Achilles Injury

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!

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.

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.

Bobby Jr said:

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.

Click to expand...

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?

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/showthread.php?t=101633&highlight=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=DgHoePuZaPw&feature=related

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

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.

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.

charliefedererer said:

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

Click to expand...

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.

i_heart_ib said:

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?

Click to expand...

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.)

Bobby Jr said:

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/showthread.php?t=101633&highlight=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=DgHoePuZaPw&feature=related

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

Click to expand...

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

Bobby Jr said:

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.

Click to expand...

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?

charliefedererer said:

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.)

Click to expand...

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.

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.

i_heart_ib said:

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?

Click to expand...

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.

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.

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.

http://www.livestrong.com/article/147146-eccentric-exercises-for-achilles-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 !

Any links for Eccentric Therapy?

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.

Chas Tennis said:

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.

Click to expand...

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".

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.

TW Thread with Discussion of Eccentric Exercise for Achilles

Very detailed discussion of eccentric exercises and Achilles injury.

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

charliefedererer said:

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

Click to expand...

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?

Torres,

Try massaging your calf. Could be a trigger point there referring pain to the Achilles. It's free and if it does not work, then plan B.

^ I'll did a bit of that last light by using right calf on my bent left knee whilst lying down, but I don't think it's the calf thats the current problem.

Played a couple of hours this evening and the right achilles started flaring up again towards the end and made me not want to push off or bounce off my right leg whilst on the balls of my feet.

Looks I've done something to my achilles. The soreness / stinginess is right in the spot that charlie federer identified in his picture:



I have a team match this weekend, and a singles tourney on the 30th!!

Chas Tennis said:

Very detailed discussion of eccentric exercises and Achilles injury.

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

Click to expand...

Excellent - thank you.

Torres,

Put a heating pad on it before you play to loosen it up.

JLDN said:

Excellent - thank you.

Click to expand...

I don't know about this treatment but it is interesting. I am hoping there is some hope for these difficult tendon injuries such as tennis elbow or Achilles.

I would not do any exercise or stretch if possibly injured without seeing a Dr first.

Torres said:

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?

Click to expand...

I participated in that thread and had a chronic left Achilles. I finally gave PRP therapy a try, had two shots and took off 8-10 weeks to lets the shots do their work and begin my rehab. I am now basically 100 % but I do three things several times a week:

1. regular eccentric exercise on a slant board (start very slowly and on a flat surface then build up

2. regular foam roller work for calves/achlles/Quads and Hams


3. icing, use a bucket or very small trash can, our tap water her where i live is very cold, do it for 10 minutes, approximately 50 degrees. i find immersing the entire lower foot from achilles down is much more effective then inormal icing.

Thanks Drak.

The right achilles flared again today after about 2 hours of a 3 hour session. Again, felt painful to push off after it flared.

Have seen the physio in the meantime. Had some ultrasound and massage. She said exactly what you said - eccentric, massage/loosen calf, ice achilles.

The eccentric exercises (to anyone else interested), are desgined to strengthen the tendon over its entire (not just part) of its lengnth. Same principle as with tennis elbow eccentric exercises. Basically, I stand off the edge of a step, sink down as far as it will go to stretch the achilles and then rise up on my toes. x10, x 2-3 times a day. Very easy exercise to do as well in terms of discipline, routine etc. Not sure whether it should be 2 footed or 1 footed, but I've been doing it with 1 foot.

Will see how things go over the next couple of weeks.

Do the exercise with both feet so you can hopefully prevent the tendon in the other leg from getting bad as well.

I'm thinking you should stop at the time it flares up.

mikeler said:

Do the exercise with both feet so you can hopefully prevent the tendon in the other leg from getting bad as well.

Click to expand...

Other leg is 100% super healthy.

The right achilles is more susceptible to strain because I had a Bostrum on the outside ankle and some drilling after my blowing my ankle out a few years ago playing football. I think I also have some pins in there.

