Other for Achilles Tendinitis

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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, Massage, Rest, Other

    stop running until it gets better. keep doing the ice, heat, roller while not running on it. hit the deep end and do pool running to keep the muscles firing and don't push it.

    when i get massages now, about twice per month, my therapist sometimes goes to town on my achilles and it feels ohh so good after!


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  • 10
    Feb2016
    • Injury Status Cured
    • Runner Yes

    Treatment Ratings

      Cured
      Dry Needling, Rest, Other, Strengthening Exercises

    I had three episodes. The key each time was 8 weeks or so NO, zero, nada running. It has been a year since the last episode. I did have ART, Graston, needling......it greatly improved recovery time. The assessment isolated the root cause and I began a functional strength routine for hips, gluteus.


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

    Treatment Ratings

      Not Improved
      Ice, Massage, Stretching, Other, Strengthening Exercises

    I started back running after doing the NYC MARATHON last year and developed sharp pain in my achilles. Saw a dr and PT 1st week in January. Diagnosed it as achilles tendonosis. I have been doing the stretches, strenthening, ice, heat, rolling and now 4mths later I am still in pain and not better off then early january. I see a sports dr who works with the pacers/Colts in april. Would it help if they put a boot on me for a few weeks? Anyone have any luck overcoming this? Getting depressed not being able to run anymore..


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

    Treatment Ratings

      Cured
      Ice, Rest, Compression, Supportive Shoes, Stretching, Other

    I have dealt with Achilles issues for years too, starting way back in 2008. Derailed multiple seasons for me, and there was a time when I thought 10k was the max my body would allow for. Knock on all the wood but I've been drama free for two seasons of marathon and now Ironman training. Here's how I roll: (btw, 41 years old, 6 feet, 185, MOP everything):

    The thing I recommend right now is this portable ultrasound machine. I have something similar. I worked it into my RICE routine, especially when it was really bad. Ice 2-3x a day and Ultrasound 2-3x day for 10 minutes. In about 10 days I started to notice a change. It helps break up some of the scar tissue that can make achilles issues the plague they can be. Even now, if I feel a bit of ache or twinge after a workout I'll sit with the machine for ten minutes while I watch TV or something and it helps. YMMV, but I can't recommend this highly enough from my experience - I think it was the most significant thing I did to get on the path to wellness. And no, not affiliated with them or anything, probably there are other/cheaper, different/better models out there, this is an example. http://amzn.com/B00T8UH8EE
    I quit trying to be the fastest guy in the world. So many seasons I'd do one too many speed workouts and be out for 6 weeks, and I'd think - I don't care how slow I'd go, I just wish I could be out there. So I limited speed work for several seasons. And I still don't do it as often as most. I'm not out to win any reasons, just enjoy myself. That means intentionally slowing down, and only - diligently, patiently - paying back my training and never going beyond myself. It means I pace much more conservatively than maybe I need to, but I don't care. FWIW, I'm almost as fast this season as I was 8 years ago, I think because I'm not wearing down so hard.
    More proactive rest. I take 2 days off a week. I don't obsess about everything. I do yoga/stretching on one of my days off and treat it like a long run or ride - not negotiable.
    The minimalist shoe fad really did me in. I tweaked my Achilles the first time doing speed workouts on Newtons, and it was years before I felt like myself again. I train and race in Hoka's now. I don't love everything about them, but they're cushy and forgiving and they help keep me out there instead of stuck inside.
    Crossing my legs or sitting for long periods with my elbows on my knees is a major aggravation for me, and can start issues happening if I'm not careful. I'm really mindful of anything limiting blood flow to my lower legs.


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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

    Treatment Ratings

      Cured
      Boot, Massage, Rest
      Almost Cured
      Other

    did many ART sessions. Not scientific, but, I think these helped the most: Boot (at night), deep sessions with roller and lacrosse ball/triggerpoint) AND time off from running. For me that area right above the top of the tendon really needs constant rolling, etc.

    When I was hurting and read "it will get better" I didn't believe it - but, it will; just not as fast as you want it to :-(


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

    I suffered an Achilles injury right after Boston Marathon this year...partial vertical tear. I tried a bunch of things for a few months (eccentrics, rest, prolotherapy, massage, etc.) with zero improvement (based on ultrasound of the tendon). Finally gave PRP a shot in mid August. I should note that it was incredibly painful. Felt markedly WORSE for a couple weeks after the injection, no anti-inflammatories allowed, but was told this is normal as that is part of the healing process. Resumed the heel drops afterwards and slowly improved. The tendon tear DID heal in about 8 weeks after the PRP treatment (based on ultrasound), but was still quite sore. The doc recommended EPAT, and I had 5 sessions of that. Started run-walking again in early October (after starting EPAT), very gradually building up the mileage...just did a 12 mile easy run this weekend as part of a 30mpw block. Not discomfort free but Id call it 85-90% better. I think the combination of PRP and EPAT was phenomenal for my situation.

    If you don't have a tear, maybe give the EPAT a try first...it is relatively painless, quick, and no recovery period. The PRP is likely gonna set you back a bit before you get better.


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  • 10
    Feb2016
    • Injury Status Recovering
    • Runner Yes

    Treatment Ratings

      Almost Cured
      Massage, Stretching, Other, Compression Socks

    I've had it before and I know how to manage it. For me, it pops up when my mileage increases. I have been able to use them to keep my pesky achilles under control during this indoor track season.

    1. Wear compression socks. I sleep in mine, even though it says not to.
    2. Attack them with a foam roller. It does not feel good, but no pain, no gain.
    3. Before you run, heat them with a heating pad. My school has a really nice athletic facility with really hot pads, but I think you can buy them. Make it really hot though (just don't burn your legs.)
    4. Stretching your calves, etc, doesn't really help me. But stretching my legs in general does. I don't know why.

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

    Treatment Ratings

      Cured
      Ice,