Achilles tendonitis/tendinosis

I’m glad that worked for you. Tendons are the worst. I don’t know what, except maybe time, fixed my Achilles tendonitis, but I’m so glad to be largely free of it for the past year or so. I still feel just a little bit of it if I jog more than 2 miles or walk on pavement more than seven or so miles a day. But just a bit.

Stretch, stretch, stretch, roll roll, roll.  Rinse, repeat.  Daily.

Night splints work. Most people sleep with their toes pointed down and over a few hours of sleep, the plantar fascia becomes contracted. You probably noticed the most severe pain first thing in the morning when you got out of bed and began walking. As others posted..
stretch, stretch, stretch.

I’ve found using a wedge of some sort to stretch the calves and plantar fascia is very effective (they have them at my YMCA). At home, I’ll stand on a stair tread and drop my heels down to cock my ankles about 45 degrees +/- to create much the same effect. And when on the trail, finding an angled root or rock serves the same purpose. And I’ll do it several times a day.

No snake oil…just stretch.

I would also point out from experience that my worst flair up of Achilles pain during an extended backpacking trip about three years ago involved a transition to zero drop Altra’s. I transitioned from 10 mm to 0 mm over a summer preparing for a 10-day hike, but still had problems that began on day 4 and I gutted it out with Naproxen. The symptoms went away when I switched back to the slight drop. I do realize that is entirely a personal experience with my feet, ymmv.

Speaking of shoes and personal experience, I found it helpful to switch my shoes much more often. Both switching to different shoes day-to-day and throwing away old shoes much earlier. Also, not wearing shoes without some padding at the back of the ankle.

Most of the best research I’ve seen for Achilles Tendinopathy issues comes out of Australia. Jill Cook in particular. IMO the best research supports a progressive strengthening routine for return to activities.

Here’s some of the better info I’ve found…..

10 things not to do if you have lower limb tendon pain (Jill Cook)
http://semrc.blogs.latrobe.edu.au/10-things-not-to-do-if-you-have-lower-limb-tendon-pain/

Also, Jill Cook on Twitter
https://twitter.com/ProfJillCook/with_replies

Jill Cook on stretching..
https://twitter.com/ProfJillCook/status/894719722675085312

Also Seth O’Neill, Peter Malliaras, and Karin Silbernagel.

A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation, Karin Silbernagel et al.
https://www.jospt.org/doi/full/10.2519/jospt.2015.5885

Physio Edge 082 Achilles tendinopathy treatment – the latest research with Dr Seth O’Neill
https://www.clinicaledge.co/podcast/physio-edge-podcast/082LIVE

This Aussie Physio article is decent and draws on the work of the above mentioned researchers.
The 3 key stages for Achilles Tendinopathy exercises
https://www.pogophysio.com.au/blog/the-3-key-stages-for-achilles-tendinopathy-exercises/

Interesting, that says stretching and massage don’t work

Instead, exercise to strengthen muscle, sort of like Russ, except you don’t need a stair or slant to go down, but you want to go up.  Either just up and hold, or up, down, repeat, or up, down, repeat with weights to increase the force required – like in the last link

I think it’s good when you start getting contradictory advice.  Try both and see what works for you.  Look at other sources to see which one works for more people…  Maybe when you’re stretching you’re also getting some muscle strengthening so they’re not contradictory

Seems to me you can’t stretch a tendon, so all those stretching exercises listed above should be discontinued immediately.  However, you can stretch a muscle, and doing so with the calf helps relieve stress on the achilles tendon.  You can do that using the same exercises listed above, so commence those immediately.  :-)

I felt that doing calf stretches like where you sort of push against the wall only made my tendonitis feel worse. While I was doing it it was excruciating. So I couldn’t keep it up. I didn’t feel like the calf raises on the stairs did much. But the self-massage, pressing against painful parts and really massaging them out, that helped. But the silly night splint that doesn’t even feel like it’s doing anything has worked the most. And it’s also the easiest thing to do.

Here is a technique I found very helpful when I was dealing with insertional Achilles tendonitis.  It’s called the Alfredson Protocol.  It is also frequently recommended for chronic midportion Achilles tendonitis, using a lower heel drop.  I think it is worth considering if you have a chronic Achilles tendonitis problem.  It can be done at home,which is a whole lot cheaper than physical therapy.  Be warned, however, that it is time consuming, may be painful, and takes a lot of discipline to stay with it for 12 weeks.

