Achilles Healed???

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Achilles Healed???

Postby Squigs » Mon Aug 04, 2014 5:30 pm

Just over 6 weeks ago I strained my achilles while cycling (but could have also been influenced by doing a bit of soccer). I had a week of easy cycling after that and it started feeling quite normal, so I decided to go in a MTB race. During the race the strain seemed to come back as a dull ache and after the race it felt quite sore.

The next day I consulted a physio who gave me a few exercises, stretches and some tests to gauge how the achilles was healing. Also the physio said that I could still ride but take it easy. Over the past 5 weeks I had the first few weeks doing easy rides + the stuff the physio gave me but it didn't seem like it was healing at all, so over the last 2 weeks I've stayed completely off the bike and now it feels like normal and I can complete the tests the physio gave me.

Although it seems to be back at about full strength, the achilles still seems to be slightly larger than the other (although the swelling has gone down which I had when I first strained it). I was just wondering whether anyone else has had an achilles strain and is their achilles that they strained slightly larger than the other or does that indicate that my achilles is still not fully healed?

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by BNA » Mon Aug 04, 2014 10:23 pm

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Re: Achilles Healed???

Postby Parker » Mon Aug 04, 2014 10:23 pm

Go back to the physio
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Re: Achilles Healed???

Postby trailgumby » Mon Aug 04, 2014 10:35 pm

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Parker wrote:Go back to the physio

+1. Don't chance it. You don't want more weeks off the bike than you absolutely must have.
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Re: Achilles Healed???

Postby Calvin27 » Mon Aug 04, 2014 10:40 pm

Could be something worse so get it checked out by a second opinion. I 2 physios and 3 ultrasounds and they all told me different things. The issue could be 2 things. You either riding road for too long and the achilles needs more stretching or simply too much impact between soccer and MTB.

Mine turned out to be a tennis injury so my tennis physio was pretty much on top of it. That meant no tennis for 3 months even though it took about 6! Achilles don't really get used for road biking so my physio let me do riding. MTB however is out as you use this part heaps. Mine took about 6 months to completely heal and that mean no tennis or mtb (I did anyways just avoided the jumps and took it real easy (even might have bought a dually too haha). Unfortunately for me it never fully healed but is manageable if I keep stretching and doing exercises.
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Re: Achilles Healed???

Postby Dr_Mutley » Tue Aug 05, 2014 2:36 am

See a different physio?

How far behind the 1st metatarsophalangeal (MTP) do you have your cleat? U can easily unload your calf/Achilles complex by moving your cleat more rearward. If u do make sure u move both a similar distance rearward (assuming symmetrical foot length). Also, if you move your cleats rearward, u will need to drop your saddle height a little to compensate.
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Re: Achilles Healed???

Postby Squigs » Tue Aug 05, 2014 7:15 am

Thanks for the replies. I'll see if I can get to another physio.

Dr_Mutley wrote:How far behind the 1st metatarsophalangeal (MTP) do you have your cleat? U can easily unload your calf/Achilles complex by moving your cleat more rearward.


How do you tell where the 1st metatarsopalangeal is? Anyway I have always run my cleats as far back on the shoe as they go.
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Re: Achilles Healed???

Postby kb » Tue Aug 05, 2014 10:44 am

Dr_Mutley wrote:See a different physio?

How far behind the 1st metatarsophalangeal (MTP) do you have your cleat? U can easily unload your calf/Achilles complex by moving your cleat more rearward. If u do make sure u move both a similar distance rearward (assuming symmetrical foot length). Also, if you move your cleats rearward, u will need to drop your saddle height a little to compensate.

And if you're short like me, be aware of increased toe / front wheel overlap :-)
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Re: Achilles Healed???

Postby Parker » Tue Aug 05, 2014 11:23 am

It doesn't seem to me that you've even been back to the same phsyio that you saw. Normally you would go back to the same physio at least 1 extra time before throwing your hands in the air and concluding that it can't be fixed.