So the whole right calf/ankle/achilles tends to be under a bit more strain because probably doesn't stretch over as long a range as the other leg. I think the doc put the screws in too tight.

I just guess I'll have to work harder on preventative stuff, stretches and these eccentric exercises with that achilles.

I got pain in my right Achilles last year. A few months later, I got it in my left Achilles worse than in my right. So now I always do the calf stretches in addition to the throwers ten for my shoulder and the flexbar for my elbow.

^ It's amazing how we don't think about preventative, stretching and strengthening exercises, when the pros do it as a matter of course.

I'm really digging those eccentric 'step raise' exercises on the achilles. Feels like there's alot of controlled force going through the achilles' entire length. My achilles and calf is going to be super strong in a few weeks time!

Torres said:

^ It's amazing how we don't think about preventative, stretching and strengthening exercises, when the pros do it as a matter of course.

I'm really digging those eccentric 'step raise' exercises on the achilles. Feels like there's alot of controlled force going through the achilles' entire length. My achilles and calf is going to be super strong in a few weeks time!

Click to expand...

You don't think about preventative exercises until you feel the pain of an injury that you want to prevent in the future! Those calf raises do feel good and I think they help you with that first step pushing off the tennis court.

Played 2 hours on Monday, 1 hour on Wednesday and the achilles didn't flare. Played 3.5 hours today, and it flared towards the end. I've noticed a thickening / swelling / slight bulge at the back of the achilles. Its not as bad as the photo further above, but I can feel it with my hand. Instead of the back of the achilles curving inwards, it bulges very slightly outwards :-(

Got some ratings matches coming up at the end of this month, then after that, I might have to take a break or cut right back on the tennis.

^^^ I also got that bump in both of my Achilles tendons.

Presumably that was as a result of the tendonitis? What did you do by way of treatment?

I have to say I didn't notice any bump a couple of weeks ago so not sure if its appeared because of continued playing or those eccentric exercises....

I think it was due to the tendinitis. I used ultrasound, electrostimulation and heat mostly.

Torres said:

Presumably that was as a result of the tendonitis? What did you do by way of treatment?

I have to say I didn't notice any bump a couple of weeks ago so not sure if its appeared because of continued playing or those eccentric exercises....

Click to expand...

I would suggest iceing (bucket method) every day and especially after play, secondly use a foam roller in conjunction with the eccentric raises. That roller should be used on the entire calf and achilles area, great for hamstrings and quads as well. Initially you will notice knots (pressure) points and you will stop on those for 10-15 seconds to alleviate them. It's a little painful at first but you will notice a big difference after a few weeks.

Drak

1) Preventive Exercises & Stretches. Conditioning exercises & stretches intended for healthy tendons & muscles to prevent injuries might do more damage to injured tissue.

2) Rehab Exercises & Stretches. Doing rehab exercises without a Dr's diagnosis involving an ongoing injury issue is very risky. Also, rehab exercises and stretches have to be carefully selected based on the Drs evaluation and carefully supervised by a trained physical therapist. I've had injuries, diagnoses and physical therapy. Done right, I don't see another reasonable alternative.

3) "Tendinitis" is a term often trivialized by ignorant TV commentators regarding athletes. I have heard the phrase 'he/she has a little tendonitis' several times. I believe that commentators making such statements have no real idea of how serious those injury issues are. It sends the wrong message.

You should stop stressing your injured tissue - tennis is very stressful for the Achilles -and see a Dr.

I found the Pro-Tech Achilles Tendon strap very helpful.

Torres said:

Thanks Drak.

The right achilles flared again today after about 2 hours of a 3 hour session. Again, felt painful to push off after it flared.

Have seen the physio in the meantime. Had some ultrasound and massage. She said exactly what you said - eccentric, massage/loosen calf, ice achilles.

