Achilles Tendon – Comeback Case Study – 6 Month Follow-Up

Ok, I’ve been remiss. My last update was in October. My last comment was my hopes for the New times 5k in November to be in the low 18’s. This was optimistic. I ran 19:33 and was pleased with that. I could have run about 19 flat but ran it with my son – it was fun. (I’ll write on that experience another time.)

So, let’s look at things I’ve done and not done. First, until December I did gradually increase weekly and monthly mileages. My monthly mileage climbed from Sept. (87) then leveled off – Oct-Dec looked like this: 146, 142, 141. January hit 153 – my most miles in 14 months. To get miles in, I have continued to frequently do a couple shorter runs during the day. My long run got up to 8 miles. My long day hit 12 miles. My average pace overall was pathetically slow for me. I averaged 7:45/mile on a good day to 9:30/mile on a slow one. However, the gradual strengthening of my body is slowly taking place. Since the beginning of January 37, 23, 40, 40 in consecutive weeks. This pattern continues. I cannot keep the week-to-week consistency. I just feel like I am weak, achy and no energy. It’s slowly improving. Despite the miles I was slower than I had been at any point of my life – other than my first year of running as a sophomore in HS. I was running on average 25-30% more miles than at any time in the past 5 years or more and was in worse shape.

Training tidbit: This is a perfect real life example that illustrates more miles do not get you in better condition. It is not the miles, it is what you do with the miles that counts.

The Achilles continued to ache day to day. No real pattern. But I did have to take days off and listen to my body. I cut out anti-inflammatories and use them only rarely right now. I iced regularly after workouts through December. Now I ice as needed.

Folks – Do not try the following at home. This is an “experiment of one” and I’m sharing it with you. Coming from a medical background, I cannot recommend this. It may or may not work and there is a risk of more serious injury involved. (Now my lawyer is happy too.)

After continuing to analyze my recovery, different modalities of treatment and why they were recommended a thought occurred to me. Why can’t I do this rehab “organically” – meaning within doing workouts versus a separate treatment. ASTYM has been shown to give good results with some of my runners ailments and it is touted as excellent with Achilles tendonosis. But this is not a comfortable treatment.

So, my conclusion was to introduce speed training – even high speeds (sprints) – to lengthen and realign the tendon structure itself. Who needs ASTYM and eccentric exercises rehab if it can happen naturally? I started with very low doses. 1×200 (33 seconds) or 1×400 almost all out (67 seconds). I always warmed up well. It was an interesting outcome. Each day-after I felt stronger and had limited to no Achilles discomfort.

In mid-December I started adding speed work. The quality work has been up and down on pacing but it ranges from current 5k pace, to former 5k pace to mile pace and even a few hard reps. I’ve worn racing flats (with my orthotics) on a couple occasions without any problems! Within just 4-6 weeks I’m just now approaching my former “out of season” condition.

  • I ran a 5:25 mile.
  • I ran 3 miles in 18:30 very controlled for one workout.
  • I did a 10 mile steady run in just under 70 minutes. It was a good breakthrough.
  • After 12 miles of mostly easy early morning running. I finished with 8×400 and averaged 83s; the last two 400s were 78 and 72… and I could have done more.
  • My average pace for every day runs is settling in between 7:15-7:45. And my “bad” days are about 8:00s.

For the past two weeks I have not had any sensations in my Achilles tendon. No tenderness. No morning aching. No discomfort on acceleration. But I do have a wonderfully strange sensation of strength in my lower legs.

I’m convinced I’m on the right track (pun intended). I cannot do plyometric exercises yet. I can do modest skipping drills. My next integration is developing my power output with weight training per the fabulous USATF conference I attended.

Stay tuned for more updates. Drop me a line with any questions you may have about Achilles tendons – from tendonitis to tendonosis to tendon tears to surgeries – I’ve been there.

