Achilles Healed???

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Dr_Mutley
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Re: Achilles Healed???

Postby Dr_Mutley » Sat Nov 01, 2014 5:09 pm

Haven't reread your entire thread but have u had your gait and dynamic foot biomechanics assessed by someone qualified? Abnormal foot biomechanics during gist is just going to aggravate your already unhappy Achilles and slow down your healing time...

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g-boaf
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Re: Achilles Healed???

Postby g-boaf » Fri Jan 23, 2015 8:26 am

A bit of a thread revival I know, but I'm also having trouble with the achilles tendon at the moment on my right foot. It is quite painful, but it eases up a bit if I do only light activities (walking, riding at low power for only shorter periods, eg, 1.5 hours). If I take it easy for a day or two it will ease up mostly, but then if I do some serious interval training (eg, 1.5 hours), it will become aggravated again. I'm not noticing any swelling in the area, it is just sore.

I generally do week in week out 300-400km. Over the holidays I did 440km, 200km, 610km, 575km at varying levels of intensity, but nothing I thought to be out of the ordinary, so I don't suspect increase in distance to be the culprit - I'm already quite fit and used to that level of distance and definitely not overweight either (58kg, 174cm).

It only ever occurs on the right foot, and I'm at a loss to explain it. Pedal technique perhaps? I'm not feeling like the legs are over extended and my cleats are already fairly far back on the shoes. I'm told that I pedal with me feet quite flat by people who have observed that over time.

The other thing I do notice is that my feet move up and down a bit in the shoes (right foot only), even though they are tightened as much as they can go.

Would that have any impact on it? I'd like to get this sorted out - it is could very well undo all the gains I've made over the holidays. :?

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Re: Achilles Healed???

Postby Dr_Mutley » Sat Jan 24, 2015 12:13 am

Do u have good arch support in your riding shoes? Try dropping your saddle height for a week or 2 and see if that changes things at all? Add in some prolong heel drop stretches?

vosadrian
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Re: Achilles Healed???

Postby vosadrian » Thu Jan 29, 2015 11:34 am

I'm still struggling with mine.

For me I did 1000kms in 6 days (had done 3-400k a week for months before) and also during that ride did some "ankling" while climbing I had not done before, and also used my good shoes exclusively rather than my softer commuter shoes for most of it (as I normally do). I think the shoes were putting pressure on that area and were fine for normal riding volume but too much with the high volume. Have not worn those shoes in 6 months now and sticking with commuter shoes. Mines might be getting a little better recently, but very slow progress. I would advise at all costs to get on this quick. Take a break for a few weeks and do some heel drop exercises. I was like you wanting to capitalise on some good form, and I wish I had just backed off straight away before it got chronic, as it is becoming one of the worst I things I have experienced to have chronic long term pain preventing me doing all my favourite activities whilst reminding me it is there pretty much constantly.

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g-boaf
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Re: Achilles Healed???

Postby g-boaf » Thu Jan 29, 2015 11:49 am

Dr_Mutley wrote:Do u have good arch support in your riding shoes? Try dropping your saddle height for a week or 2 and see if that changes things at all? Add in some prolong heel drop stretches?
Thanks for the suggestions. I'm not sure the shoes are good for arch support. The saddle height might be a bit difficult, my bike has ISP - though there are a couple of spacers there, I can possibly remove one (about 5mm). I've tried some heel drop stretches. I was also shown a way to tape it that really helped and it is feeling better. I was able to do some decent interval training efforts without discomfort.

I will try a ride on the weekend and see how it holds up without that taping. I did a fairly tough 1.5 hour interval training this morning (similar last two days also) and it is feeling alright. I'm not feeling discomfort or pain at the moment either (removed the taping after I finished).
vosadrian wrote:I was like you wanting to capitalise on some good form, and I wish I had just backed off straight away before it got chronic, as it is becoming one of the worst I things I have experienced to have chronic long term pain preventing me doing all my favourite activities whilst reminding me it is there pretty much constantly.
Thanks for the warning. I'm being super cautious now - I don't want to get to that point. I'm still doing my interval training indoors on a trainer (1.5 hours is the longest session), but the TSS and sheer volume is lower, I'm not doing 20 hours per week. Last week was 9.5 hours across 4 days, and this week is looking like maybe 10 hours. Dropping the volume appears to have helped a bit.

