Achilles Injury

[i_heart_ib]

My achilles has been ailing for about 4-5 months now. Not any sharp pain, but you can feel it after some activities like jumping, running, etc. Has anyone else had a similar injury? If so, what do you think this is? Tendinosis?

I have an orthopedic appointment in a couple weeks but I was just checking in here to see if anyone else had some possible answers. Thanks!

[ollinger]

Achilles tendonitis is annoying, but more importantly one's chance of an achilles rupture is increased when tendonitis is present, so lay off physical activity for a while.

[Bobby Jr]

Tendonosis is something which is hard to cure by visiting a doctor. Chances are you'll be given a set of rest/stretch type activities to do. There's not a pill or one-shot treatment that can solve it. (note: tendonosis from what I understand does not in itself make the Achilles tendon more prone to tearing)

I had Achilles tendonosis for a while and found a sort of management place with it. I warm up thoroughly, do post tennis warm-down (walk for about 10 mins) stretches and also off-day stretches often twice a day concentrating on the lower part of the calf. I also do the rolling pin exercise too (can't find the video at the second) which is a Godsend for calf niggles.

Tendonitis however is a whole other story as Ollinger mentions above.

[i_heart_ib]

Originally Posted by Bobby Jr

Tendonosis is something which is hard to cure by visiting a doctor. Chances are you'll be given a set of rest/stretch type activities to do. There's not a pill or one-shot treatment that can solve it. (note: tendonosis from what I understand does not in itself make the Achilles tendon more prone to tearing)

I had Achilles tendonosis for a while and found a sort of management place with it. I warm up thoroughly, do post tennis warm-down (walk for about 10 mins) stretches and also off-day stretches often twice a day concentrating on the lower part of the calf. I also do the rolling pin exercise too (can't find the video at the second) which is a Godsend for calf niggles.

Tendonitis however is a whole other story as Ollinger mentions above.

I've had this injury for 4-5 months now, so would that be a sign of tendinosis and not tendinitis? Im kinda confused, cause I have tendinosis in my right shoulder as well, but while I read that tendinosis is "degeneration" of the tendon, my doctor is telling me that my tendinosis is "chronic" inflammation, so kinda like long-term tendonitis?

[Bobby Jr]

Tendonosis is generally chronic, as-in not acute but just annoying. I've had mine for about a year and have kept playing relatively regularly. I've reduced it by about 75% from where it was initially through daily stretching and being careful.

Tendonosis usually doesn't affect you too much while playing - it might play up near the end of a hit etc but generally you can function. It's afterwards - often hours later or the next morning especially when you notice it. My Achilles isn't aching sore but is mildly tender to squeeze between by thumb and forefinger.

If you had tendonitis playing tennis would almost certainly get more and more painful.

Tendonosis treatment usually allows for light activity (e.g. non-serious tennis, light running) with stretching and sometimes medical treatments. Icing/compression tend not to help much at all.

Tendonitis treatment is usually immediate stuff like rest, ice, compression etc and laying off the activities completely. Then a gradual build up back into activity.

A couple of links which you might find interesting as part of learning more:
A good thread on this site: http://tt.tennis-warehouse.com/showt...ight=achillies

One of the best related stretches you can do. I do this twice daily and credit it with much of the success I've had with alleviating my issues: http://www.youtube.com/watch?v=DgHoe...eature=related

A general info site on the various types/causes/levels etc: http://www.achillestendon.com/Injuries.html

[ATP100]

No matter your age, one of these:

HoMedics Thera-P Compact Percussion Massager

And one of these:

Medi-Rub Foot Massager (very powerful, works calves also)

These two are a must have, IMO.

[charliefedererer]

It would be hard to improve on this description of Achilles tendinitis from the American Academy of Orthopedic Surgeons:
http://orthoinfo.aaos.org/topic.cfm?topic=a00147

"Simply defined, tendinitis is inflammation of a tendon. Inflammation is the body's natural response to injury or disease, and often causes swelling, pain, or irritation. There are two types of Achilles tendinitis, based upon which part of the tendon is inflamed.

1. Noninsertional Achilles tendinitis
Noninsertional Achilles Tendinitis
In noninsertional Achilles tendinitis, fibers in the middle portion of the tendon have begun to break down with tiny tears (degenerate), swell, and thicken.

Tendinitis of the middle portion of the tendon more commonly affects younger, active people."









"2. Insertional Achilles Tendinitis
Insertional Achilles tendinitis involves the lower portion of the heel, where the tendon attaches (inserts) to the heel bone."




"In both noninsertional and insertional Achilles tendinitis, damaged tendon fibers may also calcify (harden). Bone spurs (extra bone growth) often form with insertional Achilles tendinitis."

