Achilles Tendonitis – Recovery and Workouts

I previously covered symptoms, causes and treatments to Achilles tendonitis. Let’s now take a look at how to reintroduce your running routines. Here is a six step process.

Step One: Once you have been given the medical authority’s go-ahead to return to running (or you have decided you’ve waited long enough and are returning to running regardless) you need to tune into your body. You may have always been a “morning” runner or “midday” runner or “evening” runner. Now, your Achilles will play a large role in dictating the best time to run. Some people will do better earlier in the day because later in the day the Achilles become tender (perhaps due to a long day on your feet). Some people find that mornings are much tougher to get going and you now require time to get the body warmed up before getting into any faster motion. One more point, some people will find it easier to do a little “something” everyday instead of taking rest days. That means that complete rest days may not work for you. Learn the patterns that help you run consistently and with reduced or absence of any tightness or discomfort.

Step Two: If you know for certain your Achilles injury was directly due to your training stupidity then go ahead with the next steps. Otherwise, you must remediate your underlying biomechanical problem or you are courting a re-injury. The number one predictor of injury is past injury to the area. If you have not done rehabilitation exercises and/or been fitted for orthotics then you have not affected the root cause of how you got injured. Some of the critical rehab exercises will include: one-legged full squats; squats/lunges and one leg stands on wobble-board; toe-walking; heel-walking. Toe raises are not advised; however you may try to do a reverse toe raise (not stretching). These are done by raising up on both toes then slowly lowering on one. When done working one calf, do the other. Though this is commonly performed on a stair, do not lower your heel below level (90 degrees) until you have progressed pain free.

Step Three: Run easy and run short. This is a relative term so I will not prescribe a pace or distance. I’m accustomed to running 5Ks in 16:00-17:00 range, an “easy” pace is 7:30/mile and for my comeback I might start out at 8:00-8:30 pace or so. You have to know yourself. Nobody can tell you what pace is safe (Though my “sports medicine doctor” told me 10:00 miles. He has no basis for pace estimation and therfore is speaking outside his expertise.) Break your run up into chunks to start out. Even though you aren’t running hard, treat it like an interval workout. Depending on the severity of your injury, you may return to alternate 100 meters “jog” and 100 meters walk. It may be 400 meters “easy” then resting your Achilles by walking around easily for a minute or so then do your next 400. Other than perhaps being out of shape, the pace should give no resultant discomfort to the Achilles region. You might feel a slight stiffness or tightness. That is probably ok. Regardless of how your Achilles feels, get in the habit of icing after workouts. Two times 10 minutes with a few minutes in between should suffice.

Step Four: Let pain be your guide. Remember that profound advice from the treatment list? It is critical to follow. Remember, you got yourself here because you didn’t listen to your body. Get over it and start listening. As you run, get in tune to your “new” Achilles tendon. Tune into your foot-strike, stride length and frequency. Do changes in any of these create different sensations for your Achilles tendon? You may find that altering “how” you run may increase or decrease discomfort. Tune in to the various surfaces you run on as well as any slants that affect your foot-strike. For instance the camber of a road can create more discomfort. Compromise and learn each day. Though it may be imperceptible to someone else, you can make very small adjustments that will make a world of difference. Keep icing after workouts.

TIP: You may find you get a quick start by soaking your lower legs in a hot tub before going for your run. It increases blood flow and helps decrease stiffness.

Step Five: Increase your miles slowly. The old 10% rule for increasing mileage may not apply to you any more. Increase your pace slowly. Do not change running surfaces dramatically and avoid trails and sand (beaches) for sure. Stay on the most level and even footing surfaces possible. Do not – increase pace and distance simultaneously. You will be asking for trouble.

Step Six: At some point you will want to try out getting in racing shape again. You may want to add hill training, track work, beach running, trails and plyometrics. Resist the urge to introduce any of these too soon. And avoid introducing any two of these at the same time. These are high risk activities for Achilles tendonitis sufferers. Read my lips – there is no such thing as introducing or running these too slowly. Try one repeat on a hill or one faster repeat on the track. Before doing actual hill work, test yourself on some stadium stairs. These are short and controls your stride with steps. See how your Achilles reacts over the next 24 hours. Then, the next week you can add another repeat – maybe. Trails, beaches or other varible surfaces need patience and very modest efforts and frequencies on the comeback trail (pun intended).

Though plyometrics are wonderful for strength and speed development they are extremely ill-advised until you have been 100% rehabilitated. These are ballistic movements and very tough on Achilles tendons even when you are healthy. The most elementary level of plyometric exercises may be doable. I would strongly recommend performing lunges, step-ups, medicine ball drills, core exercises and all the one-legged exercises in preparation. There are many variations that will enhance your strength without the risk of plyometrics. If you’re smart and fortunate, you may one day return to full plyometric workouts.

NOTE: You will notice that I have not advised stretching in the process. This is a highly controversial topic. Stretching is correlated with increased injuries for males and has neutral affect for females. Given that, one possible contributing cause to Achilles tendonitis is a tight calf muscle. If that is the case you may need to introduce stretching. Beware, stretching irritates the tendon! So, go slow, go easy, go static. Do not do heel drops to stretch the calf. Do not stretch until you “feel a good stretch”… it’s too far!

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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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89 Responses to Achilles Tendonitis – Recovery and Workouts

  1. Aaron says:

    I wish I found this about 4 days ago! Great information!

    Aaron

  2. Aaron – thanks.. I hope it helps. If you have any specific drop me a line. I’ll just tell you that there is indeed hope!
    Coach Dean

  3. Danyah says:

    Great advice! I’m back to a walk/run after five weeks off – just being proactive, positive, and patient – it’s really changed my way of thinking about my training.

  4. Ah yes… patience… that critical element I didn’t really elaborate on… and that I know is a virtue of every runner (NOT!). Thank you. It sounds like you’re doing the right stuff. Keep it rolling!
    Coach Dean

  5. Ewan Black, PhD says:

    Since weight training for legs is the number one cause of off-field lower body injuries, and indeed the catalyst to many on-field injuries, I would strongly advise against this; such training is certainly not suitable for 25+ runners.

    Take for example the bar bell squat: injuries such as the following were so commonplace in the military that the exercise was actually stopped in physical training

    (i) Adductor magnus strains and tears
    (ii) Achilles tears
    (iii) Pubis symphysis strain and tears

    This is clearly applies more so to dead-lifts and bent-over rows.

    In fact, football trainers now actively discourage over-doing lower body weight training in young athletes, as the biomechanical imbalances thus caused reek havoc on ligaments and tendons and have ended careers.

    In short, if you have had an Achilles injury, do not train with weights or it may never get better:

    Walk…walk…walk….walk…

    Then introduce jogging gradually.

  6. Dean Hebert says:

    Ewan,
    I appreciate your perspective. I have not found the research for the data that you mention about lower leg off/on field injuries correlated with lower leg weight work. [But I don’t follow a lot of stuff written on other sports.] Though there is potential relation from your military example, they aren’t runners. They do run. In my experience they also do not take care of themselves by wearing appropriate footwear; as well as the other equipment they often lug around. So, though interesting, I would not necessarily use this to advise runners. (Though again.. not totally disregard it.)

    I do disagree with the 25+ comment. Weight training is absolutely critical for older runners (40+) since we lose muscle with age. With that we lose power. Power output of muscles is essential to maintaining speed. But, given that, notice i have not prescribed the types of weight lifting you mention at all. I (and most coaches and physiologists today) advocate more running specific strength training with body weight only: “Some of the critical rehab exercises will include: one-legged full squats; squats/lunges and one leg stands on wobble-board; toe-walking; heel-walking.”

    But there are some important points here.
    1. The exact cure-all treatment for Achilles does not exist. That is why there are so many treatments and some work for some people but not all.
    2. The exact rehab approach for all Achilles sufferers does not exist. That is why so many approaches are used and not all work for everyone. (Including stretching and strengthening.. with or without weights)
    3. What ever causes the Achilles issue will cause it to recur if remediation of that specific cause isn’t done.

    The bottom line is to do everything in moderation; be willing to try many approaches in your return to health; and read your body, on the Achilles-injury return.

