamine sulfate. I also added a couple of my own, L-carnatine and vitamin E. Within a month I was back to nearly perfect. Now I have no pain at all, and consider it healed.

Again, this worked for me, might not for you. yada yada yada.

Dale asks: "Does anyone have any treatment for Achilles Tendinitis?" Dale, it's been a week now. Minor cases can be a lot better by this point, and judging by your ability to run a little, you are probably in this group. Don't overdo it.

This is what I would try.

First, I believe the optimal window for Non Steroidal Anti Inflammatory Drug (NSAID) use is over, so I would attempt to cut out the ibuprofen. Sure, you deaden the pain and help the swelling on the drug, but you also impede the healing.

Second, after allowing 24 hours for the ibuprofen to wear off, I would only run as much as you can do without pain. Stop immediately at the first twinge of pain. I would also consider alternative forms of exercise at this point, such as swimming, some gentle cycling, some Stairmaster, etc. The tendon needs relative rest. Very gentle stretching is also indicated, though as Karl mentioned, too much or too aggressive a stretch can actually worsen the situation.

Third, give your body the proper nutrition it needs to heal. I would suggest adding extra milk to your diet (especially before bed), and supplementing with lysine, glycine, and vitamins C & E. I didn't think that this worked until I tried it and found out how much faster I recovered from long runs as a result.

Fourth, don't push the recovery. Scientific studies have suggested that you lose very little endurance even with a 3 week layoff from running. If you can find a non-weight bearing exercise, try it until Ice Age time.

"I'm a little concerned as I am planning on doing Ice Age in a few weeks. Should I just put in some low miles between now and then?"

Definitely do low mileage, and I would tend to stay off the trails, too. Not good Ice Age training, but the tendon needs the time to heal before you stress it on tough trails.

"Should I stay off it for more than a week? Will I lose anything by staying off it during this time frame. I plan on continuing the ice, meds, and stretching regimens, but not sure about the running part.

See what I said above. The more rest, the better, and you stand to lose little in terms of aerobic fitness as a result.

Hope this helps.

Remember, this advise should not substitute for that obtained by your personal health care provider

Jay gave good advice. Watch the stretching, unless you use something like a Prostretch, as it is easy to over do it, as it is already injured. I'd try running of SOFT surfaces, like grass. NO or very little speed work. Try a self massage with your thumbs to get the circulation going. Oh, and what most of us lack in our training, besides speed, is WALKING. Its non-impact, and it works. One last issue, I had success with heel cups (lifts) to get me through, it really took the stress off. Or just cut the heel portion of an old pair of shoe inserts and add then on top of your current inserts. And lastly, on that topic, is it time for a new pair of shoes?

The first thing I'd do is stop stretching that area. The weakest link in the chain is trying to heal, but the fibers can't re-connect and knit together if you keep pulling at them.

The chain is bone 1 - tendon 1 - muscle - tendon 2 - bone 2.

Assume that the soreness is in tendon 2. You can take the chain out of tension by massaging from the tendon 1 end of the muscle toward, but not over, tendon 2.

Be sure to ice just before you go to bed. After icing, put on a sock which will cover the sore area so that it will stay warm ( better blood flow ) while you sleep.

You can keep in shape for your upcoming run by substituting deep-water pool running for running on the roads or trails. Put on a personal flotation device, get into water deep enough so that your feet don't touch bottom, and go through your normal running motion, including the arm swing. 45 minutes should be enough to exercise you. It feels ridiculously easy while you're doing it but when you get out of the water you'll be surprised how tired your legs feel.

If you don't have access to a pool and must run on a surface, warm up the area before running to increase the flexibility of the connective tissue. DO NOT run on up hills ( think about how flexing the toes up stretches the muscles and tendons on the back of the leg ), and run very gently no matter how good it feels. It is only two weeks to Ice Age so you should be tapering markedly now anyway. After 25 miles at Collegiate Peaks, you have all the endurance work you need. Now you only need to run a bit to keep your aerobic enzymes topped off. Back off the non-steroidal anti-inflammatory unless the area is really sore.

If you're taking care of it, don't worry - the stress would slow healing. Relax and think of all those oxygen molecules waiting for you at only 800' elevation on the Ice Age course.

The above are only my opinions, not professional medical advice.

Just wanted to thank everyone who responded back to me on and offline regarding my recent bout with AT.

Everyone had good info to pass along, and turns out I was doing all the right things (with the exception of stretching - shouldn't do that) from the beginning which helped prevent this from getting too far out of hand.

Turns out it is a very mild case of it, isolated on the outward side of the tendon. My doctor (who knows about the needs of ultra runners) gave me some heel lifts. I already feel the difference. Based on his advice, I plan on running a very easy and slow 3 miles on a locally groomed trail today and Thursday. I'm also supplementing this with some cross-training at the local gym (cycling, weights). He wants me to run a easy 5 miler on Sunday and/or Monday. If it is ok (no or very little pain) then I should be okay for Ice Age. I doubt if I will blister the course. I just want to finish it in one piece and relatively pain free.

