Achilles Healed???
The information / discussion in the Cycling Health Forum is not qualified medical advice. Please consult your doctor.
-
- Posts: 675
- Joined: Mon Jun 30, 2014 5:08 pm
- Location: Sydney
- Contact:
Re: Achilles Healed???
Postby tcdev » Sat Jan 31, 2015 11:19 pm
I was travelling Europe on my honeymoon when I 'injured' my Achilles, seemingly stepping carelessly on a gutter. I had trouble walking for about a week, which put a dent in our travel plans. Over the next few years the pain would re-occur several times and I ended up seeking treatment at various times from GPs, physios and sports doctors. At its worst I literally couldn't walk at all. More frustrating was that it appeared to happen most often when travelling overseas!
In the end X-rays showed some minor calcification but not enough to explain my incapacitation. The final - and I believe correct - diagnosis was gout! In retrospect I'd had a few very minor attacks in my big toe but nothing like what I had experienced in my heel! I adjusted my diet in an attempt to to avoid further attacks but after a year or so although still very infrequent they were becoming more severe so I went onto preventative gout medication. That was about a year ago and I haven't had an issue since.
As I said, not likely to be the issue with anyone here and now, but perhaps for someone in the future looking for information, it could be a possible cause...
2011 Schwinn Sporterra Comp
2021 Giant Contend AR1
-
- Posts: 184
- Joined: Mon Jan 17, 2011 4:28 pm
Re: Achilles Healed???
Postby NeillS » Sun Feb 01, 2015 9:55 pm
-
- Posts: 3459
- Joined: Mon Jun 30, 2014 10:23 am
Re: Achilles Healed???
Postby CKinnard » Sun Feb 01, 2015 10:41 pm
where are you Neill? do you use diagnostic ultrasound to help educate/persuade clients for the need for deep tissue work? I presume you are a physio.NeillS wrote:I agree with CKinnard on all points. Except that I don't faff around - same as him, I hurt people when I have to (which is quite often) in order to solve their problems. I'm more than happy to put them through 30 minutes of pain in order to solve a problem. I DGAF if they bad mouth me to their friends, I've got a waiting list of people ready to take their place every day if they cancel their appointment!
-
- Posts: 1176
- Joined: Fri Mar 22, 2013 4:58 pm
Re: Achilles Healed???
Postby vosadrian » Mon Feb 02, 2015 8:57 am
Physio in Parramatta doing SWT. They are doing it to the area of pain in the achilles (mid point).CKinnard wrote:Who is doing the SWT? and what part of your leg/foot?vosadrian wrote:Bummer... I am in Sydney. Happy with my current physio, but he is taking a different approach to you, so at some point if I am not making progress I need to decide what to do next. Currently I am doing:
* Shock wave therapy (6 times over the last 8 weeks or so)
* Calf massage done at same as above
* Daily heel drops to floor level (3X15 in morning only and no additional weight)
* Foam roller on calf morning and evening
* Slow gradual build up in cycling volume (had 6 weeks off the bike up to Christmas) up to about 150k per week at moderate intensity (itching to get back to race pace!!)
Progress is slow. Hard to detect in fact, but I think there is more good days now than there was a few months ago.
Are they loosening your plantar fascia, and your tarsal joints (mid foot joints)?
Re massage, just encourage them to explore more deeply/firmly what's going on with your soleus, mid gastro, and tibialis posterior (S, MG, TP) and firm up the treatment of it.
If they have 2 or 3D ultrasound imaging, get them to show you what's going on where the pain is. You should see lot of thick avascular sclerotic fibrosus.
I'd posit that your hammies are tight as well, and you could get more aggressive stretching those.
What's your saddle to bar drop?
What's length crank do you use?
What's your inseam?
And always remember diet and hydration - I see so many people's musculoskeletal problems disappear when they up their vege and fruit intake, and get their hydration right.
Tarsal joints get loosened (he moves it around). Previously an MRI revealed fluid build up on tarsal joint indicating some synovitis?
