Achilles Tendinopathy (Achilles Tendonitis)

This is another of those injuries that was thought to be related to inflammation, but turns out to be a degenerative tendinopathy. I’ve had no experience with this at all, but post with your experiences and we can collect the best advice up here.

I will recommend that anyone dealing with this condition watch this talk by Jill Cook of La Trobe University, where she talks about what’s really going on in a tendinopathy.

Although it’s no longer up to date (Cook talks about how eccentric exercises are insufficient), the Running Writings Injury Series has two pages on this condition as well.

Jill Cook’s group is probably the leading research group in the world on tendinopathy, specifically in the lower limb. It’s now theorized that most cases of chronic tendon pain are related to this “degenerative” tendinopathy, and acute cases are “reactive” tendinopathies. The actual “why does it hurt?” is also still pretty debatable, but it’s theorized that small tendon cells die off in an inflammatory process initially and their cell matrix becomes disorganized. Chemicals in this disorganized matrix basically communicate with nerves when tension or compression is placed on the tendon. Insertional tendinopathies can be more symptomatic in positions with compression on the tendon. For the Achilles, that’s basically stretching into end-range dorsiflexion or the classic hanging off a step stretch. Tendons need tension to improve their load tolerance, so a heavy loading program for tendinopathy is currently the gold standard. Eccentric vs isometric vs concentric doesn’t seem to matter as long as the load is heavy and it isn’t making the tendon more symptomatic in a 24 hour window.

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I’ve been dealing with an Achilles injury over the past few months or so. It never really prevented me from running but it slowly got worse over time, creating a nasty pain when about midway during my runs. After consultation with a physiotherapist I got an exercise that requires one to stand on a stair with the ball of the foot on the edge of the stair, lift the foot so that you stand on your toes, then lift one foot from the stair so that you are standing one one foot only, and finally ‘push’ the foot back to the horizontal position.

By doing this exercise on a daily basis and only doing long runs much slower than I am used to do over the past few weeks, recovery has gone pretty well - I have not felt my Achilles after the first week. Higher speed workouts also do not seem to affect the Achilles that much anymore.

For me the key lesson wrt this injury was to consult a physiotherapist and follow a structured plan for training.

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Sounds like a version of eccentric heel raises—those seem to be recommended for a lot of lower-leg injuries these days.

Glad to hear you caught it before it prevented you from running and that you were able to come back quickly!

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When in doubt, load the calf.

In all seriousness, a lot of the tendinopathy research points towards loading the tendon heavy, regardless of contraction type (isometric, concentric, eccentric). It may be a little easier to reach appropriate loads with eccentrics because you’re forcing yourself to slow down against gravity. Definitely important towards end-stage Achilles rehab to work on plyometrics as well- the Achilles tendon stores and releases energy and is basically responsible for half of the energy we need to run. We don’t improve this quality with slow heavy strength training alone.

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I’ve been having this heel pain right in the middle of the heel pad on the underside of the right foot for about 6 weeks. I was running on it for a while but usually after only 30 minutes I could feel it rearing it’s ugly pain, then after 45 minutes it was really sore. I haven’t run now for 2 weeks. I also get pain from just walking on it after an hour or so straight (like walking the streets in our neighborhood or working around our yard). I don’t know if it’s plantar fasciitis or a bruise that won’t go away, or something else. I don’t recall landing on a rock/root during a run to cause a major bruise. The only time it’s sore in the mornings is if it’s really sore the day before. I’ve been loading the calves a lot with stretching and flexing. I’ve also been massaging the underside of the foot and arch with a rolling stick and with various sizes and hardness of balls.

If anyone has ideas or suggestions, please let me know. This is really frustrating especially since I only run about 20 miles a week as it is and my speed has really slowed the past years – it doesn’t seem as though I’m stressing my legs and feet enough to cause this kind of injury. Anyway, any suggestions are welcome!

Thanks-

Steve

Hi @steveshaum, I would check out the Plantar Fasciiopathy thread, specifically the toe-propped heel raise variation. If you have any questions about it feel free to message me directly (or email at jasontuoript@gmail.com).