  7. runnerforchrist says:

    Coach…Thanks a lot for posting this topic.

    I learned a lot from it.

    Will it be alright If I could add you up in my blogroll?

    God bless.

  8. Pingback: Achilles Tendinitis : 5 Step Treatment & cure | Marathon: You Can Do It

  9. Dean Hebert says:

    Thanks for dropping by. Overall I would agree with your actions. But, there is a real issue with falling asleep with ice packs wrapped on you. The advice from all medical sectors never advise more than 10-20 minutes at a time and repeat after equal time off. This avoids tissue damage from the cold. It is a case of more is not better.

    As for the Quertecin/Bromelain mixture it’s of course hard to say if it makes a difference or not. If you feel it is key to your maintaining health and you aren’t having side-effects then stick with it. I like experimentation… at the same time I am cautious about prescribing anything to others – natural or otherwise – that hasn’t been shown in research to work. But, it’s always worth a try. I may even check that out.

    Thanks

  10. Kyle Norman says:

    Dean,

    I’m going through some Achilles tendon irritation and I’ve gotten a lot of good info out of your posts. Great site. A member of the Yahoo Supertraining forum referenced it and I’ve linked to it on the Resources page of my blog the Denver Fitness Journal (www.denverfitnessjournal.com). Keep up the good, informative work!

  11. natalie says:

    i just found yur advice while browsing i have achilles tendonitis and im trying to treat it myself,the massage of my tendon and icing helps but when i go jogging it hurts afterwards,the thing is i recently lost 4 stone and im afraid to stop the jogging in case i put weight back on,will i just do more damage if i dont stop?

    • Dean Hebert says:

      Natalie,
      Congrats on losing so much weight and getting into shape… great work!
      I completely understand your concerns both on effect on achilles and putting weight back on.
      So, first, if you do a number of treatments including ASTYM you may be able to keep running… get better and never worry about time off and gaining weight. It’s highly individual. However, sometimes only rest will do it. But that does not have to be extended period of time… it may only be a week or two. Be diligent in your diet and cross train during this time.

      And finally, if you don’t mind the discomfort (kinda like just tolerating a bad headache all the time) maybe you just keep running and hope it goes away. It can happen. My tendonitis has ebbed and flowed for many years. I simply did not want to take drastic measures and it was tolerable so I just kept going – for years.

      Hang in there and keep m e up on how you’re doing.

  12. Barb says:

    I was wondering how long is the recovery after surgery for the acchilles tendinitious ? I had surgery in november of 2010 & i still have pain in my heal

  13. Drew says:

    THanks for this post. I run 16:00 to 17:00 5k and got at from doing hill training every other day. im finding that the strengthening therapy exercises are the best but i cannot get myself running pain free 100% i gradually increased distance from .25 to 3 miles finding that anything over 1.5 kind of irritates it the pain usually subsides and i really want to get an exact course of how to make it back because nothing has worked yet. ive taken the rest which works but when i come back the at seems to be almost chronic its been gonig on for 6 months…if i can comfortably run a mile to two miles a day pain free but the at never completely goes away what good is that? can you possibly post a simple but sure workout plan that might be a bit helpful? ireall appreciate it
    thanks

    • Dean Hebert says:

      Since it recurs after only about 1.5 miles it is obvious that whatever the cause is – you (and your PT) have not addressed it completely. The exercises are a good start. But, I have been working with a PT who is doing special studies on running related injury/rehab. Since I had seen her for my rehab from surgery we’ve kept up our contact. Here is a bit more I have learned: the cause could be way up the power chain – glutes, hams, lower back. So if your exercises aren’t including those areas, even though your current exercises help they may not be addressing all the imbalances. It can also be inflexible feet! She did an interesting assessment on that for me – I’m guilty. I need FOOT exercises – not achilles or calf stuff (well ok some of that of course).

      As for a training plan, of course that is what I do for a living. I can design one for you. BUT, until the causing imbalance is addressed there is no sure fire plan that will get you back because they will all lead to a recurrence.

      The final note I’ll share is that though I ended up with surgery I actually ran for years with on and off again symptoms. It was like a headache almost constantly there. And I still ran a 2:30s marathon; regularly ran 15s for 5ks even at 40-plus years old. So it was something I had to deal with; heed; work around at times; but it did not prohibit me from running and racing. Hang in there and be diligent – you’ll be back.

  14. Richard says:

    Found this info, looks good. However, I broke my right leg last year (R Tibial spiral fracture-Undisplaced) and May 14 will be its first annaversary and a year of operations, metal rods in and out, infections galore etc, etc. I have been allowed to return to running, does the above tips apply to people in my case, as I am finding it hard to get any information as to what I should be doing to allow for a safe return to running. Basic fitness is fine and I cycle 100 miles a week and I do weights and core body workouts, as well as swimming.

  15. Jack S. says:

    Hey there, I just returned from an achilles injury I had roughly 2 months ago. I had my first run today and the run felt great. Though I’m feeling some tenderness roughly 4 hours after my run today, I’m icing as I type this. Interestingly enough, I had the same issue when I came back after a stress fracture in my tibia. The spot hurt a little bit the first week then went away and I’ve never had an issue again. Am I in a similar situation? Can I just push through for my first week?

    • Dean Hebert says:

      Jack,
      Congrats on returning to the running world. I would use great caution in “pushing through” with soft tissue injuries – especially the very NON-forgiving nature of Achilles Tendons. A big difference is that a bone heals stronger than original condition with calcification but soft tissue does not.

      Stay on the ice routines for sure, and do all the eccentric and other exercises. That last part is the one thing I have not done as diligently as I could and it has delayed my complete return as a result. Stay in touch.

  16. Chard williams says:

    Hi, I have been getting over Achilles tendonitis, I am absolutely fine with jogging or even runs at a quick pace. However I have just started playing football again and although I am fine when playing, the next day my Achilles is tight and sore for the next 3-4 days, however jogging on it is still fine the next day and feels comfortable. I am presuming it is sprinting and adding the extra pace and weight pressure on it?
    How do you go about getting back into sprinting/football without it flaring up for a week after? Any advice will be appreciated.
    Thanks

    • Dean Hebert says:

      Chard,
      You have very typical responses to the tendonitis. You’re right on your observations – it is the explosive nature of football (I’ll take it that since you are in UK it is our “soccer”) that will do it.
      1. Reduce the AMOUNT of football. You may only be able to tolerate a half at this time… maybe less. Get to the point that you play, and are not sore in following days.
      2. Then gradually increase playing time. Tracking your response all the time.
      3. Religiously do your physical therapy exercises. Even though you maybe out of PT… do not stop those exercises.
      4. For some people a heel lift is what helps also. Experiment.

      Hope these few simple things can get you back at it. Patience is the key… not one of most athlete’s virtues.

      • Chard williams says:

        Thanks for the advice, like I said even after a game of football, normal jogging is still fine, do you suggest that i stop the jogging after Matches whilst it is still sore to touch and abit tight, I ask only because I run to the gym every other day which is a 3mile round trip? And I can do this comfortably even after a football match! It just seems sore to the touch and to stretch it seems tight after for a few days or more!

      • Dean Hebert says:

        I would recommend some experimentation. Try NO jogging afterwards. See what happens. It is possible that this little extra is what is aggravating the Achilles. If it is sore, then a rest day is probably indicated… unless the pattern is that it tends to loosen up as you run AND is not WORSE after you stop.

  17. Mike says:

    Hi Dean,

    Just wanted to thank you for your very helpful overview of the tendon problem and possible solutions. Many of the helpful things I have picked up over the last number of years are echoed in your piece and it’s great to get confirmation of many “gut feelings” I already experienced.

    The over-riding lesson I have learned in dealing with this problem is that it is essential to do the right thing at the right time in the process. It is really that that trips people up (pun intended!). If you’re in the chronic stage, then you need active physiotherapy, shockwave therapy, etc. , but FORGET ABOUT forcing up the number and intensity of exercises to accelerate the process. There’s just NO WAY to accelerate the process of healing. It’s a tendon not a muscle so is poorly fed with blood, hence the healing time is that much longer. As your condition improves, over months rather than weeks, you can add in new exercises in a very conservative manner. That’s the process, as frustratingly slow as that can be!