"Treatment
Nonsurgical Treatment
In most cases, nonsurgical treatment options will provide pain relief, although it may take a few months for symptoms to completely subside. Even with early treatment, the pain may last longer than 3 months. If you have had pain for several months before seeking treatment, it may take 6 months before treatment methods take effect.

Rest. The first step in reducing pain is to decrease or even stop the activities that make the pain worse. If you regularly do high-impact exercises (such as running), switching to low-impact activities will put less stress on the Achilles tendon. Cross-training activities such as biking, elliptical exercise, and swimming are low-impact options to help you stay active."

"If you have experienced a sudden "pop" in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon. See your doctor immediately if you think you may have torn your tendon."


There is more information at the above site.
I think they avoid the term tendonosis so as not to confuse by introducing yet another term.
But basically tendonosis would be the end stage, chronic, degenerated tendon phase that is preceded by active tendonitis symptoms.
I think if the pain is really bothering you, holding off even on the "non-impact" cross training mentioned above would be wise until you see the doctor.



One of the things that is apparent, is that orthopods see extreme cases - usually in those that "push through the pain" and don't rest.

[Bobby Jr]

Originally Posted by charliefedererer

But basically tendonosis would be the end stage, chronic, degenerated tendon phase that is preceded by active tendonitis symptoms.

This is an interesting one. My Ortho explained it more in terms of tendonitis is the more acute, dangerous ailment. Tendonosis is a more chronic and far more manageable version which many people find a way to work with for long periods with streching and easing their physical efforts.

He said people with (what he referred to as) tendonitis were higher risk of further serious Achillies injury compared to those with tendonosis... But this doesn't seem all that consistent with what you mention above - which seems to say that tendonosis comes later than tendonitis as the issue worsens. I understood they were quite distinct in a few key ways - #1 being tendonitis is usually the result of an acute event and tendonosis more the result of periods of increased or over-training (which is why it's most common in spring as people start to train more).

From what I read over a number of years it seemed that if you don't have any swelling and suffer from periodic stiffness and tenderness on the tendon is limited mainly to touch (i.e. you don't have it when walking etc) then you've likely got tendonosis. With Tendonitis you'd usually have swelling/puffiness around the area and would be in more pain more of the time, even to the extent that it would often hurt even when you're not moving.

For me it's been a long discovery of what I can do to be able to play sport still - and the limits there, as well as what I need to daily to address the issue. My issue still exists but, as I said above, has massively reduced through careful self-therapy (which has never included icing) of daily stretches, strengthening exercises and self-massage. I have, based on the pic above, noninsertional tendonitis - in fact that pic represents almost exactly where my tenderness was located.

My Ortho is one of the many who has started to refer to my sort of issue a tendonopathy - code for: it hurts but there's no real issue we can see or address with medical therapy. I'm about to read the link you posted. Always keen to broaden the learning on it. Good posting... I tend to be more worried about my Achilles when I read about it online rather than what I experience in daily life.

[charliefedererer]

Originally Posted by i_heart_ib

I've had this injury for 4-5 months now, so would that be a sign of tendinosis and not tendinitis? Im kinda confused, cause I have tendinosis in my right shoulder as well, but while I read that tendinosis is "degeneration" of the tendon, my doctor is telling me that my tendinosis is "chronic" inflammation, so kinda like long-term tendonitis?

How is your shoulder doing by the way?


Many with long term "tendonitis" don't have pure inflammation ("-itis" connotes active inflammation) but some amount of "tendonosis" a well (-"osis is short for "fibrosis", which is the replacement by fibrous "scar tissue" of the healthy tissue that was abnormally present.)


Tendons are meant to glide easily past one another, and past adjacent bone and ligaments.
With "tendonosis", the fibrotic, scarred tendon areas don't slide smoothly, leading to more inflammation - "tendonitis".


At any one time there can be more or less active inflammation - "tendonitis".

Over time, remodelling of fibrotic "scarred" tissue can occur so that the tendon glides more smoothly.


[Only occasionally does the tendon get so diffusely fibrotic or "scarred", that it will never glide smoothly, or so "stuck" to adjacent tendon, ligament or bone, that it will not respond to any other treatment but surgical removal.]


The best way to preventing "tendonosis" from occurring is to stop play during episodes of "tendonitis", to let the tendon rest and heal.



Realize that after periods of tendonitis, that just because the pain is gone, the remodelling of the tissue at the microscopic level is nowhere near complete.
That remodeling of tissue at the microscopic level goes on for months.



