Achilles Healed???

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tcdev
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Re: Achilles Healed???

Postby tcdev » Sat Jan 31, 2015 11:19 pm

I'm not suggesting anyone here has this issue but for future reference for anyone searching this thread I thought I'd just throw this out there...

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...
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NeillS
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Re: Achilles Healed???

Postby NeillS » Sun Feb 01, 2015 9:55 pm

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!

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Re: Achilles Healed???

Postby CKinnard » Sun Feb 01, 2015 10:41 pm

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!
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.

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Re: Achilles Healed???

Postby vosadrian » Mon Feb 02, 2015 8:57 am

CKinnard wrote:
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.
Who is doing the SWT? and what part of your leg/foot?
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.
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

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Re: Achilles Healed???

Postby NeillS » Tue Feb 03, 2015 11:38 am

If you've had a BG fit then you can usually lower the saddle anywhere between 10 and 30mm from where they ended up with you. Plenty of fallout from having the saddle even slightly too high, and most of the Spesh fits end up that way. The knee angle stuff is rubbish.

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

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Re: Achilles Healed???

Postby vosadrian » Tue Feb 03, 2015 1:09 pm

At the time of the BG fit I was getting sore knees and most of the fit concentrated on that. The fit seemed to sort that out for me. I am not sure whether my previous fit was very bad or the new fit is very good, but I have been happy with it for several years and only developed the achilles issue after a massive week of riding, and I don't know if the injury is bike fit related or not. I do know that 6 weeks off the bike (so not riding with this fit) did not fix it.

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Re: Achilles Healed???

Postby CKinnard » Wed Feb 04, 2015 12:55 pm

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
MRI often does not have the resolution (or radiologist experience) to discriminate tendonosis changes.
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.

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Re: Achilles Healed???

Postby NeillS » Thu Feb 05, 2015 8:49 am

Good lord, there's another physio out there with a clue. I'm astounded.

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Re: Achilles Healed???

Postby g-boaf » Thu Feb 05, 2015 9:32 am

CKinnard: Thanks for all of those suggestions and the information posted above. My issues seem to be clearing up, not experiencing the pain anymore and I'm doing some pretty hard interval training this week and getting good gains. I had to rush off to work this morning after my training so didn't get time for stretches, but I'll do them when I get home this afternoon.

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Re: Achilles Healed???

Postby vosadrian » Thu Feb 05, 2015 11:57 am

That is great news g-boaf. You have dodged a bullet there.

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.

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Re: Achilles Healed???

Postby g-boaf » Thu Feb 05, 2015 2:43 pm

vosadrian wrote:That is great news g-boaf. You have dodged a bullet there.
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:So is there any physios in Sydney with a clue?
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.

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.

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Re: Achilles Healed???

Postby vosadrian » Fri Feb 06, 2015 8:47 am

g-boaf wrote:
vosadrian wrote:That is great news g-boaf. You have dodged a bullet there.
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:So is there any physios in Sydney with a clue?
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.

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.
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.

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Re: Achilles Healed???

Postby CKinnard » Fri Feb 06, 2015 12:59 pm

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.
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.

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.

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Re: Achilles Healed???

Postby Xplora » Fri Feb 06, 2015 10:41 pm

Dunno if you could have avoided this wait Adrian. I think the key is acknowledging a fundamental flaw in your position or technique that will need to be rebuilt from the ground up. A bike fit is an exercise in philosophy and comprises. BG spesh fit got you a great result which took you to Dozens of KOMs and strong race results, but it might have been too much for your 1000km trek. I have concluded that my race fit is not my cruise fit. That does not render Steve Hogg useless, it means I want to sit in a 1hour position for 5 hours and that doesn't make sense!

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.

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Re: Achilles Healed???

Postby vosadrian » Mon Feb 09, 2015 9:18 am

Hey Leigh, Where did you get your kettle bells and deep tissue massage done?

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Re: Achilles Healed???

Postby Calvin27 » Mon Feb 09, 2015 4:43 pm

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 :(
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Achilles Healed???

Postby Mickzo » Mon Feb 09, 2015 4:57 pm

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 :(
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;

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.

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Re: Achilles Healed???

Postby vosadrian » Tue Feb 10, 2015 4:39 pm

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?

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Re: Achilles Healed???

Postby Calvin27 » Tue Feb 10, 2015 4:55 pm

Yep pretty much it. The big giveaway is morning pain that slowly recedes.

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.
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Re: Achilles Healed???

Postby vosadrian » Tue Feb 10, 2015 5:01 pm

Thanks Calvin,

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.

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Re: Achilles Healed???

Postby Xplora » Tue Feb 10, 2015 7:29 pm

Kettle bells at home, learnt from the web.
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.

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Re: Achilles Healed???

Postby Calvin27 » Tue Feb 10, 2015 8:33 pm

The left still hurting throughout the day means it's a little more progressed in terms of the injury. My right ended up like that which prompted me to get proper treatment.
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Re: Achilles Healed???

Postby g-boaf » Wed Feb 11, 2015 9:09 am

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?
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.

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.

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Re: Achilles Healed???

Postby vosadrian » Mon May 25, 2015 1:48 pm

Hi Guys,

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

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Re: Achilles Healed???

Postby g-boaf » Mon May 25, 2015 2:09 pm

The problem is spending money without knowing that the money spent is actually going to yield any benefit. That gets expensive and I'd guess it will be demoralising too.

Can you find some shoes that are similar to those ones you had before, maybe add some padding to replicate those?

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