Achilles problems

[Rich_Sweden]

Many or most cases of 'tendonitis' are in fact tendinosis; consequently the problem is not inflammation and damage to the achilles, but instead a neovascularization - blood vessels have grown into the tendon and causing swelling. I have had this problem off-and-on for two years and dealt with and continue to deal with it through excentric training. With the initial problem two years ago I finally was able to see one of the top specialists for tendon and especially achilles injuries (Alfred Håkansson, if you are interested in searching for his research papers). The basic idea is that through excentric training - standing on a stair, raising your weight up using both feet and than gradually lowering your heel while standing on just the one foot - you shear off those vascularizations. The problem is that if you are fit then body weight is not enough and you have to load weight on your back. His recommendation was to use as much weight as you can stand - it will hurt. I use 15 kg in a pack just for maintenance excentric stretching, but when problems begin to increase the load will increase to 30-40 kg (then I do this in the gym). The other important factor is doing this with dedication; when I first had serious problems I would do 15 kg loads at home (3x10reps for each leg - to keep it balanced) in the morning and evening and pass through a gym at the university at some point during the day for a heavy set, building up from 15 to ultimately 40 kg. It took 3-4 weeks to have a noticeable effect.
I was very sceptical this would work, but in the weeks I was waiting for surgery (where he scrapes the inner side of the achilles to shear off these vascularizations) things turned around after 4 weeks. Surgery was first tentatively delayed, but after the improvement started we agreed to cancel it.

[Youngy]

It's almost a year since my last race (Passing Clouds) because of achilles tendinosis. Unfortunately for me the injury (confirmed through ultrasound) is where the tendon enters the heel bone. I stopped running last November and started again very tentatively in February this year. I've been to a physio and tried eccentric and various improving stability exercises all to no avail. I'm not sure really what to do next. Has anyone had the injury in the same area and if so did anything in particular work for you?

[Derby Tup]

It's almost a year since my last race (Passing Clouds) because of achilles tendinosis. Unfortunately for me the injury (confirmed through ultrasound) is where the tendon enters the heel bone. I stopped running last November and started again very tentatively in February this year. I've been to a physio and tried eccentric and various improving stability exercises all to no avail. I'm not sure really what to do next. Has anyone had the injury in the same area and if so did anything in particular work for you?

I have an ongoing battle with Achilles tendenitis. How many reps do you do with the eccentric excercises and how often? I do up to sixty reps twice a day when mine flares up. Good luck!

[Youngy]

I've done 15*3 reps per leg 3 times a day weighted by up to 15kg in a rucksack. I must admit I'm more than a little frustrated by the problem. Sometimes I think I'm getting somewhere but then the problem surfaces again and the heel is quite tender. I rarely have problems when I'm running but have been told not to ignore it.

Before I stopped running last year I couldn't walk down the stairs in the morning without holding the banister because my foot was so stiff but once I got some movement into the tendon I never had any pain (classic early tendinosis). Since doing the eccentrics I haven't had the morning stiffness so I guess that's some improvement. Nightmare.

[IanDarkpeak]

I've done 15*3 reps per leg 3 times a day weighted by up to 15kg in a rucksack. I must admit I'm more than a little frustrated by the problem. Sometimes I think I'm getting somewhere but then the problem surfaces again and the heel is quite tender. I rarely have problems when I'm running but have been told not to ignore it.

Before I stopped running last year I couldn't walk down the stairs in the morning without holding the banister because my foot was so stiff but once I got some movement into the tendon I never had any pain (classic early tendinosis). Since doing the eccentrics I haven't had the morning stiffness so I guess that's some improvement. Nightmare.

I've had some thing similar but put it down to early arthritus, did your ankles crack or click in the morning?

[Youngy]

Ian

I've had the odd time when the ankle has cracked for a bit but its been ok for a while now. The technician carrying out the ultrasound identified the point of tendinosis very quickly. No blood vessels had formed thankfully but it does appear to be a permanent injury now.

I got a bit fed up with doing short easy runs so did a trundle from Westend valley up to Bleaklow head, over to Shelf Moor and then back over Alport Moor to Fairholmes the other week (a bit daft perhaps). It doesn't appear to have made things worse but the heel is still tender at times.

[Rich_Sweden]

Insertional achilles tendinopathy according to the latest research papers (I read about everything available when my achilles became problematic), is not as responsive to eccentric training. But a response could take 12 weeks or possibility more before coming even into a maintenance phase for the problem. Look for the following research article if you can get access to it, "New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study", P Jonsson, H Alfredson, K Sunding, M Fahlström, J Cook. Br J Sports Med 2008;42:746–749.

Keep working on it!

[Youngy]

Rich

Thanks for the encouragement. I've got the article (given to me by my physio). The main difference with the eccentrics is that you don't drop your heel below the level of the front of the foot (if that makes sense). I've done the exercises for several months and intend to keep it up - although the paper says that there's a 70% success rate (hence 30% unsuccessful). Eek.

[Derby Tup]

http://www.sportsinjurybulletin.com/...el-injury.html

These are the exercises that have helped me in the past and which I have recently re-started doing after my right Achilles started giving me trouble

I tend to do 20 x each leg x each exercise at least once but sometimes twice per day, ideally not first thing when the tendon is stiff and sore. I haven't done the fourth exercise i.e. stretch, just the first three

The exercises have worked with both left and right Achilles and usually within just three to four weeks of starting

[dominion]

youngy, don't know which bit of Staffs you are in but, I got my achillies sorted with accupuncture by a bloke in Burton on Trent. http://www.burtonphysiocentre.co.uk/

He's an interesting bloke to talk to, completely dismissive of a lot of treatments such as ultrasound.