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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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22 Responses to Achilles Tendon – Comeback Case Study – 6 Month Follow-Up

  1. Hi.
    I have suffered for years. See the post below for a quick fix.

    http://domaneschi.blogspot.com/2007/12/how-to-fix-broken-achilles-in-1-easy.html

    As an update to the post, I have started running, and the outside of my achilles is just starting to ache slightly. So the problem isn’t licked but greatly improved anyhow.

    I will try your “sprint” treatment and see how it goes.
    I firmly believe my issues are all related to tonnes of ankle trauma suffered playing rugby and football (soccer) and the consequent lower leg instability.

    I haven’t the the “lower leg strength” sensation that you talk about for years.
    We’ll see how it goes.

    Mick

  2. Mick,
    It’s a sticky one to cure for sure. I don’t know that I’m actually advising anyone to do what I’ve done versus sharing my “experiment of one”. Just as you have intuitively self-treated with the Swiss ball; we reach for some other treatment. Sometimes the traditional medical world simple is stuck in old paradigms and most certainly that world is slow to move to something new and overly cautious in prescribing treatments. I think orthopedists and podiatrists are accustomed to treating little old ladies (not meant disparagingly) and lack the ability to be aggressive with athletes. Of course, then we get into the fact that we are entirely too letigious a society. They fear getting sued so they do what is safe.. not what is best for a patient.

    But even all that aside, I am trying to use what I have learned about anatomy & physiology as well as from the science behind treatments like ASTYM to attack this Achilles issue. In the end, only time will tell. There are many questions even about what I’m doing such as – is it the same for all Achilles problems; does it matter what location the tendonitis is; are tears the same as tendonitises for treatment, etc. Good luck to you. Stay in touch with your progress.
    Coach Dean

  3. Jim says:

    It will be interesting to compare our different approaches. Granted we are training for different things, but still worth comparing. As you know for a good year I tore my calf muscle 3 times. So fitness was a low point. I started traing slow miles, building, got stronger, but nothing fast. My basic training pace was about 7:30…bad days…alot slower..good days..not much faster. But I got stronger and after some time..got to 21 miles on a long run in training for a 50k race. Then november hit , cold weather, hard surfaces, and my knee acted up. Classic Chondromalacia. Couldnt run for 6 weeks ( some light running mixed in, 3-5 miles, but mostly zeros)
    Jan 1 started training again, and have been averaging 40 miles per week, up to a 15 miler long run. Taking 1-2 days off per week due to bad weather, or just not wanted to run. The pafce…generally 7:30-8 minutes, although have been able to run a few at around 7 or slightly under. Still, no speed work at all..nothing. I find the 7 minute pace feels all out. Breathing is very difficult and I feel like I am racing. 7:30 pace feels comfortable. Obviously for my purposes at this point, I need strength and long runs. So at this point, your speed is much better, as would be expected, and my strength for long runs is better, which is too be expected. It will be interesting to see how things progress.

  4. One thing that I am very interested in is how the pain has moved over the years. Originally it was the medial part of my left achilles, then as I got better, the pain moved to a tickle on the lateral part of both achilles.

    I guess the premise is based on an assumptions on my part.
    – The pain comes from structural weakness in some muscle rather than impact trauma

    To get rid of the medial pain, I strengthened my core with the swiss ball.
    Now what I am finding is that strengthening glutes may be aiding the lateral pain.

    what are others experience in this?

  5. Mick,
    You are correct, Achilles tendonitis is not from impact trauma at all. It is a an overuse – tightness-stretch-resistance-ballistic-push-off oriented injury. So it isn’t a hard surface/impact that causes it. And true – if you have an imbalance of musculature which causes favoring – then that indeed can induce tendonitis. And so of course the solution is strengthening of those muscle groups. And one thign you might be experiencing is that more than one group of muscles may be culprit! Remediate one… the other imbalance may still be there… and the pain may shift but not go away.
    Coach Dean