A basic explanation of the technique:

https://www.sportsinjuryclinic.net/sport-injuries/ankle-pain/achilles-pain/achilles-tendonitis-exercises

A rigorous analysis of the technique initially appearing in the British Journal of Sports Medicine and later in Pubmed:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277725/

Mine flare, so I’ll switch to bicycle riding and wearing serious aftermarket insoles in my street shoes.

the Australian guy says to do it on a flat surface

the sportsinjuryclinic guy says to do it on a step and lower your heel slightly

in common is raising your ankle

maybe it’s not that important whether you lower your heel slightly

the Australian guy adds weights after a while, maybe that is or isn’t important

this gives good ideas to try

the Australian guy says to do it on a flat surface

“the sportsinjuryclinic guy says to do it on a step and lower your heel slightly

in common is raising your ankle

maybe it’s not that important whether you lower your heel slightly

the Australian guy adds weights after a while, maybe that is or isn’t important

this gives good ideas to try”

The flat surface technique is for insertional Achilles tendonopathy, and the heel drop technique is for mid portion Achilles tendinopathy.  The short answer, as I understand the reasoning, is that dropping the heel increases the force applied to the tendon attachment area, due to the mechanical advantage generated as the tendon passes over the rounded surface of the calcaneus bone just above the insertion area, in a manner similar to a pulley.  Apparently that additional force is considered risky during the initial phase of the protocol.  Whether or not that would continue to be true as the injury heals and the tendon grows stronger I do not know, but I chose not to risk it just to satisfy my curiosity.  I started with no weight and gradually worked up to a gallon water bottle.  Intuitively, the gradual addition of weight makes sense, as with any other part of the body when the goal is to build strength and increase fiber density, in this case tendon fibers.  I have not had a recurrence of the injury since, and I have definitely put that Achilles tendon to the test.  Check the diagrams on the right side of the first page in the link below.  It should give you a pretty good idea of the “pulley effect” I am talking about.

https://en.wikipedia.org/wiki/Calcaneus

Along with backpacking, I race Ironman and ultra running events.  There was a time when both my achilles were injured and sidelined me.  Before you do anything drastic, I HIGHLY recommend seeking a Dr. that performs PRP (platelet rich plasma) injections.  Essentially, they take your blood, spin out all the good, healing stuff, and inject it back into the tendon (which gets very little blood which is why it won’t heal).  I had this done – 2 injections to each achilles, and it worked awesome.

Platelet Rich Plasma (PRP) Injections

Dr Jill Cook (the top Achilles researcher/clinician on the planet IMO)
https://twitter.com/profjillcook/status/1177562054485393408

“I had this done – 2 injections to each achilles, and it worked awesome.”

I also had it done for quadriceps tendonitis, back in 2010, with excellent results.  It was still experimental at the time and not covered by insurance.  I’m told by the doc who performed the procedure that the numbers are in now, at least for correlation, if not causation.  So, I’d second Perry’s recommendation.  A less drastic approach is to use 1/4-1/3 of a standard nitroglycerin patch, placed over the sore area to increase blood supply.  It is a vasodilator that I have used off and on for emerging tendonitis issue around the knees for years, on the recommendation of the same doc, who is on the University of Washington football team staff.  It is worth at least investigating and discussing with your doc.  It requires a prescription, and is an off label use.

I tried the nitroglycerin patches. I’d forgotten about that. I used them at the same time as I used the splint mentioned in the OP. If either of them worked, they didn’t work very quickly.

“If either of them worked, they didn’t work very quickly.”

I’ve found that they work best over a few days, and only for minor tendonitis.  You can’t apply a patch to the same place 2 days in a row, or you’ll risk the tissue getting used to it and not responding.  So, it’s every other day, which takes longer.  For more major tendonitis, PRP is probably the best bet, IME.

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Well so far the night splint thing has been a miracle for walking around the house pain free. I went for a walk today and my heel hurts a little bit, but while walking around I didn’t feel like my whole foot was tied up in knots, nor did I feel any pain, but now after sitting for a while, my heel hurts a little. It’s better, but still not fixed. More tolerable than it used to be. I mean, it was so bad my foot literally felt like it was being deformed and crunched up, almost sclerotic or something. Feeling a bit more normal now.

After about 2 decades of suffering, and seeing Drs., splints (mostly Velcro) really worked as did serious insoles in the short term, … along with biking.  Got all this paraphernalia from my non-medical brother.

It’s the long term I’m worried about.  Another brother (older tennis player/golfer type) got his Achilles torn and was bedridden as it was treated/healed.  I’ve heard about doctors in San Francisco attaching some sort of reinforcing graft surgically, but need to recheck it.  Different states have different laws on whatever procedures..

I forgot something else I did. I used to move my foot like I was writing the alphabet with my big toe, keeping the leg still. I’d just take off my shoe and do it at my desk when I had a second at the office. I’m not sure the name of what I was stretching and strengthening, but it seemed to help.