I don't think they have ultrasound capability. I had a MRI in around september which reveal 3 things at a minor level: bursitis, tendonosis, and synovitis. Not sure if it has changes since then.
I am not doing anything with my hammies but perhaps I should?
Saddle height is 725mm. Saddle position is 75mm@0deg. Reach is 515 Bar, 675 hoods. Drop is 45mm. Knee angle set to 30 degrees. This is specialised BG Fit. Not sure of inseam. The majority of the fit was spent working to get 30 degree knee angle.
Cheers,
Adrian
-
- Posts: 184
- Joined: Mon Jan 17, 2011 4:28 pm
Re: Achilles Healed???
Postby NeillS » Tue Feb 03, 2015 11:38 am
CK yeah I work in Flemington in Melbourne. Do sports and spinal stuff and a little bit of bike fitting (usually fixing up other people's mistakes). http://www.showgroundsphysio.com.au" onclick="window.open(this.href);return false; is me
-
- Posts: 1176
- Joined: Fri Mar 22, 2013 4:58 pm
Re: Achilles Healed???
Postby vosadrian » Tue Feb 03, 2015 1:09 pm
-
- Posts: 3459
- Joined: Mon Jun 30, 2014 10:23 am
Re: Achilles Healed???
Postby CKinnard » Wed Feb 04, 2015 12:55 pm
MRI often does not have the resolution (or radiologist experience) to discriminate tendonosis changes.vosadrian wrote:Physio in Parramatta doing SWT. They are doing it to the area of pain in the achilles (mid point).
Tarsal joints get loosened (he moves it around). Previously an MRI revealed fluid build up on tarsal joint indicating some synovitis?
I don't think they have ultrasound capability. I had a MRI in around september which reveal 3 things at a minor level: bursitis, tendonosis, and synovitis. Not sure if it has changes since then.
I am not doing anything with my hammies but perhaps I should?
Saddle height is 725mm. Saddle position is 75mm@0deg. Reach is 515 Bar, 675 hoods. Drop is 45mm. Knee angle set to 30 degrees. This is specialised BG Fit. Not sure of inseam. The majority of the fit was spent working to get 30 degree knee angle.
Cheers,
Adrian
Most physios who have a few decades of experience handling problem tissue will respect symptoms at least as much as imaging.
Imaging is always reliant on the experience of the radiologist, who is usually interpreting one 2 dimensional static image, without the benefit of subjective and dynamic objective assessment, over time.
Yes hammer your hams, always (stretching and strengthening). Nothing makes a greater diff to smoothing/enhancing pedaling efficiency, and unloading calf muscles. Healthy lengthened hams will smooth the transition from lower limb extension (1 o'clock to 5 o'clock) to lower limb pull back (4.30 to 7 o'clock). How so? if your hams are tight, your quads and gluts will be reflexively inhibited towards 6 o'clock, and your calf will take on more of the load to compensate. If reflex inhibition from tight hams can be avoided, you transition more smoothly from maximal glut/quad activity to hams activity. The calf will not be excessively overloaded eccentrically, which is what initiates and perpetuates tendonosis damage.
And take on board stabilizing your foot arch. If you have a higher firmer orthotic/insert in a running shoe than in your cycling shoe, swap them over.
Or load some firm shaped foam under your arches underneath the insert/orthotic. If the arch collapses between 1 and 6 o'clock, that will increase load through the achilles tendon. Pain and stiffness in the mid foot joints (tarsal joints) also tends to reflexively increase load through the achilles.
And it goes without saying that you want your heel bone stably supported by the rear of the shoe.
Apart from that, seriously, take hydration state, fruit and vegetable intake, and quality rest, much more seriously. This stuff makes a massive difference over time to healing and recovery rates. It has a profound influence on inflammation and tissue repair, which are the two pathological processes perpetuating your achilles pain. I've had stunningly quick remission of chronic tendonosis states when diet, banning caffeine and alcohol, and rest are addressed (in addition to the above).