  6. Dennis says:

    Hi, I ruptured my achilles tendon 3 weeks ago. I had surgery, and I’ve been on crutches ever since then. I’ll be getting into a walking boot in about a week, and I’ll be able to walk around slowly.
    Just a word of caution. I’ve had achilles tendonitis for a couple of years, and so it lead to a total rupture on one of my heels. You can find out more about it on my site: AchillesBlog.com

    best of luck, and I’ll provide a link on my site to your informative articles about achilles tendonitis.

    thanks

  7. Lucio Lagunas says:

    Hi, I ruptured my achilles tendon in 2005 playing a pickup game of football. A few months after I began running as a form rehab. However, after about 10 months of running, I couldn’t log more than 15 miles a week or more than 3 miles per day, without incurring some pain and discomfort around the achilles. The soreness usually occurred the following day and increased after a day of rest. After months of icing, ibuprofen and massages I finally got fed up and decided to increase my mileage and intensity of runs. Within 3 weeks, the soreness and discomfort that I had previously experienced following my runs completely disappeared. Its one of the strangest ailments/recovery that I have ever experienced. Your blog was the first time I read anything similar to what I experienced. The idea of putting more stress on an injury goes against all medical advice, yet it worked wonders for me.

    Best of luck and I hope you stay injury free,
    Lucio

  8. Lucio,
    Thank you so much for your comment. I couldn’t agree more tough injury and strange recovery cycle! I’m also glad to hear someone else had a similar experience. Stay in touch and good luck with your running too!

  9. Kate says:

    Great information! I haven’t run for 3 months (so hard!) trying to rehab a chronic achillies problem that is the result of 16 years of treeplanting (I’m 45 years old and a top age group triathlete). I have tried eswt and am told that by mid february I should see significant improvement. I am x-c skiing, cycling and swimming to keep in shape. I think my problem (other than the treeplanting) is tight calf muscles and supination due to high arches. I really confused as to what exercises to do to help recover quicker. stretch the calf, don’t stretch the calf, eccentric heel dips, stretching, no stretching, no running at all or some??? Please help!! I love the other sports but miss running desperately! thanks!!!!

  10. Dean Hebert says:

    Kate,
    If indeed you have tight calves then stretching would have to be some portion of rehab. The heal drops (eccentric stretching) appear best. If your foot plant and/or arch are issues, just verify that you have the right shoes and/or orthotics (which I also believe may only be temporary – I ditched mine after a year without problem).

    I found that SOME easy running (post acute injury status) was by far better than no running. It kept me more limber (as runners go), and maintained a better general range of motion. I had much more discomfort after complete days off than on some easy running.

    If you can tolerate aqua running – that is a great way to go.

    You’ve been off running long enough and I doubt more rest is the answer. I now believe that post acute injury, return to activity has to be part of rehab and that extended total rest is an archaic approach. Just my opinion. If you’ve read the rest of my entries, you’ll see how I approached this over multiple comeback efforts.

    Please, keep me up on your comeback. I’m more than willing to give you my two-cents worth if it helps getting you back to doing what you… what WE love.

    Upward and onward!

  11. Kate says:

    Thanks for such a quick reply! I guess I’m just nervous about running again and setting myself back (my plan is to do couer d’alene ironman, qualify for Hawaii and be in the top 5). my left achillies is definitely a long time chronic injury and lots of scar tissue. i have orthotics and good shoes so i suppose i can try out a short run and see what happens. i have done aqua running 2 times per week for 14 weeks (intervals only). the weird thing is that I am actually fitter since i quit running because i have concentrated on other sports more. But…as you know, nothing really replaces running, especially trail running. The achillies problem got worse after doing a lot of backpacking this summer (similar to treeplanting – lots of weight, travelling straight up hill). It didn’t hurt at all in the last 2 ironman’s I did – 2006 & 2007.

