Eccentric Protocol for Achilles Tendinitis

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  • Anonymous Achilles Tendinitis

    • Age 55+
    • Male
    • 147 lbs
    • 5' 9"
    • Bridgewater NJ
    25
    Apr2016
    • Injury Status In Pain
    • Physical activity per week 4-8 hours
    • Chronicity 18+ Months
    • Repeat injury? No
    • Runner No
    • If Runner? change in mileage or terrain No

    Treatment Ratings

      Not Improved
      NSAIDs - Anti Inflammatory drugs, Strassburg Sock, Strengthening Exercises, Stretching, Eccentric Protocol, Brace, Rest, Shockwave, Ice, Orthotics, Physical Therapy, Compression Socks

    Partial tear of Achilles playing competitive tennis. Still feeling the effects over two years afterwards. Have tried many treatments. Orthodics, NSAIDs, and high quality brace have been the most helpful but not enough to resume competitve play. Discouraged.


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  • Anonymous Achilles Tendinitis

    • Age 55+
    • Female
    • 200 lbs
    • 5' 6"
    • Austin, TX
    24
    Apr2016
    • Injury Status In Pain
    • Physical activity per week 4-8 hours
    • Chronicity 18+ Months
    • Repeat injury? No
    • If Runner? change in mileage or terrain No

    Treatment Ratings

      Not Improved
      NSAIDs - Anti Inflammatory drugs, Ice, Massage, Rest, Taping, Eccentric Protocol, Heel Lifts, Stretching

    Nothing has worked, Currently trying pulsed EMF therapy. It does relieve pain temporarily, but has not helped on a more permanent basis.


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  • rosebourne Achilles Tendinitis

    • Age 55+
    • Female
    • 250 lbs
    • 5' 8"
    • Prince Frederick Maryland
    22
    Apr2016
    • Injury Status In Pain
    • Physical activity per week 4-8 hours
    • Chronicity 0 - 6 Months
    • Runner No

    Treatment Ratings

      Improved
      Rest
      Not Improved
      Stretching, Supportive Shoes, Eccentric Protocol, NSAIDs - Anti Inflammatory drugs, Massage, Ice, Orthotics, Physical Therapy, Strengthening Exercises

    It hurts when I try to walk. And when I sit down and try to get up, it stiff up on me. So I have a hard time trying to walk around.


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  • 10
    Feb2016
    • Chronicity 18+ Months

    Treatment Ratings

      Cured
      Surgery
      Almost Cured
      Boot
      Improved
      Eccentric Protocol, Rest, Massage, Physical Therapy, Other
      Not Improved
      Platelet Rich Plasma Injection, Acupuncture, Orthotics

    I could write volumes about achilles tendinosis. I've had it off and on (bilaterally) for the better part of 18 years. It has been a significant limiter to my training and race participation over the years. I've spent $1,000's in wasted entry fees and canceled travel plans. Looking on the bright side, I've learned to think positively, to persevere, and most importantly not to take this sport too seriously. Anyhow, here's a summary of my experience:

    July 4, 1997: pain started in left AT. After 4 months of physical therapy including all the standard stuff: rest, ultrasound, cross friction massage, iontophoresis I could run again at an acceptable level of pain.

    1997-2006: fluctuating pain levels in both ATs. These nine years of running/cycling frequency dictated by pain levels. Saved hard/long runs mostly for race day. Tried just about every non-surgical remedy under the sun, multiple times. gazillion doctor visits, more physical therapy, MRI's, eccentric calf raises, pissed a lot of money on useless orthotics. I spent a significant amount of time researching tendinosis and discovered that most orthopedics and podiatrists really don't know what to do. I saw a dozen different doctors over this time period confirming this at least for me. You can confirm this as well: arm yourself with list of questions requiring concrete, detailed responses prior to visiting your doctor and watch them squirm for answers. (One supposedly world-renowned ankle reconstruction orthopedic didn't even attempt to find a solution, looking me straight in the eye instead and said nothing could be done; I should stop running and play golf)

