[enyfd]

Any one have any feedback on dealing with retrocalacneal bursitis ? (insertional achilles tendonitis) going on 8 weeks, MRI reveals mild retrocalacneal burstis.
It came on after a climbing trip, borrowed a pair of boots that were too small, I think that contributed to it, and all the rucking and step ups before hand.

its still lingering. have not run or done step ups etc since the injury. Just met with a sports podiatrist who said I have a high arch in the right foot which also contributed to it. Im icing, now have the night splint, doing calf stretches, etc. Padding out the heel to reduce friction and applying voltaern gel.
Just looking to see how anyone else may have made out with this injury
Thanks
Anthony

Topic

[saschroeder]

saschroeder on March 27, 2019 at 9:16 am #19174

I have battled Achilles tendon issues for years, including retrocalcaneal bursitis. It sounds like you’re case is relatively new and may be more easily fixed than mine was. One thing you might try, and that helped me for some time, is eccentric lowering exercises. These are very effective for Achilles tendon issues… particularly when they are in the body of the tendon, but also for insertional issues if done correctly. They are done by rising up on the balls of both feet then lowering down, slowly, on just the affected foot. (If both feet are affected do both… rise up on 2, lower slowly on 1.) The main difference for insertional issues is that you only lower your heel to a flat floor rather than standing on a step and lowering your heel below the step as for issues in the main body of the tendon. These are exercises a physical therapist could help you with.

Another thing you might check on is the presence of a Haglund’s deformity (identified by an x-ray). If this is present, you may have ongoing issues (as I did). If you have a Haglund’s deformity and months of PT/rest don’t help, and can provide additional advice.

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on March 28, 2019 at 10:27 am #19230

Tendon injury and recovery is a big topic and worthy of a longer post, but I’ll do a quick primer. The key is to improve the function of the tendon region that is still able to improve. As this region gets stronger, your symptoms improve. Initial therapy starts with 45sec isometrics (calf raise ‘hold’). Progression into other exercises to push the tendon to greater function is quite gradual. Current thinking is moving away from eccentrics, and into higher load isotonics. Patience is the key requirement to improving this injury. Extended periods of tendon pain usually have training errors as a key component.

Pete

[enyfd]

enyfd on March 30, 2019 at 8:48 pm #19286

Thanks, Pete I look forward to a possible deeper dive on tendon issues in the future from you. In the meantime could you elaborate on the isotonics?. While my regular PT was telling me to do the eccentrics, the Podiotrist stressed calf stretching. Patientence is without a doubt the hardest part as it’s a frustrating injury that limits your training and activity for fear of exacerbating it.

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on March 31, 2019 at 5:08 pm #19635

Eccentric training has long been used to load the tendon. The thinking is that the tendon (as opposed to the contractile tissue) sees more load in an eccentric movement, providing more specific stress and ‘recovery’ stimulation. This type of training teases out 1/2 of normal functional movement however. A strong school of thought is to train functional movements, and not try to isolate too much. The world of rehab is full of dead ends from thinking we can isolate structures to rehab (remember VMO training for patellofemoral dysfunction!!).
When bringing a tendon back to a healthier status, you want to progress through a loading sequence from easy to hard without increasing pain the following day. Easy loading would incorporate isometrics, with moderate loading using heavy but slow resistance exercise, with advanced training including plyometrics and movement specific activities. I would still include eccentrics, but focusing on them misses the point of progressing loads gradually, including single limb activities, and climbing the movement complexity ladder. Recent randomized controlled studies have born this out with superior results to heavy slow resistance tendon rehab compared to eccentrics.
I’m probably raising more questions than answers, but that’s what a forum is for!
Cheers,
Pete

[Stuart]

Stuart on April 3, 2019 at 5:29 pm #19797

Hey Pete, would you be willing to share some of the literature that you refer to? I’d be really interested to see it.

I am a certified athletic trainer and have not come across that research and used eccentric training quite a bit while treating tendinopathies etc. and have had good results. I would love to see that research.

Thanks.

[djcrusoe0929]

djcrusoe0929 on April 3, 2019 at 9:39 pm #19807

Stuart,

Here is a link for the comparison of heavy slow resistance training vs. eccentrics

There is also some interesting stuff on the need for motor control in tendinopathy rehab here

Hope this helps!
Dan Crusoe

[Stuart]

Stuart on April 4, 2019 at 1:14 pm #19844

Awesome, thanks for sharing.

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on April 4, 2019 at 2:27 pm #19848

Beat me to it with the link, that’s the one! Thanks Dan.
Pete