For example, seeing physio for ribs, I've had one appointment with him and I'm doing what I've been told... I have another appointment today to check progress... if I wasn't noticing a difference after three sessions then I'd consider seeing someone else.
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Re: Achilles Healed???

Postby nescius » Tue Aug 05, 2014 12:50 pm

The achilles tendon can take a long time to heal fully, I had a visible lump for at least a year after a bout of tendinopathy a few years ago. I was off the bike for 6 weeks then gradual return for a few months, I think it was around 6 months before it felt fully healed.
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Re: Achilles Healed???

Postby Squigs » Tue Aug 05, 2014 3:10 pm

Parker wrote:It doesn't seem to me that you've even been back to the same phsyio that you saw. Normally you would go back to the same physio at least 1 extra time before throwing your hands in the air and concluding that it can't be fixed.

For example, seeing physio for ribs, I've had one appointment with him and I'm doing what I've been told... I have another appointment today to check progress... if I wasn't noticing a difference after three sessions then I'd consider seeing someone else.


I have been back to the same physio twice over the past 5 weeks for treatment. It just hard to get into my physio easily because she is often booked out for up to 2 weeks.
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Re: Achilles Healed???

Postby Parker » Tue Aug 05, 2014 3:23 pm

Oh that's crap.
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Re: Achilles Healed???

Postby Calvin27 » Tue Aug 05, 2014 3:23 pm

My treatment was pretty much 6 weeks treatment (really deep tissue release) and graduation of exercises. Then moved to 8 sessions fortnightly. The first few sessions were the worst and I could barely walk for a 2 days. The thing is tendons take forever to heal and they are nothing like muscles or tissue. The physio pretty much said the rubs were just to release tension in the adjoining muscles which had been taking the load due to the tendon being injured.

After the sessions the physio pretty much said keep up with the exercises and come back for a rub once in a while when stretching wasn't cutting it. The most important thing is to make sure you do the exercises and don't get lazy. I pretty much stretched on the hour before and after bed + heat pack while watching tv. This took about 6 months before it was manageable - that is no more stiffness or soreness after MTBing or tennis. Physios are expensive so I just get a deep tissue massage once in a while. Physios will tell you not to do this (they are unqualified) but I trust my masseuse.

Now that it is manageable I still have to do about 3 sets of stretches throughout the day and sometimes ice after a heavy intensive session (of riding or tennis) and then heat pack when recovering. I learned the hard way to keep this up after I relapsed a little about 3 months ago.

I'm not sure how serious the injury is for you but don't be fooled into thinking the physio can just fix it and forget about it... unless you are under 25.
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Re: Achilles Healed???

Postby Squigs » Tue Aug 05, 2014 5:45 pm

I am under 25 so I am expecting it to heal quicker than someone who is 40+. When I first went to the physio she said that it would take about 3-6weeks (currently 5 and a half weeks in) to recover so I am thinking it wasn't too bad. She also said that I can go back to my normal training once I can do 30+ single footed heel raises without any pain or discomfort which I can already achieve. The only thing I was concerned about was that the injured achilles is about 4mm thicker than the other.
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Re: Achilles Healed???

Postby fatherofmany » Thu Aug 07, 2014 9:02 pm

Have been through tendonitis in both achilles tendons and you are describing a symptom which I had and which eventually disappeared. But it basically took a lot of rest and then a gradual increase in exercise until I am nearly back to normal 2 years later. The swelling (if the same as mine- disclaimer ;) ) is inflammation which needs time to heal. Being that tendons have bugger all blood flow, they take a lot longer to heal than muscle.

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Re: Achilles Healed???

Postby vosadrian » Fri Sep 05, 2014 12:04 pm

Hi Guys,

Just wanted to report my experience and ask a few questions.