    July 2006: By this time, I couldn't run more than 10 feet. Left AT was a mess. After more research, I concluded that topaz microdebridement surgery might work for me. I flew from Fla where I was living at the time to Santa Monica, CA to have the procedure done by a podiatrist who appeared to have some success with procedure. Surgery required general anesthesia. Post surgery, non-weight bearing boot for 2 weeks, followed by weight bearing boot for another 4 weeks. I wasn't able to run for 7 months - long rehab period. However, after 7 months I was cured. No more pain. Unfortunately, soon afterward, my right AT became more of a limiter.

    Nov 2009: Went back to Santa Monica for my right AT (now living in CA). Tried PRP. Fail.

    Dec 2009: Topaz microdebridement on my right AT. I was a better patient this time so rehab was more like 5 months. However, this time I'd say the success was about 80%. A portion of the painful tendon didn't fully heal but was good enough to run somewhat unimpeded.

    ~2012: right AT getting more bothersome and hampered running.

    ~2013: MRI on right AT. Tendinosis confirmed. tried acupuncture, more PT, loads of eccentrics to no avail.

    August 2014: pain in right AT (which had been pain free for 8 years) came on strong day after race. Now I have it in both legs again.

    October 2014: went back to Santa Monica. Tried PRP twice in both legs over 8 week period. FAIL. In my view, PRP sucks and is a waste of time and $. I knew that before but, against my better judgement, allowed the doc to talk me into it. $1,500 down the tubes.

    March 2015: Here's where it gets interesting, at least to me. After more research and internal reflection, I decided to go to the king of achilles tendons. So, I contacted Hakan Alfredson in Sweden (of the Alfredson eccentric protocol fame) and booked an appointment to see him.

    March 28, 2015: Flew from CA to Umea, Sweden. Three days later, I was on the table and Prof. Alfredson was performing bilateral AT surgery (ultrasound+Doppler-guided mini-surgical scraping). It was under local anesthesia. I felt no pain. The surgery took about 1 hour and I got up from the table and walked back to my hotel room which was about 200 yrs from his office. By the way, nobody in the U.S. is doing this yet. And, it's been a successful procedures to the many professional athletes that travel from all over the world to see him. I flew home on 4/2.

    April 4, 2015: Here it is less than a week after bilateral surgery and I am walking almost normally and with no pain. I can't believe it. The rehab procedure calls for me to begin light running in 5 to 7 weeks, and I am very hopeful that this works. Here's some info on his procedure:

    http://omicsgroup.org/...ts-2165-7025-213.pdf


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  • 10
    Feb2016
    • Injury Status Cured
    • Runner Yes

    Treatment Ratings

      Cured
      Ice, Eccentric Protocol, Stretching, Strengthening Exercises

    I struggled with chronic achilles tendinitis and crepitus after a stress fracture. I started doing a ton of heel drops/raises (like at least 2-300/day) and it went away.

    As a tip, though - I also recommend supplementing the calf exercises with some shin strengthening, ie writing the alphabet by pointing your toes, etc. Too much calf strengthening without doing the same for the opposing muscle will create some bad shin issues.

    Lastly, stretch your calves, roll them, anything to keep them loose, and ice the achilles. I like the method of freezing water in a paper cup peeling the top.


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  • 10
    Feb2016
    • Injury Status Cured
    • Chronicity 18+ Months
    • Runner Yes

    Treatment Ratings

      Cured
      Rest, Night splint, Eccentric Protocol, Other

    I've struggled with Achiles issues since I started tri's / running (2009). Got through last year and IMMOO, but had a flare-up in the last week or so.

    I dialed back my running, but kept at it. If your pain allows do shorter runs for a week or two (3 miles or so). You won't lose much run fitness. After a week or so, see if you can do a day or 2 of 2x the runs.

