Achilles Tendon Central

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.

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About Dean Hebert

I’m a mental game coach, author and speaker. I work with individual athletes, parents, coaches, and teams on sports performance enhancement. Beyond my academic post-graduate work in sports psychology - the psychology behind athlete performance – I am a certified Mental Games Coaching Professional (MGCP) and certified hypnotherapist. I’ve authored several books and hundreds of articles. “Coach, I didn’t run because…” (2008) is a seriously light-hearted look at making excuses not to workout and how to overcome them. “Focus for Fitness” (2009) and “Screw the Goals Give me the Donut” (2010) are two of my eBooks on mental game approaches for the everyday athlete. I wrote these because I believe that everyone can benefit from the powerful mental techniques that the world’s best athletes use. I have been cited in Runners World, Best Health magazine (CN), SWEAT Magazine, and the Washington Examiner amongst many other publications. I have been a featured mental games coach in Runner’s World and for the internationally acclaimed trail running resource - trailrunningclub.com. I also regularly appear on sports and fitness talk shows such as LTKFitness, Runnersroundtable and for more than three years I have co-hosted a weekly video series with Coach Joe English for Running-Advice.com. I specialize in mental toughness training. My clients include tennis, synchronized swimming, golf, race-kart, soccer, motocross, volleyball, MMA, cycling (road, off-road, time-trialist), running, duathlon and triathlon, basketball, football and baseball athletes. I have coached world-class athletes and athletes internationally. I have a passion for working with youth athletes and helping them apply mental game skills and techniques to all areas of life. Most importantly, my aim is to have people enjoy sports and life to their fullest through peak performances.
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7 Responses to Achilles Tendon Central

  1. Roy Adams says:

    Your article was interesting as i could identify myself with alot of your struggles with achilles tendonitus. I have had trouble with both feet for a number of years and recently with my left which just refuses to heel even with 6 months off from racing and trainnng. I am 58 years old and have been a successful 5k and 10 k competitor for 10 years. I have had ulta-sound, stem, laser rest, ice, DMSO, MSM, massage, chiropractic, accupunture treatments and my tendon is still swollen and bulged out. I have done heal drops which seem to help. I am thinking of easing into barefoot running on grass. I have a feeling that this may help what do you think?

  2. We’ve traveled a similar path. I would be careful on the barefoot running. The lack of heel lift will exacerbate the issue because through the OVER-stretching in a dynamic fashion will cause trauma to the tendon. I tried it many years ago and almost crippled myself in the process. I still have some minor “bulging” in my achilles but for the most part I am asymptomatic. The thickening is a results of healing & scarring and I’ve been told by a couple docs that it may be that way forever but it also may go away but may take a year or two to do so! Yikes! So, I don’t worry about the thickness – I do pay attention to anything that makes any pain return (i.e. wearing sandals for any length of time). If heel drops are working – I’d stay with those before ever doing barefoot running.

    Barefoot running advocates will differ on this. My opinion is that if you are HEALTHY (i.e. not rehabbing from injuries); have never needed any heel lift in your shoes; are generally flexible; and happen to normally NOT wear street shoes (or high heels for the ladies) it might be worth trying. The gap in logic is that in the western world we do NOT naturally go barefoot most of the time as in some third world countries. Instead, from even before we walk – we wear shoes… with varying degrees of heel lifting. The affects won’t be easily overcome by introducing barefoot running. I’m not saying it can’t happen. I’m saying it is unlikely and in my experience specifically with injuries – it is unwise and will exacerbate the problem.

    Finally, if you do want to experiment – I’d start at the point of going barefoot for a period of time each day and just walking around. I’d even recommend getting street shoes that are as flat as possible (no heel lifts). Remember, you’re trying to change 58 year of conditioning! Then progress to VERY short running bouts – 20-50 meters. If after weeks of gradual increase WITHOUT symptoms then continue this process. Good luck. I’d love to hear back from you on how it goes!

  3. Doug says:

    After decades of inactivity, I began running at age 47. During the first 3 years of running I experienced shin splints, knee pain, runner’s toe. I kept running and followed all the conventional wisdom: state of the art shoes to correct pronation, thin socks and correctly fitting shoes to prevent toenail loss, exercizes to strengthen muscles and alleviate shin pain. After all this, running was still not fun at times. Internet research guided me to barefoot running. I began 4 years ago and the transition to barefoot running, after running 30-50 miles per week shod, was not easy. During these 4 years, averaging 25 miles per week barefoot, I have had any barefoot related injury that prevented me from running. Lost toenails, shin and knee pain are a thing of the past. But the best thing is that running is fun-like I remember it as a barefoot running child. The downside is that it is not socially acceptable and there is a large amount of ignorance concerning the subject. Nevertheless, I enjoy running barefoot and the opportunity to meet many interesting people as I trod my barefoot running journey. You can learn more at DaytonBarefootRunner on Facebook.

    • Doug says:

      Correction above . . . I have not had any barefoot related injury . . .

    • Dean Hebert says:

      I’m glad you are back to enjoying your running. I would look deeper however into your experience in that anyone who drops mileage in half will experience less injuries and it has been shown statistically anyway that runner 25 miles per week or less is the threshold for very minimal injury rates… above which there is a dramatic rise. You do state that “at times” your running wasn’t fun while shod. I think that is true of everyone… shod or not and is a psychological not necessarily bio-physical experience. Though I’ll grant that if you hurt all the time… it sure is a challenge to see running as “fun or enjoyable”. Happy running!

  4. will kimbrough says:

    I ran competitively, year round, from age 8 to 18, and have continued running almost daily since then. I am 47 now, and the achilles tendonitis on my right side has been off and on for about 15 years. I began walking and running barefoot 2 1/2 years ago. I took my sweet time getting used to it—-short walks, then longer walks, then short jogs, then longer jogs, and finally some running. This really seemed to help for a little over 2 years (knee, hip and back pain seem to be gone from my life since I began barefooting), but now the achilles tendon pain is back: stiffness in the morning, pain if I run. It loosens up during a walk, but after about 30 minutes begins to stiffen up again. I am taking ibuprofen, using Voltaren Gel, gently stretching, icing the achilles tendon. I am not running. I guess I really need to let it heal this time. But you know how it is to be a runner: you want to RUN!

    On the barefoot running: if you can find a safe grassy area, running barefoot in the dewy grass is heavenly!

    Thanks for your blog.

    • Dean Hebert says:

      Will,
      Thanks for your note. You are right, gotta go easy when it comes to the Achilles. You are a good example however that underscores all I’ve said about barefoot running… it is not the cure all and is not any better than running with shoes. Injuries still occur… even the ones some barefoot advocates want to say won’t happen i.e. Achilles issues. Keep your comeback going.. .one day at a time.

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