Exercise Gurus: Achilles tendinitis?

Connoisseur

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Sep 14, 2002
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I know there were a couple of threads on this a while back but I wanted to start a new post on this to get some fresh advice as I'm hearing conflicting ideas. The basics:

I started running seriously 3 weeks ago in old sneakers. I think it was a situation of too much too soon as I was already running about 4 miles in 35-40 minutes in about 1-2 weeks (this is from not running at ALL before). Started getting sharp tendon pain a little more than week ago and figured it wasn't good since I had trouble walking as well. I stopped running for the week but I still walked as I live in NYC. 90% of the pain went away and at worst I only felt a very mild soreness. Fast forward to yesterday and I decided to give it another go. I bought new sneakers from a store where they actually video taped my running stance and made suggestions based on analysis (apparently I have a neutral running stance). I still ran 4 miles but I did it at a much slower pace (around 5 mph) and did a lot more stretching before and after the run. The pain came back although it's only at around 60% of the previous weeks but there's that creaking noise in my left tendon.

My Questions (mostly related to how long i should rest, any medications, treatment options etc):
1) Should I or should I NOT be icing my tendons on a daily basis? I hear conflicting reports.
2) Should I or should I NOT be taking Advil (ibuprofen) to reduce swelling? Once again, conflicting reports.
3) How long does this typically take to heal? Or should I just go with how it feels and start slowly?
4) I know my ankles/calves are fairly weak (genetics). My calves especially are pretty small relative to the rest of my body. Are there good strength training exercises so I can rectify this?
5) Do I need to see a doctor?

I think my very end goal is to be able to do 5-6 miles in 45-50 minutes. I don't think i'll ever be a half marathon/marathon runner by any stretch but I'd be proud of myself if I could cover that distance in that time.
 
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Capt Caveman

Lifer
Jan 30, 2005
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Wrong forum. Search the topic in H&F. I've gone thru this issue and dealt with it for over a year. The only way to resolve it is to stop running and let it heal completely. If you do a lot of walking, heal lifts will help.

Also, I recommend seeing a physical therapist.
 

Meghan54

Lifer
Oct 18, 2009
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I've gone thru this issue and dealt with it for over a year. The only way to resolve it is to stop running and let it heal completely.



Exactly. You aren't going to run/walk it better....only worse. As suggested, see a doc. Probably start some prednisone to more quickly drop the swelling/irritation on the tendon.
 

Connoisseur

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Sep 14, 2002
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Oh crap. been on AT for years and I totally forgot that we have a health and fitness forum. Sorry about that guys.
 

vi edit

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Oct 28, 1999
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I got it a couple years ago from running. I was working out too hard, too soon and not letting my body build up a base.

I saw a sports medicine doc for it, but it's probably not necessary. Icing will help some, but really it's all about rest...probably 2-3 weeks. Do an exercise bike or swim if you want some sort of cardio. In the mean time you can work on prevention and strengthening. Get/build a calf stretching board. Get your calves good and stretched out and reduce the pull on that tendon.

And for strengthening you do what I call the "calf dive". You stand on the bottom step of a staircase with only your toes and ball of your foot being on the step. Hold yourself up and then just drop and let yourself bounce a bit. Do that twice a day, 3x3 for a week. Then another week move up to 3x5. Then the next week it's 5x5 twice a day. You just really want to shock that tendon..which sounds counter intuitive but it worked great for me. Then when you get back into training make sure you stretch your calves and do the "calf dives" prior to workout to wake up your achilles and get it ready for action. Keep doing the stretching and dives in the mornings and prior to workouts for as long as you need. It took me probably 6 weeks to fully recover.
 

destrekor

Lifer
Nov 18, 2005
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If you are almost positive it's Achilles Tendinitis or something similar in the general area (tendinitis of a different tendon, or you actually have bursitis, for instance), then keep reading.

I had either A.T. or some kind of bursitis (got it out in the field during training). The medics first gave me 800mg ibuprofen and directions to take that dose twice a day. Then I went back to them and they switched me to 500mg naproxen twice a day. (both are prescription-size doses).
Can't remember if it was either of those medics that directed me to use ice, or if it was a third medic some time later. Either way, 500mg naproxen (2x daily, with meal) and ice packs on the area from time to time.. that definitely helped bring the swelling and pain down at a comfortable rate and I was pleased.