    Slowly rebuild from there. You have plenty of time to hit top form for August, but you gotta take the steps now to correct it.

    Are you doing your heel drops with a weighted backpack? If not, start it now. Otherwise you are wasting your time with the exercise.

    You mentioned pain while riding...are your cleats all the way back (towards the heel)? If not, do it now. Helps alleviate stress on the Achilles while riding.

    Get a wobble board and do one-legged stands on it. Get a balance pad and do one-legged squats. Anything to help stabilize the kinetic chain of your leg.

    Strongly suggest looking into run / walk as well. Start off at 3-4 min run / 1 min walk. Work your way up to 1 mile run / 1 min walk. This conveniently comes close to the aid station placement for a HIM. It will help alleviate the stress on your calf while running and give it a chance to relax.

    I have found a heating pad to be therapeutic, as well as a night splint. Swimming was also massively therapeutic for me, so take this time to up your swimming.


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  • 10
    Feb2016
    • Injury Status Cured
    • Chronicity 0 - 6 Months
    • Runner Yes

    Treatment Ratings

      Cured
      Ice, Massage, Eccentric Protocol, Heel Lifts, Stretching, Strengthening Exercises
      Almost Cured
      Boot
      Improved
      Taping

    Three years ago as a HS sophomore, I had severe achilles tendinitis and crepitus (the creaking sensation that comes with bad tendinitis) when coming back from a stress fracture that had me on crutches and in a boot. I was able to kick it within about 8-10 days (while cutting running back to only easy runs on flat surfaces, length was typically not an issue as long as pain allowed). The things I did were:

    1) Lots and lots of heel drops/calf raises. Hundreds every day.

    2) Ice after every single run using a dixie cup with water frozen in it. These were really great in reducing inflammation as soon as I finished running.

    3) Roll and stretch the calves, preferably right after the heel drops/raises.

    4) Strengthen the ankles - practice standing on one foot. Do sets of 1 minute at a time, for each leg.

    5) In order to continue to be able to train, the PT I worked with cut me a piece of cork, about 1/4 of an inch thick. It was shaped to allow it to fit under my heel under the insole of my shoe. These helped take stress off of the calf while still letting me run.

    6) One other thing I believe helped me a lot was KT tape. The jury is still out on its effectiveness, but it did help me manage the pain and continue to run through the injury. The image at this link shows the tape pattern my PT used on me: http://rosaninstones.nl/...-tendinopathy-i2.png

    7) Cross train with other activities if pain doesn't allow running - I spent a lot of time riding a trainer and pool running when I was able to get to the pool. Riding was great because it increased blood flow without much flexion of the ankle area.

    I was racing well within 14 days of my achilles flaring up


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  • 10
    Feb2016
    • Injury Status Cured
    • Chronicity 18+ Months
    • Runner Yes

    Treatment Ratings

      Cured
      Rest
      Not Improved
      Physical Therapy, Massage, Taping, Eccentric Protocol

    Mid-30's, been running an avg of 20 mi/week, on the low end, for the past 15 years. After a move across the country I took about 3 years off of racing and then decided to get back into it (running/racing). My cardio was good so I just got back into the proverbial saddle and then Achilles pain began to creep. Got to the point where it was extremely painful to get out of bed in the morning and would bring me to a hault mid-run.

    After seeing a PT for several months, taking off a few months here and there, eccentric stretching/strengthening, KT tape, massage therapy, etc. The pain continued to come back time and time again. Very demoralizing, indeed.

    The solution? Well the probablem is I can't say with absolute certainty that this was the cure...and it's certainly not the answer you probably want to hear but quite simply, it's time off. I became so frustrated that I gave up running and endurance sports for over two years. I lifted weights and rock climbed a couple of times a week but that was about it for physical activity. Even so, there would be days where my Achilles would hurt just a little bit...as if to remind me that I could no longer run.