The problem I have is getting clients on board. They often think there's a simpler solution, nutritional supplement, injection, or orthopedic surgeon's word that is superior! Don't underestimate getting the fundamentals right, before going for marginal gains. Your body WANTS to heal that achilles. You just have to provide the ideal nutrient, oxygen, micro-environment, and rest. By the time a tendon has gone chronic, it is usually thick and short with compromised blood flow. It's the same for the tendon insertion into the calcaneus. The bone has gone through an adaptive thickening sclerotic process that compromises local circulation. This takes time to reverse. It's my view that a Calorie deficit helps catabolize some of that dense bone at the insertion point, and resorbs some tendon density.
-
- Posts: 184
- Joined: Mon Jan 17, 2011 4:28 pm
Re: Achilles Healed???
Postby NeillS » Thu Feb 05, 2015 8:49 am
- g-boaf
- Posts: 21318
- Joined: Mon Sep 26, 2011 6:11 pm
Re: Achilles Healed???
Postby g-boaf » Thu Feb 05, 2015 9:32 am
-
- Posts: 1176
- Joined: Fri Mar 22, 2013 4:58 pm
Re: Achilles Healed???
Postby vosadrian » Thu Feb 05, 2015 11:57 am
So is there any physios in Sydney with a clue?
I am going to get into the hammies more. They need it anyway. I have orthotics (that I have gotten since this achilles issue for normal shoes), but I do not run them in cycling shoes. Should I? I do run the specialized inserts which provide some arch support and with a couple of wedges also on one side. So probably more arch support than the average cycle shoe, but nothing like my orthotics.
I am pretty good at doing what I am told by a physician and I can take a bit of pain in treatment if it accelerates the healing, but I am finding most of the physios to me do similar things, though some are more into stretching than eccentric loading... but none want to really hammer the massage as suggested here.
- g-boaf
- Posts: 21318
- Joined: Mon Sep 26, 2011 6:11 pm
Re: Achilles Healed???
Postby g-boaf » Thu Feb 05, 2015 2:43 pm
Well, I hope so. I'm still cautious and making sure I do stretches and look after it properly. I'm happy to go flat out on bike rides and trainer sessions - and even more happy to be seeing and feeling really marked fitness improvements.vosadrian wrote:That is great news g-boaf. You have dodged a bullet there.
There was one in the CBD I used to go to at a physio place just opposite AMP food court in the Sydney CBD. Unfortunately she has left and gone elsewhere. She used to be the physio for a one of the well known Rugby teams (can't remember which one). I haven't seen the others.vosadrian wrote:So is there any physios in Sydney with a clue?
I've not been to Sydney Sports Med at Sydney Olympic Park, but they seem to have people there with reasonable background experience. Obviously it's hard to quantify that without talking to people they've seen/helped. I tend to like to find ones who are athletes themselves or who have worked with athletes / sporting teams.
-
- Posts: 1176
- Joined: Fri Mar 22, 2013 4:58 pm
Re: Achilles Healed???
Postby vosadrian » Fri Feb 06, 2015 8:47 am
I am happy with my physio. I have been to a few.... and all with sporting backgrounds including a commonwealth medallist in the cycling road race and an ex pro league player. They seem to be good at what they do, and I have been happy, but they do have different ideas to those mentioned by physios here of doing some deep and painful massage. I am slowly improving, but I wonder if I could have done things differently and got on top of this much quicker.g-boaf wrote:Well, I hope so. I'm still cautious and making sure I do stretches and look after it properly. I'm happy to go flat out on bike rides and trainer sessions - and even more happy to be seeing and feeling really marked fitness improvements.vosadrian wrote:That is great news g-boaf. You have dodged a bullet there.
