Good physio for achilles pain in Sydney's inner west?

[MikeyJ]

So, my training for 210km of Around the Bay came to a grinding halt this morning when I had to abort a planned 130km ride after 75km when my left achilles flared up badly.

I've not changed the cleat position on the shoe for more than 12 months, nor the seat position, and I've never had trouble with my achilles before. I suspect this injury is just due to overuse with my increased training.

So, given there are three weeks before ATB, can anyone recommend me a physio in Sydney's inner west that will help me get myself in some sort of shape to be able to complete the 210km ride? I'd hate for all this training to go to waste.

[martin_12]

Unfortunately I can't recommend a good physio in the inner West, but I can recommend stretching and eccentric exercises. Stretching in a way that included eccentric exercise cured my chronic achilles problems several years ago.

Eccentric exercise involves lengthening your calf muscle while it is supporting load (your weight). You stand on your toes on one foot on a step with calf muscle contracted (toes down, heel up) then lower your heel until your calf muscle is fully stretched, all the time taking your full weight on that leg. Then lift yourself up again with you other leg and repeat. You should do a few reps with straight knee and a few with bent knee. In your fist session do only about 5 or 6 reps total because eccentric exercise does a lot of damage to the muscle and until you are used to it your calf will feel quite sore the next day. You need to find a step that you foot doesn't slip on.

If you search pubmed http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed for the words eccentric and achilles you will find quite a few references to this treatment. It is supposed to work best if the achilles injury is in the middle of the tendon and not so well if the injury is at the ends (insertion).
See for example http://www.ncbi.nlm.nih.gov/pubmed/9617396

Good luck

Martin

[MikeyJ]

Thanks Martin, I really appreciate your reply.

I've since found a physio in Leichhardt who's been very helpful and whom I'm seeing tomorrow. However, they took the time to have a decent chat over the phone with me this morning and outlined some basic steps I could take to treat it.

That achilles/calf stretch is the first thing she recommended for me and along with regular icing of the area and some Nurofen, I'm already into some rehab.

Fingers crossed I get myself into some sort of shape for the ride in three weeks' time.

[casual_cyclist]

Thanks Martin, I really appreciate your reply.

I've since found a physio in Leichhardt who's been very helpful and whom I'm seeing tomorrow. However, they took the time to have a decent chat over the phone with me this morning and outlined some basic steps I could take to treat it.

That achilles/calf stretch is the first thing she recommended for me and along with regular icing of the area and some Nurofen, I'm already into some rehab.

Fingers crossed I get myself into some sort of shape for the ride in three weeks' time.

I agree with you that it sounds like an overuse injury. With rest and appropriate rehab you should be fine. I wouldn't worry too much about losing all the work you have put in. My last 200km was my first ride back after a four month break. Sure it hurt, but I made it

[toolonglegs]

Also drop your saddle a bit and move your cleats right back...takes a lot of pressure of your tendon while it is healing.

[MikeyJ]

I agree with you that it sounds like an overuse injury. With rest and appropriate rehab you should be fine. I wouldn't worry too much about losing all the work you have put in. My last 200km was my first ride back after a four month break. Sure it hurt, but I made it

You're a tougher man than me, that's for sure. I almost died on my first ride back for three months in mid-July, and that was just 40km. Might have been something to do with my woeful underdressing for what since found out were near-zero temps

Also drop your saddle a bit and move your cleats right back...takes a lot of pressure of your tendon while it is healing.

Thanks for the tips - a bit of research had already suggested that moving the cleat back and adjusting the seat were sound ideas. Hope it does the trick.

[jules21]

i had the same issue and spent lots at the physio, who is unlikely to give you any magic advice. they will tell you the obvious stuff, as per advice above, as well as to ensure you stretch the calf/tendon. overuse causes progressive tightening - you need to loosen it by stretching.

my physio advised me that rest if it flares up is sensible, but not a solution. you need to address the problem - don't kid yourself that resting, then going back to the same habits will fix anything. i manage my achilles by spinning a low gear, stretching after rides, moving the cleats back and icing it if necessary. it doesn't go away, but it allows me to continue cycling.

[trailgumby]

+1 to the eccentric exercises.

I'd also like to recommend Martin Krause of Back In Business Physiotherapy at North Sydney. He is a cyclist himself and often has people (like myself) referred to him by bike fit guru Steve Hogg.

You know it's a good sign when he has a fluid trainer in one of his rooms - so make sure you take your bike so he can see you pedal.

No association with him except being a happy ex-client.

[MikeyJ]

Thanks again for all the info, guys. I've been religiously doing the eccentric stretches for the past two and a half weeks and the achilles feels great.

Now I've just got to manage the ITB pain that flared up on the weekend due to my adjusted seat being a fraction too low and throwing out my cleat alignment...

The ice bag in the freezer is my new best friend.