I have been riding pretty seriously for about 3 years (aged 41 now). Last year I started racing and worked my way to A grade in the local crits. Typically riding around 200-250k a week normally in that time (100k commute and 100-150k on weekend), but up to about 400. I decided to do a charity ride that was in late June early July. It was 1000k in 6 days from Sydney to Byron Bay with a fair bit of climbing. I had worked up my riding in the months before to around 300-400 a week including a 130-200k ride on a saturday morning (I was going to be doing around 170 a day for 6 consecutive days). I did the ride and towards the end I started getting a tight sore heel in the morning (last two days). It generally loosened up as it warmed up. I knew nothing about Achilles Tendinitis and how it can become chronic. Of note is that during the long ride on a long steep climb (cat 1 with about 800m elevation and long periods of around 15%). I followed a suggestion from another rider of dropping my heals and ankling as a method to alter the muscle use and move the pain around on long painful climbs. I think this may have contributed to the heel pain.

After the long ride I had a day off and then did a slow cruisey 80k recovery spin ride on a saturday. Pain was similar to the last day of ride as it loosened up as I warmed up. I decided to take a few days off. This is when I started researching my issue and realising I had an Achilles issue. The pain eased during the few days off, so I rode to work and it returned again.

I went to see a sports physio who said I had Achilles Tendonopathy (same as Tendinitis). He gave me some stretches and told me to stay off the bike a week. Saw him a couple more times and he continued with stretches and advised low intensity short commutes to work. Did this and no real change over about a month. Pain was constant. I saw my GP, and got a CT scan done (clear from any hard tissue issues in bones etc.), and an ultra sound done. This was confusing. It revealed some mild bursitis in the bursa between Achilles and heel bone, but no Achilles issue itself. Having said that, the operator seemed to see the bursitis and spend lots of time with that assuming that was the issue and we were done in a few minutes. The pain I experience is higher up than the bursa (although I get some pain lower also), and the GP concluded they had not been thorough with the ultrasound. I took a couple weeks off cycling on the GP advice and only towards the end of that did it really start to improve. I then went back to low intensity short riding and it came back pretty quickly to the original level of pain. At this point I was frustrated. The physio I was seeing was not getting me to do the eccentric heel drops that seemed to be all over the internet as the best solution for Achilles Tendinitis.

I found a new Physio who is also an accomplished cyclist. They got me straight onto heel drops. Been doing them for a few weeks now (straight knee and increasing to around 10kg in a backpack, but not dropping heel very low below toes) combined with low intensity rides. Also I ice after each ride, so typically twice a day if commuting. I had one brief period about a week ago where it felt better. I could still feel it all the time it but it had a warm feeling of an old injury that is well healed rather than the angry feeling it normally has. I could walk up and down stairs without limping or pain. Then last weekend I was moving some stuff in my garage and was forced to take a quick step to catch something onto my bad leg, and it did not like that (neither did my knee!!). Also the Physio suggested a couple of short medium intensity efforts to guage how it handles that. It felt OK during, but towards the end of the ride it was more painful and has taken the best part of a week to return back to "normal" painful. This could also be the strain last weekend. This is where I am at now.

It feels like I have made no ground on this, but it is possible I have and just does not feel that way. Normal for me is constant pain but very low when not using it. I can normally walk without limping, but if I increase walking pace it hurts and I do limp. I have adjusted the way I descend steps. If I ride 10k really slowly (like 20kph and HR around 110-120) it does not seem to get worse. If I get into it a bit (25 kph and 130-140HR), it gets a bit worse. It is not that painful when I do heel drops, but is a little painful if I drop further below the step.

I am seeing the Physio again tomorrow. I want to ask about reducing riding to little or none and maybe replacing with swimming to keep fit. I may ask about cleat positioning if I do keep riding. I am going on a holiday with my kids in 2 weeks and want to be able to ride with my family up to around 40k during that time. I am willing to lose some ground on this during that time as it is an important activity for my family. I can regroup after the holiday.

I was just wondering if you guys could provide any advice. I see lots of reports from runners with this, but not many from riders, so I was just wondering the following:

* Can you describe the "normal" pain you experience and when. For me the pains is always there. The heel never feels normal, but a week ago it felt OK. I need to stretch my ankle in the morning as I get out of bed, and it takes a minute or so to loosen up in the morning. Then it goes to normal. Runners most often seem to report no pain except when running. I am wondering if cyclists get more like that or like what I am experiencing. When I ride it is generally not much more painful than walking unless I ride at higher intensity or longer, and then not much more pain during, but I will get pain afterwards and the next morning.