    The best periods of healing I’ve had where when I was restricting myself to:
    walking (normal intensity), biking (normal intensity), light stretching, cold when sore/heat when stiff, light strengthening of calf and related muscles. During these periods, there was zero running, zero lunging, zero one-heel drops, etc. Plenty of rest time on holidays was beneficial too as you create a time+space that is conducive to healing. Good diet and rest are essential too of course.

    Where I am now? 12 months agao, I was facing chronic tendinitis caused by my own lack of knowledge. The nodule of scar tissue I had when I stopped all sport is today very much reduced but still there. As you all know, it reduces the length of the tendon, restricts range of movement and causes peripheral effects in the calf and hamstring. My goal now is to reduce this nodule back to almost nothing using the conservative approach I’ve arrived at. Next step is running without re-aggravating the tendon and from there who knows? Football (soccer) may be over for me (I’m 36) at this point, but I’m trying to stay hopeful even though I know it’s a long shot.

    If I had a question for you and this forum it would be this: who in a similar position to myself has managed to eradicate the troublesome nodule for once and for all? (without surgery)

    Best,

    Mike

  18. Mike says:

    Ah…I was hoping you wouldn’t say that!
    Was it fully / partially successful and have you already posted somewhere on your experience pre/post-op?
    best,
    Mike

  19. Dean Hebert says:

    I have no nodule on either Achilles. My Achilles – to this day – are thicker than normal. BUT, in spite of this with the work I have done I have good flexibility there.
    In thinking about this a bit. And I think that the work I am doing with my current PT is amazing. The systems approach has been the trick- top-down and bottom-up. With ALL areas of my body dynamically more flexible it has reduced the stress on the tendon. So, nodule or not, THAT is the key I now think to getting back. You are young and will rebound far faster than I.

  20. Mike says:

    Thanks again Dean. Totally agree on 1) the holistic approach and 2) greater all-round flexibility. That’s been an issue for me, so I give myself plenty of warm-up / warm-down exercises in my routines.

    Am seeing a new physio shortly to get a second opinion and will try and pin him down on a nodule-busting strategy. If my conservative approach is just “painting over the cracks” ultimately, I’d like to take a serious look at surgery – up to now, I had mentally reserved that course for ruptures rather than tendinitis-related nodules.

    Will keep you posted.

    Mike

  21. Dave Kelly says:

    Dean – good useful information. Everything I have read states that icing the AT is of limited value due to the poor blood flow to the tendon. Would you agree that heat is more beneficial in order to get blood flowing again and therfore aid healing. I’ve been struggling with AT issues in both legs – possibly caused by tight calves or incorrect footwear or a combination of both. Everything I have read points in the direction of eccentric calf stretches being the cure to Achilles Tendonosis. Do you have a view on this

    Regards

    David

    • Dean Hebert says:

      Post workouts to reduce inflammation definitely use ice. Otherwise help them loosen up and increase blood flow as you state with heat before workouts or even stretching or doing drills etc.

      Tight calves are thought to be ONE possible cause for AT. But, it appears now that it is far more complex. If the systems approach is used you may see that it’s related to hip, foot or other area in the power chain. Each create an effect on other parts… that in fact is what was precipitating my issues. I had a very rigid fore-foot and tight hips; once these were addressed, the AT symptoms resolved when all other approaches were temporary and only palliative.

      Wrong or worn footwear can exacerbate issues.

  22. Mike says:

    Just to come back on my earlier point about doing the right thing at the right time.

    For a long time, I was waiting to be able to comfortably do eccentric heel drops for the benefits now widely acknowledged. I’ve now reached that stage and am basically using that as the “focused treatment” part of my recovery, alongside the “safe” baseline activities mentioned above (walking, biking, stretching, rest, diet). I’m using the eccentric calf-drop reps system outlined in this report:
    http://www.sportsinjurybulletin.com/archive/achilles-tendinosis.html
    (there are several studies corroborating this now)

    These exercises are really only suitable for the latter stages of the recovery stages. Very easy to do and I’m seeing benefits in calf strength, reduced nodule size (very slight reduction, but that’s pretty amazing really!), reduced stiffness, reduced pain.

    Obviously, I need a few months of this before I can say: the nodule is gone and running / football are a possibility…but finally, there is hope!

    best,

    Mike

  23. Dean Hebert says:

    Take the progress one day at a time – hope is there indeed!
    Dean

  24. Ellen Bagnato says:

    Dean – I enjoyed reading your post about achilles injury and returning to running. Two weeks ago I had my right achilles tendon repaired – it was 90% ruptured. This was caused by, I believe, tight calf muscles and potentially tighter muscles higher up in the power chain, and then the bunion on my right foot which creates some biomechanical challenges for me. Interestingly, the only other significant running injury I have had is a 2nd metatarsal stress fracture…on my right foot (the bunion foot).

    I’m a serious recreational runner, and right now, aside from not being able to drive for five more weeks (I’m a mom with several carpools and tons of other driving as part of my mom duties), is the concern that I won’t be able to return to running anywhere close to what I was doing before. I’m 46 and very healthy otherwise. Do you have very specific daily and weekly workouts to follow once I’m cleared to start running again? If so, would you share these as part of your coaching services? Finally, what would you charge for monthly coaching, realizing that it’s not just general coaching (for lack of a better term), but post- achilles tendon surgery coaching with the goal of returning me to optimal performance.

    Thanks,
    Ellen

    • Dean Hebert says:

      I’ll drop you an email with some details but you will come back! The big thing I have learned is that your bunion and stress fracture and now achilles may be related in the cause. And it may not be what you think. As we compensate from the upper back to hips to quads, to knees to calves to ankles to forefoot to toes… if one is out of whack it puts extra stress on that chain… yielding injuries to the weakest link.

  25. Dayspring says:

    I am a new runner trying to transition from treadmill running to trail or road running. I recently ran a 5k, and afterward my achilles tendons hurt, especially my right. I figured it was from running a faster pace than I trained, but now it seems to bother me after each time I run outside.
    Now I am training for my first half marathon, and the outside running is killing me. Even running at a slower pace (10 min mile), I start to feel tighteness after mile 4, or after the workout even if it’s just 2 easy miles. On the treadmill I can easily run 5 miles at a 8:30 pace without problems, and I suspect I could do a lot more.
    After I run outside my ankles feel a little sore, my calves feel very tight, and now my achilles hurt.
    So my question is, how can I train to adapt my feet and legs to all the pounding? Should I run my first mile outside, then continue my run on the treadmill, gradually increasing my outdoor running? I don’t want to risk injury, but I know I should become acclimated to road conditions before I race again.

    When I’m not training for a race I usually lift weights and do 30-45 minutes or more of cardio 3-4 times a week. I am relatively flexible. I am in decent physical shape, so these difficulties surprise me a bit.
    I would really appreciate any advice. Thanks!

    • Dean Hebert says:

      You are right that you need to harden your body to running on the roads if that is where your race will be. It won’t be pretty if you don’t do this. Lifting is good for sure but will never get you “toughened” for the rigors of running. When you make running a year-round activity you’ll start to find a few less issues too. Flexibility is both a blessing and curse since it can be a CAUSE of tendonitis and joint issues. There is a happy medium.
      Your transition has to be gradual as you have encountered and you need a comprehensive personalized program. There is no single answer other than take it slow and let pain and your body be your guide.
      If you wanted a personal transition program drop me a line.

  26. Lina says:

    Dear Dean

    Thank you for your information. Certainly many aspects to think about and try.

    I have a bit of an unusual situation (I think) whereby I used to do high impact aerobics for a long time – a long time ago. I had various injuries, but the chronic injury was indeed that of achiles tendonitis.

    After 10 years of “rest” (I stuck only to walking), I am back into aerobics (high impact being my favourite), and now my achiles tendonitis has come back into play. The unusual thing is that it is only my left foot that is severely tender and inflammed: my right – if I were to press hard into it – does have pain and some creps but it hardly bothers me at all really, even when I am high impacting.