Whether that was the best or not, I don't know. Maybe it's the route for the fastest healing time, but I don't know if the fastest healing time is the best course of action or not. :hmm:

And the only thing I can think of to help prevent further issue is to try and do some focused stretching (recovery only!) for the problem area. I do this for my calves, calf-raises and pressing feet against a wall as I stand/lean into it (stretching the back of the calves). Stretching the front of the lower legs, the muscles around the shin, is hard to do solo, easiest to do with partner-assisted stretches.

And try not to do too many static-stretches before activity. Warm-up should be more active and based on agility, don't focus on stretching and standing still. Save the majority of your static-stretches to complete after your activity, as a cool-down.

And only you can really decide if it's time to see a doctor. If the pain is intolerible, yes I'd say go to the doctor.
When it comes to sports injuries, if you feel very comfortable and believe you can accurately pinpoint a source of injury and believe you can relieve the discomfort on your own, it doesn't tend to cause any huge problems.

But a qualified individual (in terms of sports-injuries) will almost always be more accurate diagnosing the problem, and can generally help tailor a specific gameplan to help get you back out doing what you love, and they can usually put you on a path that leads to proper healing and recovery.

Depends on how bad you feel it is, and if you feel like paying for medical attention. Generally, you want to try and take it easy if there is an injury - don't go out running constantly if you are have tendinitis somewhere in the legs. If you run, take it easy, but don't keep up at the pace and frequency you had been doing previously before the injury. Remember, running caused the injury... most likely.... and even though you have new shoes that should help mitigate future running problems (if they are indeed correctly fitted for size and running style), you still have that injury. The new shoes aren't going to be a tool that helps lead to healing, rather they will help prevent future injuries once you are at baseline. If you are running constantly, you may aggravate it more and cause more problems... or you may help heal it by using it like that.

What works for one person isn't always the best for another person, even with the same type of injury. That's why doctors specializing with sports-related injury are a good idea, because they not only look at you, they try and listen and use what you say to try and figure out the best approach.

In general, listen to your body. If you can reasonably decide going to the doctor is a good idea, then do it. :)
If it feels like it is continually getting better, remain active but definitely keep away from maxing yourself out (either by running max pace or by running as often as possible). If you haven't already, start trying to take prescription-size doses of OTC NSAIDs, and use ice from time to time: try to use ice on the afflicted area once or twice a day if possible, and aim for 15 or 20 minutes per leg (if both legs/ankles are injured) every time you sit down with ice.

Good luck, and hope you can hit your goals!
 

Connoisseur

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Thanks for the responses even though this is clearly in the wrong forums. Some great advice.
 

Gibsons

Lifer
Aug 14, 2001
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My Questions (mostly related to how long i should rest, any medications, treatment options etc):
1) Should I or should I NOT be icing my tendons on a daily basis? I hear conflicting reports.
2) Should I or should I NOT be taking Advil (ibuprofen) to reduce swelling? Once again, conflicting reports.
3) How long does this typically take to heal? Or should I just go with how it feels and start slowly?
4) I know my ankles/calves are fairly weak (genetics). My calves especially are pretty small relative to the rest of my body. Are there good strength training exercises so I can rectify this?
5) Do I need to see a doctor?

I think my very end goal is to be able to do 5-6 miles in 45-50 minutes. I don't think i'll ever be a half marathon/marathon runner by any stretch but I'd be proud of myself if I could cover that distance in that time.

1. Yes, put some ice on it. A good home remedy type thing is a bag of frozen peas.

2. It's okay to use, just don't exceed the recommended dosage much or at all. Consider some aspirin instead or also. Just don't go nuts on the dosage.

3. Couple of weeks, assuming you rest properly.

4. Toe raises, a few other things. But wait til your tendonitis goes away, see #3. Note, don't wait til it "gets better." Wait til it goes away, as in completely gone.

5. No.

Set a real goal - run the xyz 10k in say, under 45. But lay off until the tendonitis goes away.
 