Too many who play sports don't realize they have microsopic tears in their tissues all the time.
The body is busy repairing those injuries all the time.
Those who play at a rate where the microscopic tears accumulate faster than the body has time to repair them develop clinical pain.
Those who return to heavy play too soon after the pain goes away, but before the tissue fully heals, likely will end up with some element of chronic fibrosis [tendenosis].
(Fibrotic tendons are not as supple and strong as "normal" tendons - in the below figure an estimation of 20% loss of strength in the tendon is given, but the exact percentage can vary widely, depending on how much of the tendon is replaced by fibrotic tissue.)

[i_heart_ib]

Originally Posted by Bobby Jr

A couple of links which you might find interesting as part of learning more:
A good thread on this site: http://tt.tennis-warehouse.com/showt...ight=achillies

One of the best related stretches you can do. I do this twice daily and credit it with much of the success I've had with alleviating my issues: http://www.youtube.com/watch?v=DgHoe...eature=related

A general info site on the various types/causes/levels etc: http://www.achillestendon.com/Injuries.html

Thanks for the links! Haven't had time to look through them thoroughly yet, but they seem helpful.

Originally Posted by Bobby Jr

For me it's been a long discovery of what I can do to be able to play sport still - and the limits there, as well as what I need to daily to address the issue. My issue still exists but, as I said above, has massively reduced through careful self-therapy (which has never included icing) of daily stretches, strengthening exercises and self-massage. I have, based on the pic above, noninsertional tendonitis - in fact that pic represents almost exactly where my tenderness was located.

Ah... how limiting are those limits? Can you still play tennis competitively or just lightly? Also, how long has it taken your achilles (after days/weeks/months of stretches, strengthening, massage) to get to the point where you can manage playing sports?

Originally Posted by charliefedererer

How is your shoulder doing by the way?


Many with long term "tendonitis" don't have pure inflammation ("-itis" connotes active inflammation) but some amount of "tendonosis" a well (-"osis is short for "fibrosis", which is the replacement by fibrous "scar tissue" of the healthy tissue that was abnormally present.)


Tendons are meant to glide easily past one another, and past adjacent bone and ligaments.
With "tendonosis", the fibrotic, scarred tendon areas don't slide smoothly, leading to more inflammation - "tendonitis".


At any one time there can be more or less active inflammation - "tendonitis".

Over time, remodelling of fibrotic "scarred" tissue can occur so that the tendon glides more smoothly.


[Only occasionally does the tendon get so diffusely fibrotic or "scarred", that it will never glide smoothly, or so "stuck" to adjacent tendon, ligament or bone, that it will not respond to any other treatment but surgical removal.]


The best way to preventing "tendonosis" from occurring is to stop play during episodes of "tendonitis", to let the tendon rest and heal.



Realize that after periods of tendonitis, that just because the pain is gone, the remodelling of the tissue at the microscopic level is nowhere near complete.
That remodeling of tissue at the microscopic level goes on for months.



Too many who play sports don't realize they have microsopic tears in their tissues all the time.
The body is busy repairing those injuries all the time.
Those who play at a rate where the microscopic tears accumulate faster than the body has time to repair them develop clinical pain.
Those who return to heavy play too soon after the pain goes away, but before the tissue fully heals, likely will end up with some element of chronic fibrosis [tendenosis].
(Fibrotic tendons are not as supple and strong as "normal" tendons - in the below figure an estimation of 20% loss of strength in the tendon is given, but the exact percentage can vary widely, depending on how much of the tendon is replaced by fibrotic tissue.)

Thanks for the info, as always! My shoulder is doing a lot better; probably a month or so away from recovery. Since my thread on my shoulder has been resurrected, I'll post a comment over there on what exercises my orthopedic told me to do. They seem to be working pretty well.

[icarus180]

I have had these issues, they recur from time to time when i overdo it on squats or sprints.

What has worked for me:
Calf stretches, especially AIS and Down Dog.
Foam rolling or, even better, rolling calves over a lacrosse ball.
Compression socks (i used to wear these babies on the court-but finally succumbed to peer pressure and now only use them after playing).
Icing.

What has not worked for me:
Explicit rest (symptoms just return when i go back on court-even after multi-month layoff)
Any stretches or excercises that have you hanging your heels below the forefoot.
Calf raises.

[Bobby Jr]

Originally Posted by i_heart_ib

Ah... how limiting are those limits? Can you still play tennis competitively or just lightly? Also, how long has it taken your achilles (after days/weeks/months of stretches, strengthening, massage) to get to the point where you can manage playing sports?

I can play tennis for a couple of hours a couple of times a week without much problem. Sometimes when I've played on hard court instead of artificial grass I notice a bit of tightness (not pain) after I finish.

BUT, I also make sure I warm/down really well. I do some basic calf raises and light stretches, then walk to the tennis club (about 10 mins), hit against the wall for about 10-15 mins making sure I don't go all out. I avoid doing heavy stretching before playing as it can temporarily reduce your strength quite significantly according more recent studies.