    I found that strange – that there was a discrepancy between the two tendons, until I remembered that I had recently heavily sprained that left ankle and it needed weeks of recovey (which I did badly) and some PT work (which I waited too long to access).

    Could it be that the tendon is in some way bothered by that injury of the ankle? To this day (6 months after the ankle injury) I have “background” tenderness and pain on pressure related to the ankle sprain, although I really hardle feel it unless I “search” for it (i.e. when I press into grooves in my ankle to note any residual tenderness/pain.

    Thanks in advance for your advice.

    • Dean Hebert says:

      Lina,
      Your tendonitis may or may not be related to the sprain – I doubt it though. Your pattern tenderness is the same (as years ago) and that means the underlying weakness which is causing your tendons to be overused has not been remediated. Rest removes the immediate SYMPTOM not the cause. The pain goes away due to rest but not removing that cause. That is evidenced by the fact that you start back at your activity and voila… the pain is back.

      In my opinion you need a comprehensive physical therapy work up such as one from a PT who has graduated from the Grey Institute.

      I hope your comeback is soon!

  27. Andrew says:

    Hi Dean.

    I’ve been training for my first Half Ironman. Until now the training has been going well and I seemed to be on track. Two weeks ago I went for a slow 21km and suffered with my right achillies. I think the cause is tight calves as mine normally hurt after longer runs but get better in a day or so. I actually thought during that specific 21 that it was just my tight calves so I pushed on thinking they will loosen and all will be well in a day or so. But, that’s not the case. I think I now have achillies tendinitis, arg, and Half Ironman is in just over a month.

    I don’t think I have such a bad case as I can do eccentric calf-drops without any pain. I am now in the situation were I am scared to run too soon as I do not want to worsen the injury or regress the healing but need to finish my training for the race.

    How long does this injury normally take to heal to a level where I can endure the “head ache” but not risk major damage?

    Cheers

    A

    • Dean Hebert says:

      Andrew,
      Unfortunately every case is so different it’s hard to say how long it will take to resolve. A few days off for minor cases often does the trick. Modify your workouts to be shorter and less intense to test it a bit. Don’t just walk out and start running another 21k and expect all to be well. Stop BEFORE it hurts. That way you will know you aren’t doing it more harm. Try heating your lower legs up before running to get blood flow going. I have soaked them in a hot tub for awhile to loosen them up – worked really well. And then ice after the workout even if they don’t hurt! Avoid hills, speed work and long workouts. Careful for the eccentric heel drops… may feel ok doing them but remember it could also be irritating them if they aren’t fully recovered. Patience … something we all need to work at.

      • Andrew says:

        Hi Dean

        Thanks for your feedback.

        I saw one of the leading sports doctors here is South Africa and he said it was not such a bad case and that I should be fine to run slowly and must pull back if I get sore. I also got given some heel cups and a few exercises to do (easy calf raises & stretches & easy achilles stretches)

        On the weekend I attempted a 7km run, the first 2km were fine and then it got sore. I run very slowly but it still hurt after the run for about 48 hours and now I have a dull pain.

        I don’t think it is as bad as a few weeks ago but I am now not sure if I should run or not. Do you think it will be wise to not run until the event and then run with the pain (if I have) on the day. What are the dangers of running with pain? Could I rupture my achilles? Will stopping running for the month prior to the event weaken my “running fitness” that much bearing in mind that I will replace my running training with extra cycling or swimming training? Also, what about anti-inflammatory / pain killer drugs? Will they help when running?

        This injury is so irritating!! But I appreciate your help.

        Cheers
        A

  28. Dean Hebert says:

    “Irritating” is an understatement in describing this. Pain is a message to your body. It is saying that something isn’t right and it is sending a message in varying intensities to back off or stop “or else”. Odds of full rupture is like going to Las Vegas -no one really knows BUT my ortho said that statistically those suffering from actual tendonitis have a slightly LESS chance of a rupture than someone with no symptoms. But “could” it happen – yes.

    Yes, stopping running an entire month before your event will weaken your running fitness. Cross training an help maintain some but only aqua running has been shown fairly reliably to maintain conditioning best.

    Though the drugs decrease inflammation the drugs also mask pain. That is like putting a muzzle on that body part trying to communicate to you what is going on. So, double-edged sword! I typically used them POST run to help with discomfort and inflammation.

    If you could get some ASTYM treatments that would be your best option if it is available to you. Very good results out there with this treatment. The more invasive is PRP procedure – BUT GREAT results with this.

    Hang in there… my recommendation would be to do cross-training and aqua running – get your event done with – then seek out full rehab and recovery.

  29. Dermot says:

    “He has no basis for pace estimation and therfore is speaking outside his expertise”. I love that statement. The person advising you of how to get back into your running i.e. the expert, you dont listen to, yet, here you are, advising people on how to get back into running post Achilles Tendinopathy advising NOT to do Heel raises / toe raises when the golden rule to sorting out tendinopathy IS building strength IN ANY WAY initially.

    I think you need to do your research before giving anecdotal advice.

    • Dean Hebert says:

      Your comment is interesting but inaccurate. I’m not sure if you mean getting tot he cause; or diagnosing the condition when you say “sorting out” tendinopathy. If you mean as a diagnostic – you’re right. If you mean as a cure – not so much.

      As for following the Drs. advice I did follow it when it came to what he was the expert at. I went to him because he is a respected sports surgeon. Post surgery – I followed everything he said. However – he is not a runner, he is not a coach, he does not know anything about relative paces. Therefore he is only guessing. He is not an expert at running. What if my all out fastest pace was that 10:00/mile pace – it means he is recommending that I go out and do an all out workout the first day! Of course this is ludicrous. That is my point. Running is not his specialty – surgery is.

      I don’t know who you’ve been seeing or what your background is but having seen a dozen doctors in multiple disciplines; numerous other healthcare professionals – both traditional and non-traditional; physical therapists with all kinds of specializations with athletes and more than 30 years of off and on again issues with achilles – read voraciously on the topic from anecdotal stories to medical and sports medicine journals. I have more than done my research. And I’ll put my knowledge up against almost anyone’s on this one. Everyone of those professionals had different answers, different ascribed causes, different magic remedies. None were in consensus on the exact cause or causes and none were in consensus on the way to come back – including not all recommended toe raises. In fact many did not due to the amount of irritation it causes. Therefore – there is no “golden rule” to sorting out tendinopathy. That is why I want to get the word out that you need to be patient and keep trying things to get relief. It is stubborn. And it is frustrating to those who suffer from it. But, by trying many things, you may find your own “golden rule” for sorting it out.

      • Ellen Bagnato says:

        Dean, I agree with you that tendinopathy’s causes and cures, are more case-by-case than anything else. Therefore, the “sorting out” and the “fix” are also case-by-case, with many, many ideas on what you should do. My achilles tendinopathy eventually came to a 90% rupture, so I had surgery in September. Prior to that, months of zero running, PT exercises, icing, limiting movement, etc. did nothing to reduce my tendinopathy, and it tore. Likewise, my recovery is slow and requires a lot of patience, common sense, and finesse. Again, it is my personal recovery experience, which may differ from recoveries that a host of experts, even my surgeon, could predict. Case in point – my PT just told me that his test of my achilles (and he’s been working on it since October, so he knows my achilles) indicates that it is “bomb proof”. Despite that, I have trouble doing walking lunges and heel raises at this point in my recovery. I can do them, but I get a lot of pain in the days following, which restricts what I do. It’s frustrating, but as you suggest, I’ve come to terms with the fact that anything involving the achilles is incredibly complex, and includes the entire power chain of muscles, ligaments, tendons, and joints. So, kudos to you for knowing enough to question a doctor that gives you a random pace target to go after when we all in fact can learn a lot about our bodies if we just used some common sense and patience.

  30. Dean Hebert says:

    I’m glad you are coming back! Your experience is typical. That is, it is completely individual. Funny contradiction.

    Keep me updated on your progress – if you need an empathetic ear – I got it!