The eccentric exercises (to anyone else interested), are desgined to strengthen the tendon over its entire (not just part) of its lengnth. Same principle as with tennis elbow eccentric exercises. Basically, I stand off the edge of a step, sink down as far as it will go to stretch the achilles and then rise up on my toes. x10, x 2-3 times a day. Very easy exercise to do as well in terms of discipline, routine etc. Not sure whether it should be 2 footed or 1 footed, but I've been doing it with 1 foot.

Will see how things go over the next couple of weeks.

Click to expand...

Hi Torres,

I'd advise anybody who is currently feeling pain to do eccentric heel drops with two legs, and maybe even in a swimming pool to make it easier if that's where you need to start. Use your leg without the injury (and maybe your arms as well) to perform the "rise" part of the motion, then drop both heels very slowly, about 10-15 seconds. You want to emphasize the down/eccentric heel drop, and think of the UP motion just as a way to start the down/eccentric/heel drop over again. Yes there is a stretching component to the exercise, but that's not what it's really about. If you are doing this correctly, you will feel muscle burn.

Think of it this way. PT is just a fancy word for controlled destruction, you are tearing down muscle so that you can build it back up again with more strength. What the eccentric heel drop therapy does is re-groom all those little micro tears that havent healed properly. By that I mean, the body knows how to rebuild muscle withing the next 24 to 48 hours when it senses that it isnt up to the tasks it is being asked to perform. But chronic problems can arise when instead of taking a day off, you go out and play tennis the next day and the day after that. The muscle is trying to re-build itself, and you are asking it to do this work on the tennis court, so the muscle does not build itself up properly. There actually is still a debate over why eccentric stuff works, but the primary notion is you are re-grooming, re-building muscle in a very specific way that heals, as well as prepares the muscle to handle more stress loads.

The worst thing you can possibly do is push too hard, too fast, and too early in your PT. So when you are 100% certain that the two legged heel drops are working for you (or at least not causing additional pain) do them a little longer. Then move on to the one leg version. The Tortoise beats the Hare every time with Achilles PT. With the one leg heel drop, you want to use both legs on the rise, it's just a way to start the drop again.When you are certain the one leg versions are helping, just stick with it! you are then very close to the finish line. I will find some videos that show how to eccentric heel drops correctly and post them in my thread eventually. When I first posted about this in 2005, the idea was at the at the fringes. Now it's more mainstream, and with that, I'm finding to my horror legions of youtube videos that are poorly demonstrating the proper technique.

PS you need to stop playing for a while. and if you can't manage that, don't play two days in a row.

I'll keep in touch

Jack

Been finally doing 3x15s of 10 second eccentrics everyday for ~3 weeks now in addition to foam rolling and stretching and wearing the Achilles strap when possible. I've gained some strength for sure, pain is decreased, and the bump on my Achilles has definitely gone down.

Mornings are definitely never perfect, though. I bought a $30 night splint at Wallgreens yesterday and I'll see what that does. Felt pretty good this morning. Not the usual struggle to get it up to speed.

How is the night strap working out?

Champs990411 said:

Been finally doing 3x15s of 10 second eccentrics everyday for ~3 weeks now in addition to foam rolling and stretching and wearing the Achilles strap when possible. I've gained some strength for sure, pain is decreased, and the bump on my Achilles has definitely gone down.

Mornings are definitely never perfect, though. I bought a $30 night splint at Wallgreens yesterday and I'll see what that does. Felt pretty good this morning. Not the usual struggle to get it up to speed.

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A little annoying to sleep with but I wake up and the Achilles is already stretched out so I hit the ground running, so to speak. It doesn't need to warm up and I don't feel like those first steps are painful and therefor regressing the injury.

Haven't worn it recently as I'm dealing with a broken pinky on that foot. Will go back to it soon.

I think I injured my other one jumping into a pool today. Trying to drink the mental and physical pain away. Just dumped both lower legs in an ice bath.

My right Achilles is still giving me issues 5 years after the injury.