* What worked for you? Any suggestions on things I can ask my Physio about.... more rest? Change bike setup (cleats)? Maybe change bike and ride my MTB with lower gearing and normal (not clipped in) pedals. Any experts in Sydney who I could see?

I don't like the idea of a recovery lasting many months, but I am stuck with that. The main thing I need to do is make sure I am recovering and not plateau or getting worse. I may be doing too much of everything or I may not be doing anough of something that can really help. Just want to make sure I am on some road (albeit a long one) to recovery. I also realise it is likely I will need to manage this in future, but would be great to be able to get back to a level where I can race and do 100k rides again.

Sorry for the essay. Maybe my experience documented here can help someone else in future.

Cheers,

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Re: Achilles Healed???

Postby Calvin27 » Fri Sep 05, 2014 12:30 pm

vosadrian wrote:* Can you describe the "normal" pain you experience and when. For me the pains is always there. The heel never feels normal, but a week ago it felt OK. I need to stretch my ankle in the morning as I get out of bed, and it takes a minute or so to loosen up in the morning. Then it goes to normal. Runners most often seem to report no pain except when running. I am wondering if cyclists get more like that or like what I am experiencing. When I ride it is generally not much more painful than walking unless I ride at higher intensity or longer, and then not much more pain during, but I will get pain afterwards and the next morning.

* What worked for you? Any suggestions on things I can ask my Physio about.... more rest? Change bike setup (cleats)? Maybe change bike and ride my MTB with lower gearing and normal (not clipped in) pedals. Any experts in Sydney who I could see?

I don't like the idea of a recovery lasting many months, but I am stuck with that. The main thing I need to do is make sure I am recovering and not plateau or getting worse. I may be doing too much of everything or I may not be doing anough of something that can really help. Just want to make sure I am on some road (albeit a long one) to recovery. I also realise it is likely I will need to manage this in future, but would be great to be able to get back to a level where I can race and do 100k rides again.


My pain was exactly as you described. Pain in the morning, but unlike most internet stuff higher than where the heel spurs are meant to be. Loosens up over time but always back in the morning. I'd say I had the same thing. I didn't feel pain when it warmed up and even during rides/other sports though. But afterwards it definitely felt like someone had taken to it with a mallet - dullish sort of pain unlike the sharp pain in the morning. I wouldn't stress about the CT or ultrasound. I went to three different places and they all told me different things. If you only do cycling, stick to the cycling physio. For me it was cycling and tennis, but more tennis so I saw a tennis physio. Eventually it got worse and worse to the point that it was just sore and painful for most of the day so I decided to just take the rest.

What worked for me? Unfortunately for me 6 months off impact sports. However, for me the damage was more-so impact related (hard court + MTB) so what that meant was no more tennis for half a year and buying myself a dually :D . Road riding was ok and I could do this throughout the recovery phase but I had to be careful not to go at it for too long. I pretty much only did max 80km rides, but with strict conditions. Very comprehensive stretching beforehand, stretch at least on the hour when going for a piss, eating or whatever and even stretching when doing short coasting on the bike. The last bit helped a lot but don't confuse this with what you mention as changing the way you pedal by moving the heel. This puts more strain on the Achilles. What you want is to just coast, keep the pedals still and stretch the achilles at the 6 o'clock position. I did this quite frequently and was the only I could actually get off the bike and not feel sore/painful.

I also did the set of prescribed exercises which eventually graduated to light jogging on grass and sprints (3 months to get to this stage). The sprints were the best in terms of balancing flexibility and strength in that range of motion. I found up hill sprints to do this the best but I wouldn't be going out for a ride the day after because your legs will be shot. During this whole time, the advice was to stretch stretch stretch. I was prescribed 3 dedicated stretch session a day as minimum including a special set for pre-getting out of bed. In actual fact I probably did about 20 mini stretch sessions a day. You can't get enough of this and this is super important. The reason why you have issues on the roadie is not because it is causing your tendon to be damaged, but because it is never used for long periods causing it to be stiff. Even now that I am considered 'recovered' I'm still hitting up about 10 stretches a day and religious about pre game/ride. My Achilles still feels a bit off if I don't keep this up but it's a small price to pay for keeping it in nick.