Turin39789

Lifer
Nov 21, 2000
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Roll the area on a lacross ball or foam roller.

I got around to getting a formal diagnosis of my tendonities(perioneal longus insertional tendonitis) and find the rolling the bottom of my foot on a lacross ball is more effective than the PT that was prescribed.
 

ElFenix

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Mar 20, 2000
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a) too much too soon
b) stretches work, but you need to be warmed up first. a lot of people stretch wrong and end up hurting themselves more
 

Connoisseur

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Thanks to the mods for the move. One last question:
1) If I see a professional should I first see a podiatrist, an orthopedist or physical therapist?

I don't know separator between the first two.
 
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Capt Caveman

Lifer
Jan 30, 2005
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Thanks to the mods for the move. One last question:
1) If I see a professional should I first see a podiatrist, an orthopedist or physical therapist?

I don't know separator between the first two.

I went to a Sports Orthopedic Specialist. He was able to diagnosis my issue as a tendonosis. He prescribed me a topical steriod(can't remember the name) to be filled and brought to a physical therapist. He also wanted me to wear heel lifts due to the pain I had from just walking. The PT had me use the steroid with a patch with a battery operate pump to allow the achilles to absorb it.

I then went to the PT for 6 weeks. First for stretching and deep tissue massage to break-up the scar tissue. Then to strengthen exercises.

Afterwards, I went back to the Dr with still some pain. He wanted me to wear a boot and change my running form(back to heel striking). I ended-up instead to not run for close to four months which finally resolved the issue.
 
Mar 22, 2002
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Thanks to the mods for the move. One last question:
1) If I see a professional should I first see a podiatrist, an orthopedist or physical therapist?

I don't know separator between the first two.

Physical therapist. That's the only person that can actually treat you thoroughly for the issue. Podiatrists have no idea about biomechanics, orthopedists are smart but think in terms of surgery and medication. PTs think in terms of what caused it and how to fix that. Definitely go visit a PT.
 

vi edit

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Oct 28, 1999
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Physical therapist. That's the only person that can actually treat you thoroughly for the issue. Podiatrists have no idea about biomechanics, orthopedists are smart but think in terms of surgery and medication. PTs think in terms of what caused it and how to fix that. Definitely go visit a PT.

An ortho guy specializing in sports med is all of that. They have a unique focus of musculoskeletal injuries and how they are caused by physical activity and training to get back to your activities. Athletes are a different breed than your typical sedentary person. They want nothing more than to get back to their sports and they usually take orders well. So the hand holding needed by a dedicated PT is much lower. The sports med doc does have training in rehab and therapy of basic injuries.

Achilles tendonitis is a basic injury(although an annoying one) that typically does not require physical therapy. It's all about rest and prevention.
 
Mar 22, 2002
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An ortho guy specializing in sports med is all of that. They have a unique focus of musculoskeletal injuries and how they are caused by physical activity and training to get back to your activities. Athletes are a different breed than your typical sedentary person. They want nothing more than to get back to their sports and they usually take orders well. So the hand holding needed by a dedicated PT is much lower. The sports med doc does have training in rehab and therapy of basic injuries.

Achilles tendonitis is a basic injury(although an annoying one) that typically does not require physical therapy. It's all about rest and prevention.

Actually, I know some orthos - they don't get the training that physical therapists get in directly treating the injury. The PT is specifically trained to be the last person the individual sees, unless surgery is deemed necessary afterward. The ortho is trained to prescribe out to PT, just like a drug intervention. Technically, to treat like a PT as an ortho, you need to be a physiatrist, which is an individual who has an MD/DO and a PT. You don't find too many of those around.

On top of that, PTs are known for having some of the best biomechanical analyses in the healthcare profession. Orthos might notice eversion and flattening of the arch, but the PT also notices that it's due to a lack of dorsiflexion or to a possible rearfoot varus. With any non-surgical musculoskeletal injury, I would always trust PT and really good chiropractors. Orthos are great, but their non-invasive interventions typically just utilize basic, non-specific exercise programs (which is not nearly as effective as a specialized program - shown in research) and prescription drugs. PTs cater (or should at least - I know some who don't) to the individual, utilizing exercises, stretches, and necessary modalities to reduce healing time. Orthos just don't do that.