There was one in the CBD I used to go to at a physio place just opposite AMP food court in the Sydney CBD. Unfortunately she has left and gone elsewhere. She used to be the physio for a one of the well known Rugby teams (can't remember which one). I haven't seen the others.vosadrian wrote:So is there any physios in Sydney with a clue?
I've not been to Sydney Sports Med at Sydney Olympic Park, but they seem to have people there with reasonable background experience. Obviously it's hard to quantify that without talking to people they've seen/helped. I tend to like to find ones who are athletes themselves or who have worked with athletes / sporting teams.
-
- Posts: 3459
- Joined: Mon Jun 30, 2014 10:23 am
Re: Achilles Healed???
Postby CKinnard » Fri Feb 06, 2015 12:59 pm
adrian, to clarify, the deep hard massage is only necessary if assessment indicates i.e. if significant hard fibrosed scar tissue exists within the three muscles mentioned earlier.vosadrian wrote:I am happy with my physio. I have been to a few.... and all with sporting backgrounds including a commonwealth medallist in the cycling road race and an ex pro league player. They seem to be good at what they do, and I have been happy, but they do have different ideas to those mentioned by physios here of doing some deep and painful massage. I am slowly improving, but I wonder if I could have done things differently and got on top of this much quicker.
physios also work within tight time constraints, and finite client budgets, and variable client pain thresholds, so may prioritize different goals at different periods of a condition. Generally though, I find once a condition has gone chronic, there is often old muscle tears/scar requiring release.
- Xplora
- Posts: 8272
- Joined: Sat Dec 11, 2010 12:33 am
- Location: TL;DR
Re: Achilles Healed???
Postby Xplora » Fri Feb 06, 2015 10:41 pm
I have had much better results from kettle bells and deep tissue massage than the 3 physios over my lifetime. They don't get the passion.
-
- Posts: 1176
- Joined: Fri Mar 22, 2013 4:58 pm
Re: Achilles Healed???
Postby vosadrian » Mon Feb 09, 2015 9:18 am
-
- Posts: 2435
- Joined: Sat Feb 09, 2013 5:45 pm
Re: Achilles Healed???
Postby Calvin27 » Mon Feb 09, 2015 4:43 pm
Anyone know a good strong and reasonably priced physio in Melbourne (CBD or E/SE suburbs?). My physio decided to pack his bags
Cushy dirt bike
Very cushy dirt bike
Bike crushed by car (RIP)
No brakes bike
Ebike
-
- Posts: 61
- Joined: Tue Mar 19, 2013 7:43 pm
Achilles Healed???
Postby Mickzo » Mon Feb 09, 2015 4:57 pm
Hey Calvin27, I'm currently getting treatment for inflammation in both achilles and also for my lower back pain from Chris Seville in Cheltenham. He also works on Sunday's from Glen Waverley. Details http://healthybodiesphysiotherapy.com.au/meet-our-team" onclick="window.open(this.href);return false;Calvin27 wrote:Crap, mine flared up again.
Anyone know a good strong and reasonably priced physio in Melbourne (CBD or E/SE suburbs?). My physio decided to pack his bags
Been seeing him for about 2 wks, pain in my achilles have pretty much gone after doing the exercises he gave me. He's now got me on some exercises for my back.
-
- Posts: 1176
- Joined: Fri Mar 22, 2013 4:58 pm
Re: Achilles Healed???
Postby vosadrian » Tue Feb 10, 2015 4:39 pm
My left however pretty much hurts all the time. Sometimes lower on the heel and sometimes higher at AT midpoint (or combos of both). After a couple of days of relative inactivity it will hurt less, but it never goes away. There has been a few rare occasions where it has felt pretty good, but never gone. If gets worse after activity like a ride, and will then take 24-48 hours to go back to base level. If I ride daily it hurts a fair bit all the time. Every second day and I might get half a day of reprieve. In the mornings it does not feel any worse than the right side, but the right goes away quickly, and the left does not improve that much. My left I avoid any footwear that covers the heel. At work I remove my left shoe while sitting at my desk. I am wearing mostly some slip-on shoes with a loose heel cup. Any business shoes make it hurt pretty much all the time. I just got some orthoheel thongs for the weekend so I can keep enclosed shoes away from causing pain and still get some arch support.
