Everything Achilles Tendon

The most popular series of posts I have written relate to Achilles tendons. As a long time Achilles tendonitis sufferer I have tried numerous treatments from conservative (rest and stretching) to aggressive (PRP, surgery). Here, I have another inquiry that I thought would be good to respond to as a post with a compilation of post links at the end.

Here is Janice’s note to me (edited for length – her full comment here)

I am desperate for some relief! I am a 50 year old female who started running last summer (2011) using the C25K program.I tried ice, I tried PT, I have even been to an orthopedist and worn the aircast.After trying PT and the Aircast and no exercise for over 6 months, I feel like it is worse. The mornings are horrific…I use the Strausburg sock or a night brace for plantar fascitis (switching from time to time). Nothing has helped. The last time I saw my ortho, he told me to try PT again and told me to try the Arizona boot. He has recommended the injections of blood into the tendon… my insurance does not cover it. – Janice

Janice,
You certainly have the signs and symptoms of chronic tendonitis. I have had it in one fashion or another for about 30 years. As you shave read in my posts I’ve tried many approaches and everyone seems to swear by their “cure”. You’e right it is frustrating. Mornings and/or days after being your feet a long time are hallmarks of Achilles tendonitis problems as is the lump on your tendon.

Let me address several points of yours. If you still have that lump, odds are that by now it is scar tissue and unlikely to go away… though POSSIBLE. It took surgery for mine to go away though I have heard others who say it went away over time. As scar tissue, it may now restrict movement of the tendon within the sheath… causing discomfort.

The fact that your doc has tried different things is ok. But, more of the same will NOT magically cure this. Immobilization has not worked.. how many more boots and casts will change that? It has been plenty long enough to prove that. I would steer clear of the Strasbourg sock – it made my Achilles FAR worse. Drop that and drop it now.. again, if it hasn’t helped yet – then more of the same won’t help it. That night brace for your fasciitis might be irritating your Achilles. Drop it. Experiment on how it feels NOT wearing and NOT doing things. There are other treatments by knowledgeable PTs for that fasciitis. Sometimes doing so many different things makes it hard to know what is causing what.

I won’t be out on a limb here by saying that you have biomechanical issues going on. The chronic fasciitis and tendonitis indicate that you are somehow making your lower leg/foot/ankle work extra hard thereby injuring it. Something is out of whack ELSEWHERE. These are only the weak link in the chain. So they hurt. All your interventions are directed at the pained area – which as I have learned – is most often not the CAUSE of the injury. It is the recipient.

The treatments that I advocate now are:
ASTM – only by a certified specialist physical therapist.
Functional PT exercises and drills for rehab – a specialist trained by the Gray Institute. (They have a completely different and holistic approach to PT work… I wouldn’t go to anyone else with running related injuries.) You need to get to the CAUSE of this and that does not mean palliative treatments for pain, discomfort or swelling. Something is wrong with your biomechanics that continues to aggravate it.
PRP injections. I had this done and I now know of other runners who have had it done (not just with Achilles). Almost everyone has reported successful results; if not cured, they all report improvement (decrease in pain and/or ability to run again).

There are many other techniques and treatment modalities. There is nothing wrong with trying them. But, these three listed appear at this time to be the best. Most others may treat minor cases or work for some people and not others. These more often work for most people (but not all).

A word about your doc. He may or may not be up with the latest on everything. Just because he’s an orthopedist or even someone who specializes in athletes does NOT mean he’s always up on what works. He may be very conservative or the opposite. He may be doing the same thing he’s done for the past 15 years or not. He may be getting kick backs from various products or drugs or not. In any case NOT all docs are created equal. If you are not pleased with him move on. Given what you have said, I would not use him for PRP. Get someone else. Ask runners in your area who have had the procedure done. Travel somewhere if you must.

You can lick this. Patience most certainly is required. Trust me. But, you can run again…

Here is a full list of my posts on Achilles Tendons related topics.

Achilles Tendon CentralAchilles Tendons TreatmentsAchilles Tendonitis – Recovery and WorkoutsAchilles Tendon – Comeback Case StudyHow do you get fast if you have Achilles tendonitis?5 Top Reasons for Not Stretching Before WorkoutsDiagnose and Treat Achilles Tendons , More On Achilles Tendons IIAchilles Tendon – Comeback Case Study – 6 Month Follow-UpAchilles Tendons – Out of Shape running is Better than No RunningTrying to Out-run Achilles TendonitisAchilles Tendon Debridement and PRPDebridement and PRP Report – Achilles TendonAchilles Tendon – PRP – Post-Surgery UpdateAchilles Tendon – PRP – Post-Op Update #2Functional Physical Therapy for Runners.

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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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5 Responses to Everything Achilles Tendon

  1. Pingback: 12 Must-Read Running Links for March 2012 | Predawn Runner

    • Dean Hebert says:

      Greg,
      I agree that injections are not #1 on anyone’s list of to-dos. However, once conservative measures have been taken PRP is a proven method of treatment. Also the injections as I understand it do not go into the tendon itself but the sheath. I’d rather just not have tendonitis!
      You have a good blog.
      Keep up the good work!

  2. amiller7x7 says:

    Coach Dean: Just a quick inquiry about your current status for your achilles tendon procedure and recovery. I am heading next week into a debridement procedure for a Myxoid condition of the achilles tendon (multiple partial vertical tears with degenerated tissue between them (from the MRI images)) – we are somewhere around 7+ months of lack of progress from this running induced injury of last summer which has progressed now to the point that I cannot even cycle at any significant wattage even with flat pedals and lowered seat (thank goodness, I can still swim!). Was curious as to how this achilles treatment has played out for you as we now several years for you post-procedure and likely into a “steady-state” condition. Also I was curious as to your take (if any) on the criteria that Kelly Starrett outlined in his recent book “Ready to Run” – I am wondering if using those concepts as a guide in the rehab process might lead to a more balanced recovery and reduce the likelihood of re-injury – it may be similar to what the Gray Institute work does but I have don’t all the research yet. Thanks in advance for any additional guidance you may provide. Al Miller

    • Dean Hebert says:

      Al,
      It has been 4 years now and I’ve been 100% as far as my Achilles go. It was definitely a good choice for me. I have not read “Ready to Run” so I can’t really comment on that. I do stand by the Gray Institute and work done by Noraxon. Here locally (AZ): http://www.jumpstartrunning.com/
      Some really amazing work and well beyond what traditional PTs do or have been trained to do BUT scientifically sound and NOT a fad thing.

  3. amiller7x7 says:

    Thanks for your update and congrats on getting the Achilles back to 100%! It’s always good to hear stories about others’ successes to keep motivation up. I did sign up for the jumpstartrunning newsletter but it’s kind of a long commute from my home to them. But we’ll see what the future holds and maybe there we will find a way to take advantage of Nicole’s expertise down the road. Thanks again for your website and for your insights!

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