Hand holding has nothing to do with it though. Athletes can't perform accessory soft tissue motion on themselves, they can't evaluate ROM objectively, they can't correct their own form frequently, etc. Athletes can do exercises and stretches, but if that's all you think PT consists of, you don't know enough about PT :)
 
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vi edit

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That's great and all but you completely ignored the "sports med" qualification and the fact that a vastly overwhelming amount of time achilles tendonitis...just like almost all other types of sports related tendonits are due to overuse and nothing more. You don't need to rehab it.
 

Capt Caveman

Lifer
Jan 30, 2005
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That's great and all but you completely ignored the "sports med" qualification and the fact that a vastly overwhelming amount of time achilles tendonitis...just like almost all other types of sports related tendonits are due to overuse and nothing more. You don't need to rehab it.

SC obviously didn't read my post and I'm glad that I went and saw a orthopedic specialist who provided me more insight of the issue, treatment options(prescribed steroids) and prevention options.

In my case, not only was it overuse but running form.
 
Mar 22, 2002
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That's great and all but you completely ignored the "sports med" qualification and the fact that a vastly overwhelming amount of time achilles tendonitis...just like almost all other types of sports related tendonits are due to overuse and nothing more. You don't need to rehab it.

The sports med qualification doesn't make them biomechanical specialists. It makes it so they understand sports injuries better. And what you're saying isn't true at all. Many, if not most, tendonitis cases have some basis in lack of mobility, rearfoot/forefoot deformities, form, etc. Sports med doctor is not qualified to fully evaluate that. And yes, you do need to rehab it - it's a strain. If you don't rehab it, you'll be continually weak at that point and you won't address the extraneous contributing factors.
 
Mar 22, 2002
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SC obviously didn't read my post and I'm glad that I went and saw a orthopedic specialist who provided me more insight of the issue, treatment options(prescribed steroids) and prevention options.

In my case, not only was it overuse but running form.

I did read it. It doesn't take four months for something to heal without something still being off. I understand where you're coming from and some iontophoresis/phonophoresis treatments are great for acute inflammation. For your tendonosis - it's still an injury induced by overuse and likely something else. In a lot of people, it's lack of dorsiflexion (which most people compensate for by everting at their subtalar joint). On top of that, the subtalar joint itself could be contributing to this as well (going through too much eversion may contribute to extra dorsiflexion may lead to overuse of the Achilles). I appreciate doctors and I cherish their knowledge. However, I've seen a lot of sports med doctors treat the obvious symptoms, but not the underlying cause. I've seen PTs do the same; but the PTs I know are much better at treating the cause than the sports doctors I know.

My advice wasn't exactly directed toward you. It was directed to the OP because I know for sure that a good PT could fix you faster than 4mo, guaranteed. You should be healed for the mostpart within 6-8 weeks if done correctly, especially if this were a case of overuse alone.
 
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Capt Caveman

Lifer
Jan 30, 2005
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My advice wasn't exactly directed toward you. It was directed to the OP because I know for sure that a good PT could fix you faster than 4mo, guaranteed. You should be healed for the mostpart within 6-8 weeks if done correctly, especially if this were a case of overuse alone.

LOL. After posting this, you seriously should not give anybody any advice. I'm sure you're more qualified and smarter than a sports doctor that treats numerous professional athletics including marathoners. And my sports doctor actually kept in communications with my PTs(who I know are more qualified than you). I think it's funny without examining someone you could make such a claim. But then again, a lot of your posts have zero experience or any expertise behind them.
 
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Mar 22, 2002
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LOL. After posting this, you seriously should not give anybody any advice. I'm sure you're more qualified and smarter than a sports doctor that treats numerous professional athletics including marathoners. And my sports doctor actually kept in communications with my PTs(who I know are more qualified than you). I think it's funny without examining someone you could make such a claim. But then again, a lot of your posts have zero experience or any expertise behind them.

