Suspected achilles' tendonitis: recovery tips?

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  • #24061

    I was just beginning wk 10 of my base period (mountaineering focused program) this Monday and after trying to throw some running into my hills treadmill workout, my achilles’ tendons started bothering me for the first time (R>L). I stopped, of course, and iced/elevated them that night and have been doing aleve once a day; I have been resting since. I am planning on canceling my hike Sat, and probably Sunday too. The stiffness was definitely less this morning than the prior one,but even just walking around at my usual Wednesday race (to socialize, not exercise) and in CVS has my R one acting up.

    I am putting training on hold until it improves; if it doesn’t improve in a week or so I was going to plan on doing some PT (will probably have to see PCP first for “official” diagnosis). Any other tips? I have read calf-lowering exercises are good, but I am holding off on doing any stretches/exercises until at least a few days off.

Posted In: Injury & Rehab

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    psathyrella on #24148

    Slow, weighted calf-lowering is for sure the gold standard, and also really the only, way to get rid of chronic tendinopathies. It sounds like you’ve only just now initially injured it, so it’s likely that by being extremely conservative (and diligent with rehab) over several weeks you can avoid the tissue going into the failed healing response that we think leads to being chronic. My favorite discussion of how to manage and understand these injuries is in Dave Macleod’s “Make or Break”, which I’d highly recommend reading, since at least for me these injuries were very counter intuitive. And although he’s mainly talking about elbows in this context, I’ve managed to kick chronic tendinopathies on both sides of my elbows and an achilles (that one lingered for four years, if you want a cautionary tale), and the principles are identical. But if I wrote one summary, it’d be: rest by itself doesn’t help after the initial inflammatory phase of a few days; but eccentrics are magical.

    Pete Dickinson MS,PT on #24159

    Calf lowering exercises are a few steps up the ladder from where you want to start your strengthening. I would begin 5x45sec calf raise holds, basically an isometric. Current thinking has moved on from just eccentrics, but strength is the key as you try to make the healthier part of the tendon strong enough to support the loads you place on the calf structure. You have to be very consistent with daily strengthening of this area, progressing from double leg load, to single leg loading, and progressing to 8rm strength loads. Keep up with deadlifts as you work on your achilles.

    kocanez on #24213

    Thank you both. Would you begin calf raises right away, or rest more?

    Discomfort started approx 4.5 days ago (although it feels like at least a week!). I have stopped all training. I walked for 20 min at a casual pace with a couple stops, and I am still having to ice my R achilles after d/t discomfort. Would you suggest starting to incorporate/increase daily walks/elliptical/other non uphill or running exercises at this point; or more rest?

    I have had tendonitis in 1 of my wrists for years now (4? 5? work related, not training) despite PT, RICE, bracing, injections; so I am anxious about this becoming a chronic problem.

    I will plan on starting deadlifts. I am hoping to be able to do a planned trip w.friends in 2 wks that involves a day hike of about 5 mi/3400 ft elevation gain over rocky terrain, and a hike of about 4 mi down the next day. Light packs since we’re staying at a hut.

    Pete Dickinson MS,PT on #24225

    I would begin isometrics immediately and daily, and trial biking for aerobic fitness initially. If bike goes ok, try elliptical. Once isometrics are tolerated, then isotonics can be added with progression to true strength loads. You should see improvement in function throughout this process. As always, the devil is in the details.

    kocanez on #24226

    Thank you Pete; I started the isometrics today, along with some calf foam rolling.

    I am thinking of doing the following progression, depending on my body’s response, moving to the next step every 2-3 days/depending; with 2 sets daily of the non-weighted/body weight exercises

    a) 2 sets daily of the 45 sec x 5 bilateral calf raises (is a minute in between sets too much?)

    b) progressing to single leg isometrics
    c) isotonic calf raise/lowering, bilateral, 8 reps x 3 sets
    d) single leg isotonics, 8 reps x 3 sets
    e) weighted double raises- 8 rep max
    r) weighted single raises- 8 rep max
    f) eccentrics?

    Would you recommend wearing sneakers during these or no?
    Also, would you say doing this with dumbbells or weight plates is fine vs using a smith machine?

    Thank you for all of your help


    Pete Dickinson MS,PT on #24259

    Excellent plan, just modify based on response. Each step may even take weeks and not days, thats the nature of tendonitis. Training shoes are fine, may even help to compensate for some foot issues. Load is load with a calf raise, whatever means is convenient.

    Anonymous on #24451

    Also make sure your running shoes are fresh! They’re only designed to last a few hundred miles, which adds up quite quickly if you’re training regularly, and lose cushion faster if you’re also adding weight.

    Good luck!

    embloom on #69456

    Similar to this person, and to other posts on this forum, it seems like I have insertional achilles tendonitis. Last year I went on a very rugged, 100 mile off trail route over the course of 7 days, with lots of elevation gain. Towards the end of the trip and afterwards, I had some kind of inflammation or damage where my achilles meets my heel (seemingly exacerbated by continuous pressure on that tendon from the back of my shoe, while going over very steep terrain). It is not pain exactly, but both tendons are squeeky, sensitive, and weak feeling, 11 months later.

    Based on your response here and to a different post about achilles tendonitis, I’m going to follow these recommendations about double to single calf raises, moving up to isometric calf raises, weighted calf raises, and finally eccentric heel drops, progressing carefully over a few months. I also like the idea of cutting out the heel of my shoes so it doesn’t apply more pressure there. I’m curious if you have any thoughts on movements or amount of activity I should avoid? I see some have commented before that continuing to run is a good idea so long as it doesn’t hurt. It’s unclear to me whether I should be generally trying to rest the tendons, while doing light running and biking to keep my aerobic fitness up, or if I should just focus on strengthening them (ie, not resting them) while continuing to do my other regular strength exercises (mostly bodyweight stuff, squats, lunges, etc). I also have a fair bit of field work coming up, involving daily hiking with weight, and I’m wondering how I should factor that in to rehabbing my achilles.

    Thanks for any insight!!!

    Garret on #69993

    From my own experience of Achilles tendonitis

    I used the following (with guidance and advice from Pete Dickinson):
    I continued very light running, starting with a walk-jog-walk protocol and progressing to continuous running.
    I quickly progressed to maximum strength exercises (5reps, 3 sets) to strengthen calf, hamstring, glute.
    I avoided any other exercise that aggravated the injury.
    I used K-tape when running.

    Towards the end of the rehab period I had 2 weeks with no running or strength training.
    I’ve been running pain since.
    I continue to use K-tape on events/training sessions that are significantly more intense or have a lot of steep inclines.
    I continue to do one max strength session a week for calf, hamstring, glute.
    – Garret

    mgroeneveld on #69996

    Erika, I’ve had achilles tendonitis for that’s lasted for years because of PT’s having no clue what to do. I finally came across this book, “Overcoming Tendonitis: A Systematic Approach to the Evidence-Based Treatment of Tendinopathy”, which has been really helpful and echo’s what Pete was saying earlier on this thread. It recommends isometric exercises first as they are less aggravating. It also recommends keeping a high volume of activity but replacing the aggravating activities with non-aggravating ones (like switching from running in hills to running on flat ground during recovery). It has a ton of other info too.

    I have no ability to diagnose if you have tendonitis.

    Overcoming Tendonitis

    Garret on #70022

    To correct my earlier post …
    It should read “I’ve been running pain free since”

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