As for recovery, I found ice to be terrible. It worked great post exercise but the next day would be ridiculously stiff. If you think about it, ice is for reducing inflammation and heat for blood flow (recovery). As I mentioned, my approach was to avoid all injury causing activities (tennis, hard MTBing) so ice was not really needed. Like I said road riding doesn't cause the injury, it just make it worse because you don't maintain flexibility. So all I stuck to was heat since I was after the recovery part. I have no idea how well this worked as I pretty much did it in parallel with everything else that was recommended but I personally felt a lot better after heat. This was not under any doctors orders, just something that I tried so keep that in mind.

Finally, there was quite a bit of massaging going on. Foam roller for thighs and stuff to make sure at least that part of my legs were in good condition, and then physio for calfs and Achilles. These sessions hurt like hell and I had some trouble walking afterwards. Important thing is not to let it sit, keep stretching even if it hurts.

So pretty much in a nutshell LOTS OF STRETCHING.
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Re: Achilles Healed???

Postby nescius » Fri Sep 05, 2014 1:40 pm

I had similar symptoms, pain in the morning but loosened up during the day and felt ok by the evening. My partner is a physio so I had ready access to treatment any time I wanted. It was painful to walk for the first week or two and I couldn't ride at all, there was a visible lump on my achilles and there was some nasty crepitus (crunchy feeling) when moving my foot.

Treatment was eccentric loading of calf and tendon and copious amounts of massage. Not so much stretching, there was some reason not to but I can't remember what it was. There was also a lot of rest, 6 weeks off the bike and no other training with the only physical activity being the calf exercises. It feels like a long time but in the grand scheme of things it wasn't that long and it was better to let it heal properly before it became a fully blown chronic condition. I didn't make any changes to my position on the bike or cleats or anything like that. This was probably 4 or 5 years ago now, so I was 32/33 at the time, it's fine now and I generally ride around 300km a week. I'll only notice a slight tightness in that calf after a particularly long or hard ride, and a little bit of massage/foam roller sorts it out.
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Re: Achilles Healed???

Postby Calvin27 » Fri Sep 05, 2014 2:17 pm

nescius wrote:Treatment was eccentric loading of calf and tendon and copious amounts of massage. Not so much stretching, there was some reason not to but I can't remember what it was.


What's the difference between eccentric loading and stretching? I might be referring to the wrong thing..
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Re: Achilles Healed???

Postby vosadrian » Fri Sep 05, 2014 2:47 pm

This is all so confusing. The first physio I saw was all for stretching. I went on his advice for a month and had virtually no change. His advice had been stretches around calves, achilles, ham strings etc. Also riding at low intensity for most of that. My new physio said the stretching was likely to aggravate it. New physio is into eccentric loading, and a few stretches mainly around ham string and foam roller on calves, thighs etc. but no specific stretches of Achilles itself. Both have suggested keeping some level of activity (riding) up and that full rest is not ideal as need to move and get blood flow to heal properly. I actually forgot to mention that I was doing foam roller above.

Eccentric heel drops are where you stand with toes on a step. Use your good leg to raise body to stand on toes. Use the bad leg to drop slowly (lengthening the calve muscle which makes it eccentric) until heal below the step (ideally to full range of movment, but I am doing less at the moment). Then repeat. 3 sets of 15 twice a day. This is the rehabilitation program that has the most support on the net. I am happier with new physio that wants me to do this since most of what I read is that eccentric loading is good and stretching may be bad.

Does anyone know about swimming? It looks like I have to be off the bike for a long period (perhaps 3 months). Hoping to keep some level of fitness, but maybe I just have to let it go.

Nescius, any more details on the massage? Is that deep massage of the injury itself on the tendon, or of the calf/thigh to reduce general tightness that then pulls on tendon? I wish my wife was a physio now!!