  31. Tess says:

    Hi Dean,

    I wonder if you’ve any advise for my situation. I was training and subsequently did a half marathon in late September last year. During my training my left Achilles started to ache but I pushed on (it wasn’t painful) and managed the half marathon anyway. I know now that was a bit silly as was upping my miles by more than 10% – isn’t hindsight wonderful! Anyway after resting it for a couple of months I finally got myself to a physio in Dec and he put me on a programme of no running, eccentric exercises and some calf stretches. Over the course of 5 weeks the pain went and the tendon was hardly tender to touch at all. So as of last Weds the physio told me I can gradually start running again, with rest days in between for now. (He’s also given me other exercises for the glutes etc). So I’ve now done a couple of short runs (3.5km & 5km) on a treadmill but the days afterwards my tendon has been aching again (not hurting though). Is this normal? I’m supposed to be running a marathon in 14 weeks so am keen to get my training up (gradually of course) but am anxious about running when it still aches (as I said its definitely more of an ache that painful) . I also think i’m quite hypervigilant to it which i’m sure isn’t helping! I guess I could do with some advice/comments about what is usual to feel when you first begin running on it again after a couple of months off? It hasn’t hurt or ached at all when i’ve run on it or immediately after, just aches the next day? I haven’t tried icing it after runs but i will do after reading this page. Any other advice?

    Many thanks
    Tess

    • Dean Hebert says:

      Tess,
      Ah yes… hindsight…
      Coming back you may have tenderness in the Achilles after workouts. You have to monitor it closely. Though it is common it is also a warning sign. These are finicky things. You’re right to tread lightly. Your ramp up to a marathon in only 14 weeks – coming from 5k – is really going to be pushing it. I advise even well conditioned runners (no injuries) to take 16 weeks. My “barometer” to success is if they can run 10 miles/15K @ goal pace when they start the 16 weeks.. it looks good. So, even if you are running just to finish – you should currently be able to do a 9-10 mile run.
      But to your point, the good news is that during and immediately after it doesn’t hurt. That is your #1 sign if you are doing too much. I would definitely ice after every workout regardless how hard. It might just be sensitive for now until it gets used to running again. I also found that taking more days off really wreaked havoc for me. I was better doing a little bit 6-7 days a week – than every other day. It seemed to keep me more flexible and dynamic range of motion that you get from running and some exercises or drills – not stretching – was my key.
      Unless you know definitively that a tight calf is the actual cause of your tendonitis – be very careful on stretching as it can aggravate it more. (This was and still is my case. Any time I do more than VERY modest stretching it will act up. Whereas dynamic full range of motion drills and starting workouts slow gradually upping the pace works perfect for me.)
      If you can tolerate NSAIDS then use them for the interim to keep any inflammation down. It’s not about pain/discomfort control – it’s about not letting it get inflamed and swell and go backwards on you.
      I know everyone is different but experiment.
      Good luck.

  32. Tess says:

    Thanks for your reply Dean.

    I’ve been icing after runs and taken on board your advice re stretching and this seems to have helped tremendously (although it’s early days I’ll admit!). I’ve managed another couple of 4 and 5 mile runs with no pain or tenderness afterwards which I think may be mainly due to the change in my stretching routine. I really was stretching it alot before. Now I’m just doing gentle stretches after runs and have cut down on the amount of eccentric exercises I was doing. Fingers crossed I’m finally on the mend and can get my training back on track. Yes I agree I don’t have the ideal amount of time to train for a marathon but I think I’m going to go for it anyway (but gently) as its a once in a lifetime thing for me to get into the London Marathon and just completing it will be a huge achievement. So fingers crossed!

  33. Dean Hebert says:

    Woohoo! London would be a marathon worth running from all I’ve heard. Can’t wait to hear how you do. Good luck.. one step at a time.

  34. Guillermo Rocco says:

    Dean,
    Here we go with another marathoner in need of help.
    I have had achilles issues ever since I started training for my first ever marathon 6 years ago. At the beginning I thought it was due to the wrong shoes or the extreme cold or hot weather. With time the aches came and went, without any physio therapy.
    Anyhow, for the last 2 years I have been running without any issues (30-60 Kms weekly) and doing all kind of hill workouts in the warm Omani weather (I live in Muscat and in Summer we run in 35-42 degree celsius…). I have just completed the Dubai marathon (27-Jan) after an 18-week programme that covered 1,000Kms. After my last long training before the race back in 31-Dec, I felt a slight ache and stiffness in my achilles. Then 2 weeks after that I did a heavy hill workout that made it worse and had to take all kind of massages to get to the marathon day in one piece. I indeed completed the marathon using for the first time ever a pair of compression socks on my calves that seemed to do the job since my achilles ache felt under control and did not bother me during the marathon. I have tried a coupe of runs after the race and the tendon is painful and it feels very stiff in the mornings until I get going and become more flexible.
    Since the last marathon is only the training for 2 ultra-marathons this year (one in April and one in June) I am taking a couple of weeks off running and replacing the exercise with cycling to maintain my fitness. I symphasise with your approach of doing something everyday to keep the mobility. The physios I have talked to think that tght calves are my problem so I need to keep streching. The question is how much…?? I’m also using a TENS machine for pain therapy but it seems that the EMS machines work better for muscle recovery? Any thoughtts?
    My ultra-marathons are my main target this year and just completing them will be the achievement that I’m after. I was lucky to finish in 3:26min in Dubai to allow me to be seeded in the 2nd group in Cape Town’s Two Oceans marathon (56K) in April and in the 3rd group in Durban’s Comrades marathon (89K) in June.
    My main worry to is to keep fit while recovering from this injury. Once in the race it seems fine and the pain comes afterwards…
    Thanks in advance for any advise!
    Regards,
    Guillermo

    • Dean Hebert says:

      Guillermo,
      You are funny but right… another one eh?
      OK, first there is no great answer on the stretching question because it depends on the cause of your Achilles tendonitis. It could be that your hips are what are causing it… or your forefoot inflexibility… anywhere along the power chain. So, unless you know that INflexibility of your calf is the real cause… go lightly or you may worsen your tendonitis.

      Forget the TENS unit they are designed for pain relief. EMS units on your calf is good. They can be for recovery but also for actual strengthening of the muscles.

      The race day pain let-up may be a mirage. Endorphins flowing in your body on race day may just be masking it.

      If you do very high intensity cycling, reps, uphill repeats etc. (not steady state rides) it will help maintain some of your running shape.
      Good luck.

  35. Jack Davis says:

    Dean,
    I am 58 and was a runner of some prowess until health problems (afib and ruptured disks) forced me to stop at 43. In May of 2011 I was finally cleared to run again. I started out slowly and it was September before I was running entire 5k distances. I was running about 90k a month with avg pace of 6:30m/k. By the end of December I ran a 24:00 5k race. Then I did something stupid and over doubled my mileage and days running starting Jan 2012. In February my left achillies started bothering me and by March it was causing me to end long runs early. Anything over 10k was a pain, litterally. I went to a doctor and have been getting a procedure called grastoning for the past 2 weeks. No running during this time. The achillies no longer hurts but it is still a little tender to the touch. Do you have any thoughts on this procedure and recovery from AT?

    Thanks

    • Dean Hebert says:

      Jack,
      First, you got me on the Graston Technique… I had not heard of it. But researched it and lo and behold it is just like the ASTYM treatments. It’s just another “brand” of instruments basically. Given my experience and many others I know.. this is a great treatment AND it’s a treatment that they WANT you to continue in your activity. Yeah!!! For ASTYM they say I think anywhere from 4-10 treatments for optimal results. Drop a line on how it works for you. And next time.. watch out for the old “too much too soon” thing… and as a masters runner it takes far less so it’s “too much too sooner”.

  36. coach_o says:

    I’m a bit late to the party, I know, but I was reading about the long miles, low heart rate nonsense, and found it pretty good, so I thought I’d read the rest of the blog.

    Um… I’m not suffering from an achilles injury. At least not any more. But I did for more than 10 years, after doing some poorly thought out plyos for basketball. I was able to manage it well enough to keep playong basketball and do the occational running by taking breaks when it got too bad. But for 10 years my pre-breakfast rutine was getting out of bed trying not to scream.

    About 16 months ago I decided to finally do something about it, and read up on it on the Internet. My cure has been eccentric calf exercises, extreme stretching after EVERY run and ice after every workout… That’s it.