Just wondering if anyone here is having similar symptoms to me?
-
- Posts: 2435
- Joined: Sat Feb 09, 2013 5:45 pm
Re: Achilles Healed???
Postby Calvin27 » Tue Feb 10, 2015 4:55 pm
I don't feel any pain after activity (including pounding the tennis hardcourts or ghetto street basketball) but I always feel it the next morning. It's much more managable if I remember to stretch furiously after these activities. But in some cases where I am playing never say die 5 setters, there is no escape, it will hurt and straight to physio. Swimming also causes problems sometimes.
Office shoes also suck. I walk to work in flats and try not to make too much distance in my work shoes. I am reluctant to buy black shoes from a pharmacy lol. I do get one foot worse than the other and that is because I am right side dominant. Always unclip left and drive the pedal with right to start, single hand backhand leading with right foot, preferred right side driving and shooting in basketball.
Cushy dirt bike
Very cushy dirt bike
Bike crushed by car (RIP)
No brakes bike
Ebike
-
- Posts: 1176
- Joined: Fri Mar 22, 2013 4:58 pm
Re: Achilles Healed???
Postby vosadrian » Tue Feb 10, 2015 5:01 pm
I am most worried about the left which does not recede much in pain throughout the day, and is pretty much there all the time. It just does not seem to be behaving like what other people report to feel who have achilles tendonitis(osis). The right seems to be pretty much classical text book AT.
- Xplora
- Posts: 8272
- Joined: Sat Dec 11, 2010 12:33 am
- Location: TL;DR
Re: Achilles Healed???
Postby Xplora » Tue Feb 10, 2015 7:29 pm
Deep tissue is a random comment. I have had a couple 90 minute sessions which were ages ago, but they resolved a ton of issues. Work has people who do shoulders while you work, they do great work.
Hard to say how this helps you. I know you will have a couple basic issues that need fixing, and tendons require a lot of care to stop hurting them during recovery! For my biceps tendons it was stretching pecs and back to ease the posture pressure, I wouldn't be surprised if you have some similar issue. Different body part though.
-
- Posts: 2435
- Joined: Sat Feb 09, 2013 5:45 pm
Re: Achilles Healed???
Postby Calvin27 » Tue Feb 10, 2015 8:33 pm
Cushy dirt bike
Very cushy dirt bike
Bike crushed by car (RIP)
No brakes bike
Ebike
- g-boaf
- Posts: 21318
- Joined: Mon Sep 26, 2011 6:11 pm
Re: Achilles Healed???
Postby g-boaf » Wed Feb 11, 2015 9:09 am
My symptoms were pain in the back of the heal, probably about a 5/10 for intensity when walking around, but 7/10 if riding fast and putting serious effort in. It would usually subside if I stayed off the heal, but walking again, that would hurt it. Like you, I have to wear tidy black shoes at work. Sometimes if I went outside I'd just take a pair of normal shoes instead, leave the office shoes at my desk. For me, it wasn't anything touching the heal that hurt it, it was just I think the fact it was damaged or injured and certain kinds of movement hurt it. Mine fairly related to how you've described the right side. The left side, that's very worrying sounding. I wonder if a different bike fit might also help you. But that is a different matter, aside from getting the injury itself treated.vosadrian wrote:I am just curious here. I am wondering what other peoples symptoms are like compared to mine. I have an issue pretty bad with my left, and minor in my right. The right hurts in the morning and after some activity like a long walk or ride but recedes quickly and is comparably bearable, but most of the time it feels pretty normal. I can wear any of my shoes without aggravating it.