I felt in a good place this time last week, as it felt better than it had. Not sure exactly what damaged it, but pretty annoyed to regress.

Thanks for the tips guys... keep them coming!
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Re: Achilles Healed???

Postby Calvin27 » Fri Sep 05, 2014 3:32 pm

vosadrian wrote:This is all so confusing. The first physio I saw was all for stretching. I went on his advice for a month and had virtually no change. His advice had been stretches around calves, achilles, ham strings etc. Also riding at low intensity for most of that. My new physio said the stretching was likely to aggravate it. New physio is into eccentric loading, and a few stretches mainly around ham string and foam roller on calves, thighs etc. but no specific stretches of Achilles itself. Both have suggested keeping some level of activity (riding) up and that full rest is not ideal as need to move and get blood flow to heal properly. I actually forgot to mention that I was doing foam roller above.

Eccentric heel drops are where you stand with toes on a step. Use your good leg to raise body to stand on toes. Use the bad leg to drop slowly (lengthening the calve muscle which makes it eccentric) until heal below the step (ideally to full range of movment, but I am doing less at the moment). Then repeat. 3 sets of 15 twice a day. This is the rehabilitation program that has the most support on the net. I am happier with new physio that wants me to do this since most of what I read is that eccentric loading is good and stretching may be bad.

Does anyone know about swimming? It looks like I have to be off the bike for a long period (perhaps 3 months). Hoping to keep some level of fitness, but maybe I just have to let it go.

Nescius, any more details on the massage? Is that deep massage of the injury itself on the tendon, or of the calf/thigh to reduce general tightness that then pulls on tendon? I wish my wife was a physio now!!

I felt in a good place this time last week, as it felt better than it had. Not sure exactly what damaged it, but pretty annoyed to regress.

Thanks for the tips guys... keep them coming!


OK, so clarification, I have been doing the eccentric stuff and stretches - sort of like a lunge but with bent leg. My physio recommendation was about the same - 3 sets of 15 3 times a day. I asked if I could over do it and he said go for your life so I did and so far it has worked out pretty well. For me I don't have a good leg :( so it was both feet with one supporting the other.

I took up swimming to at least try to maintain a level of fitness but it's all different. Swimming is how long you can go without breathing. Cycling is how long before your legs/lungs explode. Also watch out for swimming because the kicking foot usually means the tendon is in a relaxed state. I can only manage a 45 minute session, but if you're strong swimmer, don't keep it in this position for too long. It will be the same as cycling. I did swimming twice a week and mixed that with a lot of upper body and core stuff. The struggle will be keeping up the cardio. It is quite manageable. The hardest thing is trying to eat less because I wasn't doing a lot of high intensity frequently including massive weekend rides.

The massage is around the calf area. For me it was stiffness on the outside leg. The theory is relaxed muscles around have better ability to take the load and less to the tendon.

As for regressing. Don't worry about it. I've regressed twice already. But each time I am aware of it straight away and don't push it. I am at a stage where I know how much it can take so I try to keep within limits - you'll get there too.
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Re: Achilles Healed???

Postby nescius » Fri Sep 05, 2014 3:34 pm

Calvin27 wrote:
nescius wrote:Treatment was eccentric loading of calf and tendon and copious amounts of massage. Not so much stretching, there was some reason not to but I can't remember what it was.


What's the difference between eccentric loading and stretching? I might be referring to the wrong thing..

Eccentric loading is applying the load while the muscle is lengthening (as I understand it anyway) while stretching is applying load to a static muscle (I think that makes sense?). I'm not an expert, I just do as I'm told :P

vosadrian wrote:Eccentric heel drops are where you stand with toes on a step. Use your good leg to raise body to stand on toes. Use the bad leg to drop slowly (lengthening the calve muscle which makes it eccentric) until heal below the step (ideally to full range of movment, but I am doing less at the moment). Then repeat. 3 sets of 15 twice a day. This is the rehabilitation program that has the most support on the net. I am happier with new physio that wants me to do this since most of what I read is that eccentric loading is good and stretching may be bad.

yep, this is exactly what I did.