    16 months ago I had a ball of scar tissue on both achilles, which is almost gone now. Just the other day I jumped off the scorers table (no, I didn’t jump on it in a game), expected excruciating pain, and had to stop and smile because I didn’t feel a thing.

    Basically what I did was:

    Eccentric work every day for the first 6 months, now three times a week: Raise myself up using my upper body strength, then drop slowly down (6 seconds). 1×15 reps on both feet, 2×15 reps one foot at a time, with both straight and bent knee.

    Stretching after runs and eccentric workouts: 15 second stretch for each leg, then the workout begins. Using my upper body strength I raise myself up on one leg, then contract the muscle and hold for 15 seconds. Then I lower myself and stretch as much as possible for 60 seconds, then do it once more. I repeat this twice for each leg, knee straight and bent.

    And then the icing… This was the most painful thing I’ve ever experienced (yes, really). I will simply leave the ice pack on the achilles until it warms up. I know about the 20/20/20 on/off/on rule, but when I do it that way I don’t get that pain in the scar sissue I instinctively KNOW is doing me good. After about 25 minutes the scar tissue would start pulsing with pain (real pain), and the times I sat through it (and lots of times I wasn’t able to), the next morning I would feel so much better.

    I still ice these days, but the pain isn’t as bad, and my scar tissue is still decreasing.

    One curious thing, though: About a month after starting the program (before it did any good) I ran a half marathon. It was the most uncomfortable race in my life, and my achilles were absolutely killing me all race, to the point of me almost pulling out for only my second time ever. I got through it on sheer will power, but I expected to not be able to get out of bed the next day. To my amazement there was no pain. And for two months after there was no pain. I felt perfect. I still did my workouts, and after about two months the tendinitis came back, but ever since it has gotten better and better. How running a HM and it makes your injury better works I’ll never figure out – but hopefully I won’t need to anyway.

    • Dean Hebert says:

      I’m gald you have added to the discussion.

    • Dean Hebert says:

      I’m glad you have added to the discussion. Indeed there are advocates of the eccentric stretching BUT it has to be done very carefully. Though I disagree with “extreme” stretching in ALL cases – even medical professionals don’t advocate such – I am very pleased that it has worked for you!!! It’s great that you are back.
      PS
      The HM did NOT in any way made your injury better. I could list a myriad of reasons but bottom line is a race or run won’t do that.
      Keep it rolling on and off the court!!!!

      • coach_o says:

        Hi coach,

        Thanks – always a pleasure communicating with someone who takes his things seriously and who bases his coaching on sound scientific principles.

        There is no doubt my injury was caused by lack of flexibility and strength of the calf muscle as discussed here: http://www.pponline.co.uk/encyc/sports-injuries-achilles-tendonitis-324
        Quote: “Two other individual factors causing tendonitis can be lack of flexibility and lack of strength in the calf muscles. Tightness in the calf will lead to extra tension being placed on the Achilles tendon, during running and walking, especially up hills. Lack of strength may mean that the tendon will not be able to cope with the forces applied during movements. During running, the calf muscles are most active during the first half of the contact phase, when the muscles are absorbing the impact with the ground. At this point the calf muscles are working ‘eccentrically’ to control the forward motion of the lower leg. When a muscle works eccentrically, it is lengthening as it contracts, The faster this contraction, the greater the forces applied.

        With this in mind, a strengthening programme for the calf muscles should focus on developing eccentric strength, using progressively faster speeds of movement to increase the forces that the calf can handle. This type of programme is ‘functional’, which means that it involves the same type of contraction of the calf muscles that occurs during running and so should have greater benefits for injury prevention and rehabilitation.” Quote end.

        As far as eccentric work it’s not eccentric stretching as much as eccentric strength work. A lot of achilles injuries occur because of insuficient strength in the calf muscles, but traditional calf raises seem to make the problem worse in many cases. Doing eccentric strength work, however, doesn’t seem to cause the same problems.

        The way I first heard about the eccentric strength method it was a Danish Physio Therapist who had extreme achilles problems, but due to Danish healthcare rules wasn’t eligible for an operation. He set himself the task of actually rupturing his achilles tendons by doing calf drops with added weight on his back.

        However, after trying this for a while he found that his injury was getting better. The theory is that the calf drops both strengthened his calf muscles, but at the same time stretched the tendon, thus tearing the scar tissue. He experienced the same as me, as far as actual scar tissue dissapearing. Several studies have been cunducted on this and it appears that clinical studies support the results (http://ijahsp.nova.edu/articles/vol5num2/van_Usen.pdf).

        As far as the HM improving my injury I agree totally. There is no way it could improve my injury which had been very bad all the while I was training for the HM. Only something happened, but I guiess sometimes you’re not supposed to be able to explain such things lol

      • Dean Hebert says:

        Good points. I’m very aware of the Danish work and the pponline info. However, it is NOT the definitive piece on Achilles. This info is certainly SOME ways of dealing with Achilles not THE ways. It is not holistic as my article outlines the newest approaches through the Gray Institute which is my main exception to what is posed by all the calf/achilles work. Achilles tendonitis MAY be due to weakness/stiffness but it also can be many other things. The problem is that virtually all in the medical profession have defaulted to treating calf/achilles (the effect) instead of the CAUSES. Then again, if it worked for YOu that is what counts!

      • coach_o says:

        I agree. You have to look at the cause of the injury first – in my case it was a weak and shortend calf muscle. If you don’t diagnose the injury first you might as wel… well, run a half marathon to see if that cures it 🙂

  37. Paul F says:

    I need help, first of all I’m seeing a Physical Therapists. About 3 weeks ago I ran in new shoes and had them too tight and my Achilles was sore after the 3 mile run, the next day I tried to run and after about 1 min of running my Soleus get soo tight I physically can’t run thus it then pulls on my AT. I limp around for the next few days then. I can cycle and swim without problems. I’m desperate to get back running, I had this injury abut 9 years ago also, I”m 45 now. I even cut a notch out of the heel on all my shoes to give my AT more room to move without anything touching it. I’ve tried massage, heat, foam roller and stretching. Noting seems to help to allow me to run. Any advise would be welcomed.

    • Dean Hebert says:

      You’re doing the right thing – rest. As an acute injury – that is most important. And unless you want it to become chronic keep resting and keep doing your other activities. I know it seems like a long time… but 3 weeks is not very long. Achilles are very unforgiving. If you are doing anything that aggravates it – you have to stop. Any aggravation will delay healing. Watch what shoes you wear during the day even. Get heel lifts. You may be a candidate for a cortisone injection. It’s not a #1 treatment, but, it does work. You then have to lie low for a week or so before trying to run again. As for PT – get one who has gone to the Gray Institute who really understands a holistic approach. Most PTs have you do lower leg stuff when the actual cause and cure may be lower back for instance. Though “tight shoes” most likely precipitated this, it could be far more than that; your achilles is the weak link that has ended up injured. Anti-inflammatories are in order as well (ibuprofen). Good luck and be patient.

      • Paul says:

        I go barefoot all the time except when I’m not at home, will that prolong the healing? How thick of heel lifts would you recommend?

      • Dean Hebert says:

        Funny you say that, early on with my problems I thought that going barefoot would be a natural way to “stretch” the achilles. I found that it irritated it. I was better off in shoes and with lifts at least until it got better THEN and only THEN I was able to be barefoot around the house. So, I’d throw some shoes on and get a lift… how much lift depends on the person.. 1/4 inch, 1cm might be ok… 1/2 inch, 1.5cm might feel like you are in high heels… but try it. The goal is to get relief to the tendon right now.

  38. Lyndsay says:

    Hi I’m wondering if you have any thoughts on running strides. Heel strike vs mid/forefoot when it comes to achilles tendonitis. I have been off running for about 2 months and I’m hoping to get back into it at the end of the month. I have been doing some research on mid/forefoot strike and I’m wondering if I should switch to that. I currently heel strike. I’m still having on again/off again pain still even after more or less 2 months of not running. Any thoughts? Do I just need to push through the pain like you recommended to others? I just don’t want this to be a forever injury as I just fell in love w/ running.