    Then after a long winter and a few months of not noticing any residual soreness, I decided to give it a go again. In May I began running with the mindset that if I ever started to feel the pain I would stop. My cardio was embarrassing (and my weight had jumped 40 lbs from my racing peak) but in a way it was good because it prevented me from going too far, too fast. I began doing 1-2 miles 2-3x week and SLOWLY progressed from there with stretching before-and-after every run and applying cold after each run.

    Now I'm back to about 20 miles a week (as I said, taking it SLOW) and I'm cautiously optimistic. I was just talking with my wife earlier about how excited I was with my lack of Achilles pain and am planning on a 70.3 next year (either Tempe or Lack Stevens). If all else fails and if you absolutely do not want to go the surgery route, take the time. Don't give up hope and let yourself get fat and out of shape as I did, but avoid running and explosive actions (e.g. box jumps).

    In my completely ignorant surmise, it wasn't until I gave up on ever correcting the problem that I was able to leave my Achilles alone long enough for it to recover. Take from that story what you will. I'm sympathetic to anyone with a similar injury and wish there were better understanding of the healing process in this particularly situation.


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  • 10
    Feb2016
    • Injury Status Cured
    • Runner Yes

    Treatment Ratings

      Cured
      Ice, Massage, Acupuncture, Eccentric Protocol, Stretching

    1) Eccentric Calf drops, 60-100 per day
    2) Roll It - believe it or not, I used a wooden rolling pin.
    3) Massage
    4) Ice
    5) Acupuncture (works better for some then others but worth a shot)
    6) Stretch

    I tried to fix it on my own, no luck. Followed the above regiment and was back in business in no time. I couldn't run 2km without having to stop dead in my tracks. Now I'm back up to 20km runs with no problem. Follow it like clock work and you will get back sooner, casually follow it and it will take much longer.


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  • 10
    Feb2016
    • Injury Status In Pain
    • Chronicity 6-18 Months
    • Runner Yes

    Treatment Ratings

      Improved
      NSAIDs - Anti Inflammatory drugs, Massage, Stretching, Other
      Not Improved
      Physical Therapy, Acupuncture
      Worsened
      Eccentric Protocol

    I've been managing achilles tendonosis for a year now, after running for the Wounded Warriors foundation last September. I'm male, late 30's, long commute and long days stuck in an office chair - run 3-5 miles 2 or 3 days a week (for 20 years now), so pretty much the classic tendonosis candidate. I've been to a variety of specialists, from podiatrists to orthopedists to ART/graston, to accupuncture. Here's what's working, and what's not - would appreciate some guidance, as I'm loosing hope...

    Oct 2014: Physical therapy - helped loosen the calf/hips, but pain remained; started riding stationary bike to get cardio in, stopped running altogether (maintained stationary bike until recently - see below)

    Nov: Oral steroids prescribed by 1st orthopedic surgeon - slight reduction in swelling, but came back 1-2 weeks later

    Dec: deep tissue massage at podiatrist office a few times a week - helped but became too expensive and too tough to get there with my hectic schedule

    Jan: orthopedic surgeon recommended surgery - first time I "ran" since Sep, as in running right out of his office

    Feb: tried ART/Graston - first once a week, then twice a week; started Alfredson protocol (eccentric heal drops), but with no weights

    Mar: ART/Graston helping quite a bit, but felt like eccentric heal drops making it worse, or at least preventing progress - stopped doing them after 4-5 weeks

    Apr: Chiro performing ART/Graston suggested slow running to get blood flowing - started nice and easy and progressed VERY slowly. Running in Glycerin 13 (Brooks), and hard orthotics (been using for many years) - in retrospect, the shoes were probably worn out

    May: After 7-8 weeks of increasing mileage, went for a slow 2.5 mile run, foot in ice bath afterwards, next day couldn't get out of bed until 30 minutes of massage and stretching - back to square one

    Jun: stopped ART/Graston, and to another orthopedic group to see their "non-surgery solution MD" - recommended nitroglycerin patch, and said may try PRP in a few weeks if that didn't work. He said the patches could cause headaches - which gets funny... I work with anesthesiologists in my day job. 10 days after starting the patches, my eyes were red, and my head was pounding. One of the physicians took notice, and asked if I was okay - I told him about the patches, and he just started laughing - said to stop immediately. I did. The head is much better. Achilles the same...