    I will take your advice and do a 10 minute run tomorrow on a treadmill at a 9:50 pace (3 min slower than my usual half marathon pace). any other advice is SO welcome! i read through all your other advice and i like your style!

    i think i have insertional achillies tendonosis. sometimes it hurts very low at the heel, sometimes in the calf and sometimes in the classic place halfway between foot and calf. once it even hurt on the side, just under calf and was swollen. wow, I’m rambling, sorry! what do think of ESWT?

    thanks

  12. Dean Hebert says:

    You are doing everything right. Congratulations… seriously. Your discipline and keeping with aqua running intervals and staying off the running on terra firma is commendable.

    Upon return, avoid trails… they cause havoc to Achilles! Get on flat ground until you can run without symptoms.

    In many ways you most likely are fitter overall.

    I have never had ESWT; in fact I don’t have anyone I know who has had it done. So, please drop a line on what your experiences are with it. I’m open to anything that works!

  13. Kate says:

    I have done 3 runs!!! First one was 1 mile (10 minutes), then 1.5 miles and today 2 miles at 7:50. There is no stiffness just a faint reminder that the tendon is not what it used to be. I think may be i had a partial tear, not sure. Should I stretch??

    ESWT was 3 treatments all one week apart. I live in Canada (3 hours from Edmonton near Jasper National park) and most of the treatment was covered by my extended medical. I know it is VERY expensive in the USA (something like $3000-4000). Maybe people should consider flying to a large Canadian city and getting it done if they are serious about recovery, and that’s legal and everything. I started the treatment in November and finished in mid December. The physio said I would feel maximum results by mid February. The success rate is high and I believe it works. There are lots of studies out there and the treatment works best for certain achillies injuries (as well as plantar fascitis and other injuries).

    Thanks for the encouragement to take the plunge and run again. I was very nervous.

    Kate

  14. Dean Hebert says:

    Kate,
    That is great news! This is a nice addition to this thread and I love hearing success stories.

    Keep going at it slow and easy… no sudden shifts in intensity, duration, terrain or frequency of runs.

    I would continue easy running for a bit yet before endeavoring into the stretch arena. If I were to guess… I’d say stick to it until you painlessly run 10-15 miles a week. Then, oh so gradually… I would start with the heal drops for the stretches.

    In the meantime, keep up the aqua running and other activities. They are contributing both to conditioning as well as rehab.

    Can’t wait to hear of good things this coming spring from you!

  15. Diana says:

    Coach Dean, I just came upon this blog after days of achilles injury research. I was hoping for some advise. My son, an advid long distance runner, who will be 14 in a few months, has an apparent achilles injury. Last Tuesday, January 13th, he was running during gym class and felt a burning feeling in his achilles area and then he felt some pain (this is the first time ever expericencing the pain). Once home we iced, took motrin, and stopped any further activity. Went to the family general doctor on Thursday, January 15th, doctor conducted an exam of the foot, found tenderness in the heel where the achilles attaches to the heel. Told us to ice, limit sports for two weeks. He diagnoised as a very, very minor tear (maybe?). After icing we were told to use heat treatments 3X a day for 20 minutes. He said the heat would start the healing process. There is no pain when walking barefoot only pain in shoes. We inserted a heel cup and that eliminated all pain while walking. I stopped the motrin after the third day. The doctor also told him to start to the “towel stretch” before getting out of bed in the AM. We have done this because every web-site I’ve read indicates NO STRETCHING. He also told him to start doing the standing calf stretch. I apologize for the long post but I’m at a loss and hoping that we are doing everything right. My son will be starting high school in August, and will be on the cross-country team, something he has been working toward for the last few years. He is a very talented runner and has a great future in the sport…this is why I want to be sure he is getting the best advise from the doctor. He also cross-trains with swimming which the doctor said he could resume in another week. I know he is still growing and I’m wonder if this has any affect on his recovery rate. Thank you for listening and if you have any words of advise I would truly appreciate it. Thank you for your time and patience with my message.

    BTW: he wears good shoes which get replaced every three-four months. He is an over-pronater and wears Brooks Adrenlines. I thinking I may have get him an orthodic…he is also very good about stretching before and after his workouts.

  16. Dean Hebert says:

    Diana,
    First, thank you for the post and finding me, your information and details are actually more helpful than a short one… then I have to guess a lot more at what to recommend.