Massage was applied to both the tendon itself to try to break up scar tissue and reduce the size of the lump and to the calf muscle to reduce general tightness etc.
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Re: Achilles Healed???

Postby vosadrian » Fri Sep 05, 2014 4:28 pm

Thanks guys!

I am interested in the massage of the tendon. Will ask the physio about that. I give the calf and thigh a good roll with the foam roller once a day. Maybe I should do more. Not sure how that compares with a proper massage.

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Achilles Healed???

Postby Dr_Mutley » Sat Sep 06, 2014 1:48 am

Treat the causative factor here... Overloading of the tendo-achilles complex... Therefore move your cleats back a couple of millimetres at a time, along with saddle down a similar amount until your Achilles becomes less symptomatic... Combine this with sustained stretching (ie heel drops off a step for several minutes at a time) until resolution of the problem.

If it's more the medial (inside aspect) of your Achilles then assess if your arch is collapsing under load and correct as necessary... Also consider varus wedging if arch correction is sufficient...
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Re: Achilles Healed???

Postby NeillS » Sat Sep 06, 2014 7:07 pm

It's obviously bike position related, if cycling caused it and continues to be the major irritant. I've only skim-read the wall of text but I also assume it's only one foot that's affected? If so, ask yourself why; clearly you are functioning assymetrically on the bike at some level which is causing distress to the gastroc/soleus complex. If the scan was clear, it's likely that it's not tendinopathy at all - you can fairly reliably see calcific/inflammatory tendon injuries on an MRI (you said CT scan but nobody does CT's for tendon issues so I'll assume it was an MRI).

Reasons for functioning assymetrically are multitudinous. Too many to mention.

Reasons for irritating the achilles whilst cycling are much fewer. In order of likelihood;

- Cleats too far forward
- Saddle too high
- Saddle too far forward
- No arch support in cycling shoes
.... and a few others.

In short, correct the bike position issue first and see if it all disappears. Therapy for these is usually useless unless the person has a good grasp of identifying the causative factors and removing them. The first step is to remove any deep soleus trigger points which often cause these pseudo-tendinopathies by creating a shearing effect within the achilles tendon as the length-tension relationship of the gastroc and the soleus is altered outside of normal values. Dry needling is the go first up - but needs to be done by someone with good touch and accuracy.
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Re: Achilles Healed???

Postby vosadrian » Mon Sep 08, 2014 12:11 pm

Thanks for the info guys.

I had a bike fit done (Specialized BG fit) about 18 months ago. They noted my left Femur to be longer than right and compensated for this with offset cleat positioning. I run S-works shoes with SPD-SL cleats. I also have Specialized orhtotics and wedges underneath them as a result of the fit. The right cleat is position "Neutral" and the left is 5mm further back that the right. The left is the side that I am having issues on. I have done a lot of riding since the bike fit... probably around 15-20,000kms without any issue. But the most I did in a week was around 500kms. Then I did 1000kms in a week and had issues. So it is possible my fit is not right and that my body could cope as long as I did not over do it, but 6 consecutive days of 150+kms did overdo it. It is also possible that the fit is right, and my body just did not like to do 2-3 times the normal kms without any recovery inbetween.

I have not had an MRI done. I did have a CT and ultrasound. CT was looking for any bone issues and came up clear. Ultrasound revealed fluid buildup on bursa but no issue with Achilles. GP can Physio can feel a thickening in the Achilles, so we suspect Ultrasound was not thorough. I wish I had an MRI done now. I may see if I can get one.

I am thinking of using my MTB with old school pedals and some runners for a couple weeks for my commute. Just put the pedal on the arch and should reduce Achilles loading? Another benefit is the gearing should reduce the loading of some hills I have to get up (I hit 15% on my commute and no way to avoid).

Also, I just joined the work gym with a 25m pool, so going to try swimming instead of riding for some cardio work to see how that works out. I am tempted to just stay off the bike for a few weeks and only swim?

Thanks again guys.
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