Again, thanks for all your words of encouragement and remedies. It really meant a lot to me.

For those suffering from Achilles tendonitis (as I do), be advised that there has been a major development in treatment. (See disclaimers below.*)

In a recent issue of the American Journal of Sports Medicine (vol. 26 no. 3, pgs. 360 - 366), clinicians at the University Hospital of Northern Sweden reported their study of "Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendonitis." I urge you to get it via MedLine or from a medical library if you possibly can.

A series of 15 middle-aged recreational runners were treated with an amazingly simple method: stand on a step or ledge on the balls of your feet. Rise up on your GOOD leg, transfer your weight to the AFFECTED leg with ankle fully flexed downward (plantar flexion), and descend all the way down (to maximum dorsiflexion). Repeat 15 times (one set), and do 3 such sets twice a day. Also do these sets beginning with the knee of the affected leg partially bent, rather than extended (straight); this works the soleus muscle. Later on you can add weight, in the form of a backpack or weight machine on the shoulders, to increase the strengthening effect.

All 15 participants in this study had excellent results. I have had Achilles tendonitis for many years, worse this year since I increased my running mileage. But since I began doing these exercises I have had a marked reduction in pain and morning stiffness, and have even noted some increase in speed on training runs.

It's exciting to find good science -- a controlled, prospective study by reputable people -- that really works, and costs nothing!

DISCLAIMERS: I have no financial interest whatsoever in this matter. The information paraphrased above is in the public domain (published in a peer-reviewed academic journal). I am not giving medical advice. Consult your health care provider and obtain an accurate diagnosis before initiating any treatment program.

Mike Mahon wrote:

"I have a slight tear in my Achilles tendon that I recently injured in the Chicago Marathon. I am concerned about this injury plaguing me all winter and spring while I am training for Leadville. I have read some of the archived posts on Achilles tendonitis and I only have one or two questions. First, does Joint Fuel or a combination of amino acids really work? I am terribly skeptical of wonder pills (fear of snake oil, I guess). I really want to believe they will work and help me heal so I can continue training. Second, any other recommendations for injury prevention for this ankle?"

I don't know how bad your tendon is. Mine had a lump in the middle and hurt to pinch, even lightly. For my level of injury I advise warmth and Aleve before slow running and ice till you can't feel your heels after. There's a rule I haven't heard in awhile -- If it feels better after a few miles you can keep going. If it feels worse after a few miles, stop.

Tom said:

"Aleve before slow running and ice till you can't feel your heels after. There's a rule I haven't heard in awhile -- If it feels better after a few miles you can keep going. If it feels worse after a few miles, stop."

Achilles tendinitis can be one of the more difficult injuries to recover from. If it's severe, broken bones will heal much faster than the tendon will.

The reason runners get sidelined for long periods of time with Achilles tendinitis is because they try to run through the injury. In the clinic when people ask how long it will take for complete recovery, I offer this guideline:

Allow 2 days for every day following the injury that you did not seek medical attention. That scares the hell out of them, because many Achilles tendinitis cases we see have been self-treated unsuccessfully (because the runner continues to run, even at a reduced level) and have become chronic problems. It is much easier to recover from an injury that just happened than if you wait and try to run through it. Especially in the case of Achilles tendinitis.

Aleve blocks pain sensation. Running with Achilles tendinitis while taking Aleve is just asking for a more severe injury. Of course, its going to feel better after a few miles -- the drug has deadened the pain.

I'll stop now. The original question asked about Leadville training over the winter. If you take complete rest now and get over the tendinitis, you will have plenty of time to train for Leadville after the first of the year. If you keep training now, you risk being hindered next spring.

This advice is not meant to replace the advice of your personal physician and is intended for discussion purposes only.

After my Achilles tendinitis at the 1996 Ice Age, I didn't run a step for 5 weeks.

Jay, I should say that when I had my Achilles problems Aleve didn't exist. I didn't take anything religiously but if I took anything, it was aspirin. I heard stories about calf muscles rolling up in a ball and I saw people in casts after reattachment operations, but for me taking it easy and continuing to move seemed to help. I recommended Alive because that's what I use now to reduce inflammation.

I agree that knowing when you are hurting is real important. Maybe the increased use of pain killers is why I haven't heard that old saying in awhile! Is there a better over the counter drug or homeopathic that increases blood flow without killing pain? I seem to be getting over a joint and tendon problem I can't spell. I started taking glutamine and glucosimine? Opinions?

I have been following this thread with some interest and have found it quite interesting that all the advice offered has been good. Huh? How could that be as there has been so much divergence?