    The good news is that you caught this early. An acute injury is far easier to address than chronic – so in a word – patience. Patience now will yield dividends later. Rush back… he’ll end up like me with 35 years of off and on issues with those pesky things.

    Also good news – he’s very young. He will heal faster than adults. The fact that he is growing is good. It means all his tissues are growing… and usually that will mean some quick healing. (As a simple example – a broken arm for my son was in a cast for 5 weeks and adults would be a couple weeks longer often.)

    I don’t like contradicting doctors – I am not one. However, you are right on with the no stretching early on. The heal drops discussed in this thread are far more advocated nowadays but only after 100% recovered. Stretching irritates the tendon in its efforts to lengthen and loosen up that muscle.

    Do not rush to orthotics. Though some therapists and doctors will disagree, I believe he is too young and still developing and it would not be wise to build in a structural “dependency” on them so young. My guess is that the injury was incurred in gym due to poor warming up and launching into some ballistic sprints or drills or jumps or running “suicides” or an all out basketball game or whatever. So, without a past history of this kind of injury it is doubtful it is a structural issue – which is what an orthotic addresses. The most likely cause is the sudden workout.

    Your focus should indeed be on his future in the sport. Rushing back will be your biggest mistake. Here is what I advise:
    1. Swimming and aqua running are good and will maintain conditioning to a large degree.
    2. Take the time off from running and take the long term perspective.
    3. If the pain is gone and there is no swelling; then start the heel drops. Do NOT over do them. Less is better than more. There is no such thing stretching more = stretching better. In fact in at least adult males, stretching has been linked to higher – not lower – incidents of injury.
    4. Use heat before working out – it’ll help loosen it up.
    5. Use ice after each workout.
    6. No hill running and no speed work for awhile.
    7. EASILY move into some jogging every other day…then to every day. ONLY run if there is no pain. At the first sign of discomfort, stop… he isn’t ready to do more.

    With this, I’m sure he’ll recover just fine. In preparation then for the fall, be sure he continues running throughout the summer. Any sudden changes in quantity of running, speed of running, changes in terrain of running can exacerbate this kind of injury. But this is indeed a warning that this is potentially a weak spot and he should build into his conditioning routine long term preventative exercises.

    I hope this helps.

  17. Diana says:

    Coach Dean, thank you so much for the quick response. You have put my mind at ease and I just needed to hear this information from someone that has been through this experience as well as someone who has experienced injuries with the high school athlete. Patience will be out toughest hurdle, running is such a large part of his life and it has been such a positive influence on him. It’s a wake-up call…he is mortal 🙂 If this had to happen, I’m glad it did now so we could deal with it outside the season and develop better stretching techniques to prevent it from happening again.

    He was planning to start training for his last and final Track & Field season as a youth in March (we have a local youth program in our community). My guess is he may be better off sitting out the majority of the season.

    Where can I find information on proper form for the “heel drop” stretch. Also can other calf stretchs be incorported once we reach the 100% recovery point.

    Also, I heard that he should remove the heel cups from his shoes once he can walk in regular without any sensitivity.

    I plan to have him start swimming in another week. With respect to aqua running, do you recommend the deep water with a waist float or waist deep water and running along the bottom of the pool.

    Also, will strengthening the calf muscle be part of the long-term preventative exercises ?

    Again, thank you for your time, you’ve been a wealth of knowledge.

  18. Dean Hebert says:

    Ok,
    First, I wouldn’t forgo the coming track season at all. He should be running easily in 2- 4 weeks. He should be able to do some faster stuff within a few weeks after that if all goes well. Listening to your body is the key. Hints of issues… back off.

    Yes, remove heel cups when possible for the same reason about the orthotics. Right now it’s a TEMPORARY treatment so it’s NOT a permanent solution. Just avoid racing flats and spikes. They put more stress on the Achilles than training shoes.