After playing I do some basic warm-down stretches with medium intensity and then walk home (or for about 10 mins if I'm playing elsewhere). the walking (and even a little light jogging) is one of the most beneficial recovery activities you can do. I do some stretches at home later also - usually deeper stuff including the rolling pin exercise from one of those videos.

Paying this sort of attention to my warm-up/down has taken me from being able to play only lightly once a week which left me in a bit of discomfort for a few days to being able to go for weekend walks/runs, play tennis 2-3 times at pretty normal intensity for someone in their late 30s and even compete in the odd tournament.

Lastly, one thing which I would highly recommend is wearing two pairs of socks. I use the basic Nike dri-fit ones and they are tight enough with two pairs around the heel/ankle to offer a fair bit of support (even if it's mainly moral support). The good thing about those socks is they wont be annoyingly tight around your forefoot, which some are.

Aside from that - listen to Charliefederer above. The guys has mountains of knowledge which cover lots of salient points clearly.

[coolblue123]

I am suffering through one of these now. I have Achilles tendonitis and didn't listen. as a result, my Achilles couldn't support the stress and I got three torn ankle ligaments. MRI shows 2 torn and 1 total rupture. I am on a level 3 soft cast and a Jones cast inside. its been a month now and life sucks cuz courts are free and weather is nice. stuck to very light walking.
my advice rest when it hurts and stretch before u start if u r over a certain age.

[obnoxious2]

I too have achilles tendonitis and the best treatment that helped was going to physical therapy. They have this electro heat shock therapy that feels like massaging and tingling for 30 minutes. As they're turning up the electricity have them keep going until it is painful but tolerable. It will numb out after a few minutes. My achilles feels GREAT the next few days.

[Robbnc]

http://www.livestrong.com/article/14...es-tendonitis/


I don't know if anyone has mentioned this yet or not so there's a link, and you can find many more. My achilles hurt for 1 1/2 years and I tried everything.
After 3 weeks of eccentric's it was noticeably better and now after 5 months I
can't tell I ever had a problem, and I only do them once a week. I never layed off tennis but didn't do much else, now I am back up to 18 miles a week running with no problem.

Oh, let me add : I only do one eccentric exercise. On a seated calf machine I push the weight with my good leg and let it off with the other all the way. I use enough weight to resist with
a very slow rep. And I do three sets of this along with 3 sets of regular calf rises with both legs.

Good Luck !

[Chas Tennis]

Eccentric exercises are a very interesting concept as a cure. It might be a very positive thing for some chronic injuries.

Eccentric exercises are supposed to be very good for muscle hypertrophy due to their 'tearing up' of the muscle fibers. This injury more involves the Achilles tendon, correct? Have you found links that explain how it works to remodel or heal the calf injury especially on the microscopic level? Do you picture it as 'tearing up' of the poorly healed tendon and then allowing some remodeling?

There were some threads on TW a few months ago on eccentric treatment.

[Robbnc]

Originally Posted by Chas Tennis

Eccentric exercises are a very interesting concept as a cure. It might be a very positive thing for some chronic injuries.

Eccentric exercises are supposed to be very good for muscle hypertrophy due to their 'tearing up' of the muscle fibers. This injury more involves the Achilles tendon, correct? Have you found links that explain how it works to remodel or heal the calf injury especially on the microscopic level? Do you picture it as 'tearing up' of the poorly healed tendon and then allowing some remodeling?

There were some threads on TW a few months ago on eccentric treatment.

I didn't really delve into the science of it that much. I do remember reading a little on increased blood flow and collagen production. With me it was really just a case of "what have I got to lose".

[Spin Doctor]

Eccentric exercise is pretty much generally accepted right now for treatment of long-term tendonopathy,in particular for achilles tendonopathy. Some of the stretching and strengthening exercises already referred to in this thread incorporate some element of eccentric strenghthening.

[Chas Tennis]

Very detailed discussion of eccentric exercises and Achilles injury.

http://tt.tennis-warehouse.com/showthread.php?t=101633

[Torres]

Originally Posted by charliefedererer

It would be hard to improve on this description of Achilles tendinitis from the American Academy of Orthopedic Surgeons:
http://orthoinfo.aaos.org/topic.cfm?topic=a00147

Good link that - cheers. My right achilles is still sore/tender from playing a tourney a couple of weeks ago. Playing today, it seemed to flare up and made me not want to push off from that foot at all ie anything that pulls on the achilles.

The soreness is right at back of the achilles almost level with the ankle bone. Same leg where I tore a calf muscles a few months back, so the calf may have been tight anyway (putting more strain on the achilles). Pinching it between thumb/finger results in a 'stingy' sort of pain, that's not mirrored by pinching the left achilles. Presumably this is a bit of achilles tendonitis?