    • Dean Hebert says:

      Lyndsay,
      I would most strongly advocate NOT moving to mid/forefoot striking. Think about it – all the stress will come directly to your calf and tendon as a mid/forefoot striker. Heel striking would be far less traumatic. And in almost every controlled study (not those who have something in it to gain from the results) supports this. You are a heel striker for a reason. Optimize YOUR form and get stronger and more running specific power… you’ll get faster.
      Do not just run through the pain. If it has bothered you this long it is now chronic.
      Options:
      First see a PT who has gone through the Gray Institute: http://www.grayinstitute.com/gift.aspx
      Look into orthotics.
      Look into the PRP procedure.
      Get into aqua-running in the mean time.
      Good luck!

  39. Anna Alicia says:

    hi,

    Im 27 years old and I am also suffering pain due to the inflammation of my achilles tendon. My doctor have given a simple sets of exercises to follow and is still advicing me to stop running for a while. (not only running but I am also adviced that I need to stop doing most of my exercises like zumba and cardio dance). Do you have any advice on what are the most suitable exercises I can do, without injuring my foot at the same time I can still maintain my weight? (the exercises my doctor gave me doesn’t really help with weight loss or toning, i’m trying to stay toned)

    • Dean Hebert says:

      Anna,
      Zumba and cardio dance are definitely as guilty in causing your tendonitis. So, any of those activities will aggravate it. Your best bet is aqua running or stationary cycling and doing them in an interval fashion and not steady effort workouts. Better calorie burn, better conditioning and easy on the achilles. Eccentric heel drops should be part of your exercises and have been shown in most (not all) people to have better results than just plain stretching of the calf.

  40. larry says:

    Sorry to bother you. I came across your blog and wanted to ask a question regarding Achilles pain with a bump. I wanted to know does Achilles pain always lead to rupture of the Achilles. Is there any statistical information out there to suggest that? Im asking because I have some soreness and a bump at the middle of my Achilles. Also , what can be done if rest isn’t an option? Its usually stiff in the morning and get alittle better throughout the day. Does pain usually precede a tear? or is it a separate issue?

    • Dean Hebert says:

      You have classic symptoms of tendonitis. I am not a doctor but I did have similar questions for my docs and here is what I walked away with.
      No pain does not mean a greater incidence of ruptured achilles.
      Not sure what you mean that “rest isn’t an option”. Stop running, jumping, etc. So unless you run and jump for a living you need to take it easy on those Achilles. At a minimum put a heel lift in your shoes – even your work or everyday shoes to help relieve stress.
      In fact my doc said tears are usually sudden and for most cases unwarned. There is not greater chance of tear with someone with tendonitis than without. (He said % was the same but I don’t remember the numbers.)
      Find some of the treatment modalities mentioned in these posts – ASTYM would be #1 that I would recommend.
      Good luck.

  41. larry says:

    Thank you for a prompt response. I appreciate it!. I will look into ASTYM. Thanks again! Love the blog!

  42. Hikkt says:

    Hi. i briefly read some of your posts about achilles tendonosis. i was wondering if you might offer some advice. been dealing with achilles tendonosis this episode (had in 2009 and 2010). this episode started in july and to date i have done: ART, dry needling, graston, PT, not running since JULY, boot for 3 months, followed up by PT. MRI should tendonosis but ortho said more good tissue than bad so surgery not advised. i have done eccentrics since july – increasing the weight. i decided to start running again with the pain and i made it u pto 8 miles but the pain was too great. stopped again, and got a PRP injection. after the injection wore a boot for 2 weeks then started PT again. tomorrow is 6 weeks post-injection. i am seeing dr. again and i am sure she will recommend another PRP injection. i don’t know the statistics if first shot didn’t work, what are the percentages a second shot will work, etc. at this point i am considering going to another foot & ankle ortho to talk about possible surgery??? i just don’t know where else to turn and i don’t want to live my life in chronic pain. i have been using the elliptical and swimming, all with moderate pain. maybe surgery will put an end to the pain??? would appreciate your advice. thanks.

    • Dean Hebert says:

      As you have undoubtedly read, I’ve struggled with this off and on for about 35 years. I get it about constant pain. I’m not extremely familiar with how many PRP injections can/should be done. I do know that sometimes it does indeed ned more than one go-round. So, don’t avoid the doc for that reason. Do seek another opinion BUt surgery should always be a last resort. The risks are greater than all other treatments. As you have read I’ve had several surgeries. In my younger years I rebounded pretty well. This time around (2 years ago now) it has not been as smooth. Though the achilles is 99.9% – I’m happy as far as the surgery goes. The recovery, loss of strength, muscle imbalances etc. have lead to a string of other issues that I am still working through today… 30 months later. So, go lightly, seek lots more information. As I have done for others, I’m ore than willing to chat on the phone with you if you wish to discuss in more depth. Hang in there.

      • Hikkt says:

        thanks dean. it is so frustrating because i have seen no progress since july. my one attempt at running for about 1 month was too painful. it is not only the running, it’s every day that i have to deal with the pain. it’s not horrible but ALWAYS there. been in the boot twice, once for 3 weeks, second time for 2 weeks post-injection. i have an 8 a.m. appt. with the doctor who injected me. i am not sure what to even say to her. she will definitely try to convince me to get another injection. it is very expensive and not covered by insurance, but at this point, the only other alternatives i have are new orthotics and new sneakers. and of course surgery which i really don’t want. grrrrrr. in addition, i wonder (and will find out tomorrow) if i have to be back in the boot again after another injection. it seems i go backwards instead of making any progress. i feel the same way as i did in july when this all started. thanks for your opinion.

  43. Carl says:

    Hi,

    I’m so happy about my Achilles tendon recovery that I just have to share it. Maybe it will work for others.

    I’ve been running ultra marathons for a few years and I’ve suffered from achilles tendon pain pretty much from the first day I started running. The pain in the mornings are excruciating.

    Recently I started weightlifting to increase upper body strength and I also incorporated dead-lifts in my routine. I kid you not, within 4 weeks of starting dead-lifts (twice per week) my achilles pain have just about disappeared completely.

    When I started out with the dead-lifts I could actually feel all sorts of pulling and tugging in my lower leg muscles as things pulled into alignment (If that makes sense). So I reckon there must have been some type of alignment/strength issue in my lower leg/ankle area that has now disappeared.

    So after years of trying all sorts of fixes including physiotherapy, Pilates, ice, I finally found something that works for me. Dead-lifts, and more dead-lifts.

  44. Wayne Briggs says:

    Hi Dean

    I am a gardener by trade and spend a lot of my working week walking or on my feet.

    I recently returned to running and within two months I was running about 25 miles per week at about 7:30/mile pace.

    I had been wearing heel lifts after experiencing sore Achilles after buying some trainers just over a year ago. The soreness very quickly went away and I thought i’d found the cure.

    Anyway to cut to the chase after about two months of running I tore/sprained my right calf. I had been running on sand and on snow a bit, so this as well as a sudden increase in intensity could have been the cause I guess. I was also advised that the heel lift could be the problem, so I went to a specialist running shop, was told I had a ‘neutral’ gait, told I didn’t need orthotics and I purchased a pair of trainers with good cushioning across the whole shoe.

    I rested the calf injury (right calf) properly, started back into training, doing medicinal runs (i.e. walk run, walk run), gradually increasing over the next few months without a problem. I was following a half-marathon training plan on Runkeeper.com and I got to a good pace for 8 miles again (under 7:30 a mile)

    I’ve now had to stop running due to Achilles tendonitis (left Achilles), and haven’t ran for nearly two weeks. I rested while I was in pain, am gradually increasing my stretching and strengthening now, and am wearing heel pads again which appears to be helping, and I hope to run again soon.

    The main question I have is what do I do about the heel pads medium to long term. All my other shoes are flatter I guess than my running shoes. Should I wear them just in every other shoe permanently? in my running shoes when I start back as well? or try to get rid of the heel pad completely? (and if so do I do this gradually?)

    Also, I find it’s a very hard injury to gauge pain with. I’m quite often feeling or pnching my Achilles to check my recovery, but I guess it’s gonna hurt if you do that! I try to compare it with my other one – is that a good guide, or could the other one be a touch sore as well.