    Both forms of aqua running are ok. I would start with waist float to remove ALL pressure or stress on the Achilles. Then gravitate towards partial weight bearing. And on the recovery trail, use these workouts to replace some ground training… alternate from water to ground for instance.

    I’ll email you information on aqua running as well as the stretches and strengthening exercises you have asked about.

  19. Kate says:

    My success story update (so far, cross your fingers!)
    I am up to 7 miles at 6:48 pace with minimal discomfort and am hopeful for Cour’d Alene Ironman. In October I could barely walk so this is a big accomplishment. I can’t really say what worked best as I tried various things – Radial Shockwave Therapy, Active Release Therapy, PATIENCE, vitamins, glucosamine and cross training. However, the Active Release therapist really helped pinpoint my problem area and I saw significant improvement after a few treatments. Maybe it’s true you start to break down after age 45!

    If I could offer any advice it would be to try everything you can, be patient with the recovery process, buy lots of ice packs and keep active. I’ll let you know how my first race goes. Thanks for listening.

    kate

  20. Dan says:

    Hi Coach Dean,

    A bunch of good topics in this thread.

    My situation: Male, 42, 6’ 3” 180. In HS I ran XC, played basketball, and ran track for 5+ years. No training problems. My 5K times were sub 17 at age 18. For several years now my goal has been to get back below 20 minutes for 5K. I’ve come close twice. I don’t exercise as much as I should, especially during the winter.

    I’m playing basketball at the YMCA currently. It’s an over 35 league and a very short court. Not terribly tough. I get a little warm-up and stretch some before starting. Then at every whistle I take the couple of seconds and stretch something, usually calf/Achilles because that’s what’s needed.

    For the past three years I’ve had nagging soreness in my lower Achilles, right where the top of the shoe is. I first thought I was tying the shoes too tight, but that’s not it. Tender Achilles are almost the norm now. I limp out of bed in the morning because they stiffen overnight. They are very tender to massage. That’s the background.

    Tonight I did good stretching in multiple times throughout the ball game. The last two minutes were close and I pushed hard. Now the Achilles are very, very tender. In general they are flexible, if I take time to warm them up and gently progress the stretch. I had good range on them after the game tonight, to the point where I wish my ankles were more flexible to allow a smaller angle between my shin and my foot. I think I have the flexibility. Getting there takes several minutes and is uncomfortable. But it feels good once I accomplish it.

    I’m very hesitant to do anything explosive. Bursting down the court tonight at the end of the game was scary. I was trolling the web tonight looking for info and will begin (resume) taking Omega 3 and L-Glutamine.

    Any advice?

    Dan

  21. Dean Hebert says:

    Kate – such good news. Keep it going… patience is paying off. I’m not so sure we break down after 45 more but we do have to be more cautious to prevent breakdowns. We just can’t launch into things like we used to. Muscles and joints aren’t as pliable and we’ll surely pay if we don’t do things “right”.

  22. Dean Hebert says:

    Dan,
    Your symptoms definitely are indicative of tendonitis. I am not sure the supplements will help. There really isn’t much to support their use for achilles tendonitis. You’re right to avoid sudden explosive bursts – those are killer on tendons.

    In general, you’re asking for problems with achilles tendons in the jumping, fast starts and bursts in basketball.

    Careful on that stretching – once you are “flexible” or have reasonable range of motion, more won’t help in the ankle. You should never stretch and have it uncomfortable. That means you’re irritating the tendon. Though you may feel better after – the problem is that long afterward when you stop you’ll have a reaction to overdoing it. That is – swelling, tenderness and more often than not a net reduction in range of motion or flexibility because of that hard stretching.

    Go gradual and easy. Never stretch to uncomfortable. Be consistent.

    You don’t mention if you ever rested your heels to get on top of this. Since you’ve had this so long sometimes, rest with a good prescribed anti-inflammatory will knock it down so that you can do the rehab and get better.

    Good luck with it. As you’ve read, patience is an important element to recovery with this kind of injury. Rushing it will only worsen the situation.

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