So, here’s my story. My goal is to help others avoid my mistakes and offer the most up-to-date thoughts on Achilles tendon injury and treatment. I am not a doctor, physical therapist, massage therapist, accupuncturist. I am a chronic Achilles tendon injury sufferer. My Achilles tendon is my Achilles heel. In this post, I’ll give you a reader’s digest version of my history and observations on precipitating events and signs and symptoms of Achilles tedonitis, tears and ruptures. The next post I’ll review recommended remedies and my thoughts and experiences.
The Achilles tendon is a very tough fibrous tissue that connects your calf muscle to the back of your heel. Tendons are poorly vascularized (poor blood flow) therefore are difficult for your body to repair. Tendonitis (inflammation of the tendon) is characterized by one or more of the following symptoms: localized swelling (i.e. small hard lump to larger area), sensitive to pressure (i.e. squeezing tendon), discomfort that ranges from a dull ache to extremely sharp stabbing pain. The discomfort is sensed in the lower third of your lower leg from where the calf meets joins the tendon to where the tendon inserts into and wraps around your heel.
A tendon tear is more serious than just an inflamation. Definitive diagnosis is by an MRI. It is possible this will not pick up a tear also. Treatments for a tear are similar to tendonitis. It may take longer since it is more severe than tendonitis. After the tear has healed you may still have to deal with a sub-par tendon and all the tendonitis treatments are followed.
A tendon rupture is a complete “snapping” or disconnection of the tendon. Conditions that make a rupture more likely include the injection of steroids into a tendon, certain diseases (such as gout or hyperparathyroidism), and having type O blood. This requires a surgical intervention. Ruptures are not the focus of this article.
Tendonitis symptoms tend to follow this pattern: early morning tenderness or tightness or restricted motion. It may loosen up as you move around in the morning or as the day goes on. In mild cases, you may not experience any discomfort after a full warm-up. It may seem to give you problems after sitting for long periods of time, then having to get moving again. It will usually have increased sensitivity after very long, very fast, hills and ballistic or plyometric-like workouts. These will vary by individual. If the discomfort increases as workouts progress, it is a sign of a more serious case versus one in which the discomfort reduces or completely goes away after warming up.
My case started when I was 19 in 1975. I went from averaging 15 miles per week in high school and within months after graduation went to 40, 50, 60 plus miles per week and then within 12 months of high school graduation hit a 100 mile week. I remember specfically one precipitive workout… without preparation I did mile long repeats up Dead Horse Hill in Cherry Valley, MA. I lived half way up that hill. Gawd, how my Achilles hurt in the following days. But that did not deter me. No pain, no gain.
I worked the year after high school before going to college. I had my aches and pains but didn’t listen. After my cross-country season during my freshman year I experienced all the symptoms of Achilles tendonitis and other than one very awful race, I sat out my freshman track season. It was Spring 1976. It was half way through my fifth year of running.
I moved to Arizona and resumed the mileage madness… I maxed out at 126 miles in a week. I could run forever, albeit slowly. After a few seasons running for Pima Community College in Tucson, Arizona missing the national junior college marathon championships due to Achilles tendonitis I had to start looking into something other than some rest to resolve this. (More on this later.) I suffered with bilateral Achilles tendonitis. I learned that both were due to a bone spur on the top of both my heel bones (calcaneous) giving constant pressure and irritation against the tendons.
In late 1982 I had surgery on both legs simultaneously. I rejected full casts and ordered bandaging only with a half-cast. I returned to running, symptom free. It took months to rehab and recondition to pre-surgery levels of racing.
I experienced minor bouts of tendonitis over the next 17 years but mostly temporary, and minor. I used many interventions and treatments along the way. Then, in 1999 I had a serious bout of tendonitis in my left leg. X-rays revealed a bone spur had grown back and was causing the tendonitis. I had surgery once again. Though I have raced adequately, I have never fully returned to my pre-surgery racing. And now, 2007, I suffered an Achilles tendon tear. I took four months off. I’m starting to run again. I’m very limited in what I can do. My progress will be the subject of future blogs.
Here are the precipitating actions that lead to initially causing or exacerbating my bouts with tendonitis and recent tear. It won’t be a surprise. In retrospect, it was not due to a specific type of training in most cases but an abrupt change from one type to another or a dramatic increase of one type. My mileage increased way too rapidly. I went from no hills to hill training several times a week. I changed from moderate paced distance running to speed workouts. Without any strength work, I “jumped” into plyometrics. And lastly, I went from training shoes to racing flats or spikes or barefoot running without gradual integration into my running routines. What has always been my strength (ability to push myself) became my weakness.
When stricken by the tendonitis – you name it; I did it wrong. I was easily influenced by training fads. I mean, if Runner’s World said it then it must be the “right” way to train. On the other hand, when I exercised patience, consistency, moderation, gradual transitions to training phases and more scientific based training my tendonitis was held at bay. And it has only revisited when I didn’t listen to my body.