My left however pretty much hurts all the time. Sometimes lower on the heel and sometimes higher at AT midpoint (or combos of both). After a couple of days of relative inactivity it will hurt less, but it never goes away. There has been a few rare occasions where it has felt pretty good, but never gone. If gets worse after activity like a ride, and will then take 24-48 hours to go back to base level. If I ride daily it hurts a fair bit all the time. Every second day and I might get half a day of reprieve. In the mornings it does not feel any worse than the right side, but the right goes away quickly, and the left does not improve that much. My left I avoid any footwear that covers the heel. At work I remove my left shoe while sitting at my desk. I am wearing mostly some slip-on shoes with a loose heel cup. Any business shoes make it hurt pretty much all the time. I just got some orthoheel thongs for the weekend so I can keep enclosed shoes away from causing pain and still get some arch support.
Just wondering if anyone here is having similar symptoms to me?
I have dodged a bullet so it appears, my issues have subsided completely - I'm not riding with the heal taped up and it is okay. Fingers crossed it stays that way.
-
- Posts: 1176
- Joined: Fri Mar 22, 2013 4:58 pm
Re: Achilles Healed???
Postby vosadrian » Mon May 25, 2015 1:48 pm
I am still trundling along with my achilles issue. A couple months off the bike and feeling a little better, but still not great. Prepared to spend another couple of months off if it will help.
Anyway, I really like my S-Works shoes, but when this first started I was wearing them, and the first pain I had related to the achilles seemed more to be from the heel cup of the shoe rubbing in the lower achilles area. I think those shoes are a little tighter in the heel cup area, and I would like to get back to wearing them, but I am wondering if I should purchase another set of shoes for the medium term until I am completely over this that is much softer around the heel cup area. Unfortunately I have no idea which shoes are good for this. Can anyone recommend a cycling shoe that is particularly kind in the heel cup area to the heel and achilles? Prefer not to spend too much, but if I have to I will. My last cycling I was doing (with the achilles issue) was with some old DMT cycling shoes with some extra padding around the heel I put in, but looking for something less worn out and more suitable for my issue.
Cheers,
Adrian
- g-boaf
- Posts: 21318
- Joined: Mon Sep 26, 2011 6:11 pm
Re: Achilles Healed???
Postby g-boaf » Mon May 25, 2015 2:09 pm
Can you find some shoes that are similar to those ones you had before, maybe add some padding to replicate those?
- General Australian Cycling Topics
- Info / announcements
- Buying a bike / parts
- General Cycling Discussion
- The Bike Shed
- Cycling Health
- Cycling Safety and Advocacy
- Women's Cycling
- Bike & Gear Reviews
- Cycling Trade
- Stolen Bikes
- Bicycle FAQs
- Serious Biking
- Audax / Randonneuring
- Retro biking
- Commuting
- MTB
- Recumbents
- Fixed Gear/ Single Speed
- Track
- Electric Bicycles
- Cyclocross and Gravel Grinding
- Dragsters / Lowriders / Cruisers
- Children's Bikes
- Cargo Bikes and Utility Cycling
- Road Racing
- Road Biking
- Training
- Time Trial
- Triathlon
- International and National Tours and Events
- Cycle Touring
- Touring Australia
- Touring Overseas
- Touring Bikes and Equipment
- Australia
- Western Australia
- New South Wales
- Queensland
- South Australia
- Victoria
- ACT
- Tasmania
- Northern Territory
- Country & Regional
- The Market Place
- Member to Member Bike and Gear Sales
- Want to Buy, Group Buy, Swap
- My Bikes or Gear Elsewhere
- Cycling Brands
- Cannondale
- Garmin
- Giant
- Shimano
- Trek
Who is online
Users browsing this forum: No registered users
- All times are UTC+11:00
- Top
- Delete cookies
About the Australian Cycling Forums
The Australian Cycling Forums is a welcoming community where you can ask questions and talk about the type of bikes and cycling topics you like.
Bicycles Network Australia
Forum Information
Connect with BNA
This website uses affiliate links to retail platforms including ebay, amazon, proviz and ribble.