The answer is that a lot depends on the seriousness of the individuals own problem. Treatment can go all the way from a little ice, pain relievers and avoid hard workouts to the need for a cast - all a matter of severity.

A few guidelines. Grasp the Achilles tendon between thumb and forefinger, apply about a pound of pressure and flex and extend the ankle. If you feel a bubbly or grating sensation all bets are off you need complete rest, prescription strength NSAIDS +\ - immobilization etc. i.e. time to see a sports oriented MD. If not ice OTC, such as Aleve or Advil and as one lister mentioned you try easy running, it warms up i.e. hurts less as you run, your probably OK. However common sense would dictate if it doesn't get better, or worsens in any way then some rest is in order.

Again NOT ment as medical advice, just my opinion.

A formal pain scale follows, pain of (4) or above mandates rest for most injuries, pain at (6) or above, the prudint would consult an MD. This advice is not limited to Achilles problem, applies equally well to virtually all other injuries.

Phase 1. Stiffness or mild soreness after activity. Pain is usually gone within 24 hours.

Phase 2. Stiffness or mild soreness before activity that is relieved by warm-up. Symptoms are not present during activity, but return afterward, lasting up to 48 hours.

Phase 3. Stiffness or mild soreness before specific sport or occupational activity. Pain is partially relieved by warm-up. It is minimally present during activity, but does not cause the athlete to alter activity.

Phase 4. Similar to phase 3 pain but more intense, causing the athlete to alter performance of the activity. Mild pain occurs with activities of daily living, but does not cause a major change in them.

Phase 5. Significant (moderate or greater) pain before, during, and after activity, causing alteration of activity. Pain occurs with activities of daily living, but does not cause a major change in them.

Phase 6. Phase 5 pain that persists even with complete rest. Pain disrupts simple activities of daily living and prohibits doing household chores.

Phase 7. Phase 6 pain that also disrupts sleep consistently. Pain is aching in nature and intensifies with activity.

For those suffering from Achilles tendonitis (as I do), be advised that there has been a major development in treatment. (See disclaimers below.*) In a recent issue of the American Journal of Sports Medicine (vol. 26 no. 3, pgs. 360 - 366), clinicians at the University Hospital of Northern Sweden reported their study of "Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendonitis." I urge you to get it via MedLine or from a medical library if you possibly can.

A series of 15 middle-aged recreational runners were treated with an amazingly simple method: stand on a step or ledge on the balls of your feet. Rise up on your GOOD leg, transfer your weight to the AFFECTED leg with ankle fully flexed downward (plantar flexion), and descend all the way down (to maximum dorsiflexion). Repeat 15 times (one set), and do 3 such sets twice a day. Also do these sets beginning with the knee of the affected leg partially bent, rather than extended (straight); this works the soleus muscle. Later on you can add weight, in the form of a backpack overweight machine on the shoulders, to increase the strengthening effect. All 15 participants in this study had excellent results. I have had Achilles tendinosis for many years, worse this year since I increased my running mileage. But since I began doing these exercises I have had a marked reduction in pain and morning stiffness, and have even noted some increase in speed on training runs.

It's exciting to find good science -- a controlled, prospective study by reputable people -- that really works, and costs nothing!

*DISCLAIMERS: I have no financial interest whatsoever in this matter. The information paraphrased above is in the public domain (published in a peer-reviewed academic journal). I am not giving medical advice. Consult your health care provider and obtain an accurate diagnosis before initiating any treatment program.

I just wanted to say I go to the chiropractor about once a month to get my feet adjusted. It seem that my talus get locked which inhibits the dorsiflexion of my feet. I also seem to have problems with my heels becoming locked. Could it be that since after rest your injury is no better then something is causing your tendon to be stretched more than usual.

Rock Cogar wrote:

"My left Achilles tendon hurts at least a little after every run. Runs that are long (20-50 mi) or fast are most likely to cause trouble. Some stretching, ice and asper-creme (trolamine salicylate) seem to help. Sometimes runs of 40-100 miles that end in long downhills cause the pain to be absent for weeks or even a few months. Not running for a week at a time causes no healing, it always hurts after the first run back !

This condition has been pretty much unchanged since I started running 8 years ago, but I am worried that I might be causing long term damage to the tendon.

My question is: Is there any way to cure Achilles tendonitis for a really long time ?"

However, I have not had a chronic problem with anything, just transients as I increase speed or distance or do something mindless like look at the scenery instead of the trail.

Daniel, et. al. Thank you for pointing out a good idea. 20 years ago one of the magazines had almost the same procedure as a "stretch" I have been using it as a preventative measure since then, no wonder I have been so healthy, science finally backs me up.

I tried this technique last year, and while it may have helped the tendonitis, it also may be what caused my plantar fasciitis. The PF is proving very stubborn, and painful. If I had it to do over again, I would substitute stretching for some of the eccentric exercises.