    Jul: started accupuncture with traditional Chinese physician - seems to help a little. I go on Saturdays, and feel okay throughout the rest of the weekend. By Monday I'm back to same pain.

    Aug: learned the Alfredson protocol requires weight to be added (hadn't realized that before). Started loading a backpack and got back to the protocol (3 weeks ago). Also, got back to seeing ART/Graston once a week (Wednesdays), and seeing Accupuncture on Saturdays. Stopped stationary bike, as I figured it could be causing problems. Switched to eliptical machine, but staying mindful not to lift heels from the pedal, as trying to get cardio in without too much pressure on achilles.

    Sep 2015: Accupuncturist getting frustrated with the injury, and recommends injection of homeopathic meds (Traumeel). Got two weeks in a row of injections. Seems to hep with inflamation for a few days, and then back to normal. Following the alfredson protocol, and up to about 30-40 pounds of weight. After the exercises, I ice for 15 minutes, and then hot water and epson salts for 30 minutes. Also rolling the calfs and hamstrings regularly.

    Hopefully that's enough background. Here's the current problem (other than the frustration of not running more than 20 miles over an entire year). I really think the Alfredson protocol is making my problem worse. Like much worse. I've read that this is kind of the point, and in the spirit of the protocol. However, I'm looking for some guidance from the folks on the forum as to if you experienced the same increased pain, and I could use some convincing to stick with it if that's worked for any of you. For those that stuck with it, how many weeks of getting worse until you noticed it turning the corner? It doesn't hurt while doing the exercises, but my pain in general is getting worse. I had hoped to finally get over the pain, and give a new pair of Hoka's a try.

    We all likely have a love/hate relationship with running. I have to say I'm heartbroken with this injury. I just hit my 1-year anniversary today. Not sure what else to do. Thank you in advance for your thoughts and guidance.


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  • 10
    Feb2016
    • Injury Status Recovering
    • Runner Yes

    Treatment Ratings

      Almost Cured
      Shockwave, Eccentric Protocol
      Not Improved
      Platelet Rich Plasma Injection, Other

    All the non-invasive PT treatments failed, although Graston temporarily felt great for few minutes right after the sessions ended.

    PRP did zero for me other than HURT a real lot. Big needle, big platelets. Threw up about 5 minutes afterwards from the trauma (HTFU, I've heard it before). Not too expensive, maybe $500 cash out of pocket for the procedure. Health insurance covered the blood draws.

    ESWT worked and repaired about 70% of the injury. Outpatient procedure under general anesthesia. Paid 100% cash out of pocket because it's experimental and not a covered procedure. Paid $3k cash. Totally worth it. It was really nice not being in pain just from walking. I think the Ossatron branded device is manufactured in the US, which is administered as a single treatment. The French machine requires 3 dosesx1 per week, to get the same effect. My podiatrist did not own the machine, so it became logistically too difficult to line up a second treatment. I could still use another round to clear all of the scar tissue.

    I changed my diet and went mostly gluten-free and low carb. The lesser discomforts went away, which for me gets to about 95% injury repaired. Achilles tendinosis is not inflammation, but there was something going on involving diet and the affect on healing.

    I'm still doing eccentric drops, but now just beginning to look a running again. But with a lot of focus on technique and form. I can run on the treadmill for a mile and have zero achilles issues.


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  • 10
    Feb2016
    • Injury Status Cured
    • Chronicity 0 - 6 Months
    • Runner Yes

    Treatment Ratings

      Cured
      Shockwave