Actually, a broad majority of PTs are better trained when it comes to actually rehabilitating from the injury. That's how it's supposed to work - sports doc figures it out, prescribes drugs necessary, any workups, keeps activity in mind and allows individual to maximize current activity, contacts PT and communicates with them. PT treats, communicates back, and the dialogue continues. I'm telling you that someone missed something or that you unknowingly kept re-injuring yourself. A soft tissue injury, like tendonitis or a muscle strain, has three stages 1) inflammatory, 2) fibroblastic, 3) remodeling. You should be through the fibroblastic and onto the remodeling phase in about 4 weeks. The remodeling phase continues for a significantly long time, but you should be able to ease back into activity at that point. I can make my claim without examining you because, unless you have some sort of autoimmune condition that limits recovery, you did not follow the stages of healing correctly.

Lol, zero expertise? How much time have you spent working with sports med doctors in more than just your case? I'm a doctorate of physical therapy grad student - I had to pay my dues to get here. Lots of clinic time, lots of clinician interaction, lots of doctor interaction. Many, many times, sports med doctors didn't have a clue as to how to rehabilitate the actual injury. That's why PTs exist. That's like comparing a metal worker and an engineer. Can a metal worker get it done? Sure. Will it be optimal? No. Is the metal worker better at certain things than the engineer? Hell yeah. Clearly I'm not saying sports med doctors are noobs - they're great. I respect doctors and everything they do. But there's a separation between sports med doctors and PTs. Sports med doctors still rely on a lot of internal medicine to rule things out. I assure you, though, they don't go through biomechanical training like PTs do. Just like PTs don't get into surgery and only know a bit about internal medicine. Each is specialized for a certain job. Sports med docs are good at their job - rehab itself is outside of their scope.

PS: I have evidence to back what I'm saying, from stages of healing to sports med doc experience. Look at this sports med program - http://www.ucdmc.ucdavis.edu/pmr/education/fellowshipsports.html - see anything about biomechanical analysis, detailed kinesiology, or rehabilitation programs? I see a lot about anatomy, injections, and imaging. Nothing about movement based diagnosis.
 
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Capt Caveman

Lifer
Jan 30, 2005
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blahblahblahblah

So, without knowing the exact injury, you recommend the OP to see a PT first, instead of doctor that can diagnose the issue better and recommend the best course of treatment(including going to a PT for rehab).

Again, you don't know my condition and you claiming to, makes you sound even more unqualified. Sorry, I'll go along with people that have 20+ years more experience. The fact that I was not able to immobilize my foot to assist in reducing my inflammation in the beginning and needed to go back to my doctor to remedy all of the scar tissue built-up that the PT's were not able to eliminate should make you realize that not every situation/scenario is the same and that making blanket evaluations and claims is not something somebody in your future profession should be making.

I used to date a PT and she never acted the way you do in these forums. I still remember the thread when someone asked about removing ticks. You gave incorrect and horrible advice. As a student, you should learn to tailor your delivery b/c you turn a lot of people off here with your inability to simplify your explanations and making incorrect evaluations/claims is down right negligent.
 
Mar 22, 2002
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The doctor is just as qualified to say it's a musculoskeletal injury as the PT is to say it isn't a musculoskeletal injury. If you see a PT and it is a musculoskeletal injury, you're already at the place you need to be. If you see a doctor, you will need referral at some point. I'm optimizing time and money for the OP.

Like I said, unless you have a healing issue or continued injuring the problematic tissue, there is a problem. That's not me saying it - that's you not following the stages of healing.

Lol, a tick? And didn't I back down when I said, "Hm, actually, I don't know that much about ticks so ok?" Exercise, therapy, nutrition. Those are things I know and have research to back up. As a student, I try to give both the simple and the mechanistic explanation so the person can research more if desired. What I'm saying is making a basic evaluation on your time to heal. That is objective data - not an evaluation at all. There's no interpretation, nothing. You didn't follow the stages of healing. That's it. Something was wrong and either your doc or your PTs missed it.

Silly rabbit. You get an injury and think you know everything about it because what you did worked. It worked, but not in the time frame it should have. Four months of rehab for Achilles tendonitis is absurd and most insurances wouldn't pay it. Something. Was. Wrong.