    The reason I mentioned what I do for a living is that I saw a post above where somebody said ‘they find it hard to rest’, and I sort of know what they mean. I’m constantly walking, often on slopes or inclines behind a lawnmower; but I should say that less than two weeks after injury I can walk for miles like this.

    Any advice would be appreciated

    • Dean Hebert says:

      Thanks for sharing the context of your achilles issues. That helps. One thing to look at is using heel lifts in ALL shoes. The aggravation may be caused by TOO MUCH stretching of the tendon with lower heels in your NON-running shoes. Once all pain is gone you may be able to return to no lifts… but it would have to be very gradual or you’ll be back where you are today.
      Comparing your achilles and how they feel is indeed a good way to gauge how you are progressing. And it is indeed possible that the other one is sore as well but since it is LESS sore you just didn’t really pay attention to it. Now that you are pressing on them both you now can elicit some sensitivity. Both probably were in need of TLC. You don’t have to push on them so hard – until it hurts – to get an idea of progress or improvement.
      Coming back just avoid hills, speed work and really long runs. You have to be able to run short and easy before longer or harder…. otherwise.. you’ll be asking for being a spectator on race day.

  45. Amie says:

    Hey, I recently had shin splints after not having the right shoes, after about two months they finally started to go and I soon developed an achillies tendon problem in my right leg and after doing heel raises my left started to hurt. My left is now more painful than the right. After the pain started I stopped running immediately and haven’t run since- its been 3 weeks. I’m really unsure about when to start running as my achilles pain comes and goes and is only mild! I’ve researched a lot but everywhere seems to say something different about when I should start getting back into running and how much I should do!
    Any help would be great!

    • Dean Hebert says:

      Amy,
      The reason you end up with so much conflicting advice is due to the very nature of achilles injuries… they are complex and NOT of a single nature… like a broken bone (6-8 weeks in a cast and voila you’re going again).
      Pain is your guide. If it hurts then you are likely doing more damage.
      So start easy start slow, and STOP your workout while feeling No pain. Don’t wait until you DO feel pain. Always stop short just that little bit and extend it over time.
      Be sure that you are doing ALL your physical therapy exercises and do not stop them even when the tendonitis is gone. Or it will return… believe me on this one. You obviously have either imbalances or weaknesses and you need strengthening and stretching of your lower body and even your back. All of these can lead to shin splints… and to the tendonitis. It’s all about favoring something that makes something else work too hard and get an “owie” as a result. You must fix the imbalance or you are very likely to repeat this whole thing.
      Stop doing heel raises and extreme stretching. That only serves to aggravate things unless they are VERY light. Period.
      Ice after EVERY workout regardless of whether you have any pain. Complacency on these things will almost guarantee it coming back or becoming chronic.
      Hang in there. You’ll be back.

      • Amie says:

        Thank you so much, that’s very helpful. I will go and ask a trainer in the gym for some strengthening exercises! Is it a good idea to start with 10 minute runs and increase gradually if pain free or can I start with more? Thank you for your help- the best advice I’ve seen!

      • Dean Hebert says:

        10 minutes might be too much you never know… it’s VERY subjective. Just be sure to stop BEFORE it hurts.
        Oh, also, heating it (heating pad, whirlpool or the like) seems to help with blood flow and flexibility before working out might help out. Thanks for dropping by… stay in touch with your progress. As you can see we all benefit from each person’s experiences… no single answer.

  46. Brandi says:

    I am having a lot of pain in my Achilles tendon. It is most severe in the morning and honestly does not ease up until early evening after icing multiple times. I am a recreational runner, running 20-25 mi/week at a 7:30 pace. I also do weight/circuit training 2x week. A little history: I was running 35 mi/week until I started suffering from coccyx pain (no injury-just onset of pain that continued for months). The doctor gave me a cortisone shot and then told me not to run for 4-6 weeks. It was so hard for me to stop running because I did not feel pain during runs. I just could not sit down. But I followed drs orders and I continued my weight training during the time that I could not run just to try and stay fit. It drove me INSANE! I love my runs. Anyway the coccyx pain did ease up slowly and eventually went away. I very slowly eased back into my runs back in September and did so with no injury. Now, last week I was sick and did nothing for 7 days. Big deal…right? First run out did 7 miles (feeling very good after the 7 days off), then 2 days later did my weight/circuit training followed by 4 mile run. I was sore, but nothing worth mentioning. The next day I noticed I was limping a bit because my achilles tendon was extremely sore. It has been 5 days of ice and complete inactivity and it is not getting any better! My achilles hurts really bad. Not sure if I should see a doctor, work through the pain and just suck it up or what? Im not even doing the weight/circuit training…the push off from the lunges hurts so I have done nothing…is that the right thing to do? Im just going crazy doing nothing. Any advice would be most appreciated!

  47. Andrew says:

    Dean, I stumbled on this article while researching cardio exercises I can do while rehabbing my Achilles tendonitis. I haven’t stopped or dramatically decreased the weight I’ve been doing with regards to other leg exercises barbell squat, barbell deadlift, hamstring curl, bent over barbell row (which isn’t a leg exercise but obviously utilizes the hamstrings), with the exception of calf exercises. I only do dual leg toe raises.

    Would you recommend avoiding these other exercises until my Achilles heals?
    Additionally, would you recommend stationary bike over arc-trainer/elliptical or any other cardio machine in particular? (I really can’t wait to get back to running, but I’ve accepted it’ll be a while)

    Thanks for the advice.

    • Dean Hebert says:

      Good that you are working to stay in shape while getting over this. The key is do any exercise as long as it does NOT irritate the tendon. If it hurts while you do it or right after you do it then stop doing it. Stationary bike is best if you are doing interval like training on it (not so much for just steady state cycling). It appears that most of the research supports the cross-over effect for runners.. to running. Not much has been done to demonstrate the same effect for anything else. Hang in there!

  48. Kenny Walker says:

    Great article and some good advice. I have to say that after doing a bit of research and reading comments I’m scared I won’t be the same runner again. I run ultras and was looking forward to a particularly long distance race at the end of May. Can you ever go back to running 100+ mile races after getting this?! Feeling glum

    • Dean Hebert says:

      Well Mr. Glum… first things first.
      Take care of your recovery the way you should.
      Don’t “test” that achilles more than reasonable… it really has to heal (or heel 🙂 You have to be patient.
      Avoid speed work and hills. The hill thing might be tough to avoid depending on your races. But, that is a real nasty thing for your Achilles.
      If you are prudent in your return there is absolutely no reason you cannot be doing ultras again. That said… the one in May – may or may not be too soon for you. That just depends on the extent of your injury AND your rate of return.

      • Ellen Bagnato says:

        I’ll chime in here, too. I am a serious recreational runner with a marathon PR of 3:09 at the age of 44. I had a developing and perplexing achilles problem in the spring/summer of 2011. Then, after months of apparent micro-tears, my achilles tore 90% as I stumbled in my garage unloading groceries; the achilles was just too weak to withstand the turn of my ankle. I had the surgery to repair it in September, 2011. After faithfully following the directions of my doctor and physical therapist, I returned to running in March, 2012, right on schedule. During that time I examined my running form with a form coach and corrected some biomechanical issues, in an effort to lay the groundwork for injury-free running going forward (and to avoid whatever caused my achilles to start micro-tearing).

        Yes, getting back to running was slow going and I supplemented with cross training for cardio work (in fact, I did cross training the minute my doctor allowed after the surgery, so December 2011…stationary bike and swim). But, this has a happy ending because after getting myself back into running (Phase 1) and then starting some reasonable training (Phase 2) I came back to win my age groups in two half marathons in the summer of 2013 here in Colorado. I also qualified for Boston again and will be running that race in April. So, in other words, I got my speed back, and I think I’m a much smarter and better runner than I ever was. It just required me to take some serious time off due to an injury to learn all of that, but it is invaluable.

        My advice to you is to respect your achilles issue and give it the attention it deserves, and not to “cut off your nose to spite your face”, so to speak. It’s really not worth it if running is your passion. There will be time to do that 100 miler!

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