I didn't reply immediately as I wanted to try the suggestions and ease up the amount of riding a bit and see how that went.

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toolonglegs
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Re: Achilles Healed???

Postby toolonglegs » Thu Jan 29, 2015 6:19 pm

5mm will help... it does take some pressure off. Placing cleats all the way back helps as well.
I suffer from a multitude of ankle issues... once side due to all the plating and screwing from a pretty little compound fracture when I was 16. Both sides from multiple pulled / torn ligaments from rugby. But my biggest problem seems to be when the area well above the heal gets tight... ie at the bottom of the calf muscle. When that area is really tight it quickly inflames the heal area. The stretching I do is really painful but it helps a lot. Foot up high on a bench or something with foot flat then pushing forward so I get a good painful stretch in the lower calf. After that I lie for an hour or so... when going to sleep / reading with a foam roller under the bottom of the leg working out the tight bits.

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Re: Achilles Healed???

Postby CKinnard » Thu Jan 29, 2015 9:17 pm

M2CW, any achilles or rear heel pain should include very very deep hard massage into the calf muscles.
The probability is the calf has been shredded and scarred up a lot in the past, and is pulling extra hard on the achilles and heel insertion.
I had a patient last week who had a 3yr chronic achilles pain with efforts on the bike. She had had a lot of treatment before with only temporary relief.
When I started pushing around it was immediately apparent the tibialis posterior, soleus, and medial gastronemius were heavily fibrosed (scarred) and their loss of elasticity and shorter length were heavily effecting biomechanics.

Anyway, out comes the high power ultrasound to heat the crap out of the bone muscle interface and scar tissue, in goes the fingers to stretch the hell out of same...and of course it was painful....but to break up and stretch old avascular scar, treatment has to be done with intent....and for good measure, 5 acupuncture needles are aggressively dry needled into same muscles to persuade them to calm down. repeat x4 when pain and inflammation settles. when pain scores dictate, remodeling protocol begins with lots of full range heel dips and raises, jumps, etc.

That's the sort of therapy required, but it is rare to find someone prepared to do it. We are living in an age of denial and low pain thresholds.
I spent several months volunteering in a Tibetan refugee camp in the 90s, and by comparison, the typical pain threshold I see in Australia disappoints me profoundly. I am not ragging out GPs, but they are the greatest obstacle to "conservative" therapy such as this, because they reinforce that therapy should not hurt, even a little bit, which makes getting to the bottom of old issues like this impractical and fraught with litigation risk. Their preference is for cortisone shots and anti-inflammatories, whenever pain is an issue, for the rest of your life!

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toolonglegs
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Re: Achilles Healed???

Postby toolonglegs » Thu Jan 29, 2015 9:45 pm

Moving to France anytime soon CK? ;-)

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Re: Achilles Healed???

Postby CKinnard » Fri Jan 30, 2015 12:07 am

toolonglegs wrote:Moving to France anytime soon CK? ;-)
I had actually seriously considered working over there 2 years ago TLL...but I think language would be an issue. I did a year of French at school and could never get my tongue and throat around the gutteral and nasal French language :) German rolled off my tongue a lot easier.

A great old mate works in Munich, but holidays in France (see below) a lot with his French wife....and believed I'd do very well there.

https://app.strava.com/activities/164125141" onclick="window.open(this.href);return false;

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toolonglegs
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Re: Achilles Healed???

Postby toolonglegs » Fri Jan 30, 2015 1:37 am

Yeah the language is pretty tough... and NO ONE speaks English. Sure they might when you are on holiday but when your a tourist you are more likely to mixing with people who speak a few languages. Where I live I know maybe 2 people who I can talk to in English and not very well so I speak French.

Anyway any good videos or tips on self massage etc to loosen up that area... my calves are always pretty painful to touch, more so below the calf. Definitely my achilles issues are to do with my tightness. You could fire arrows off my hammies :lol: .

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Re: Achilles Healed???

Postby CKinnard » Fri Jan 30, 2015 7:09 am

toolonglegs wrote:Yeah the language is pretty tough... and NO ONE speaks English. Sure they might when you are on holiday but when your a tourist you are more likely to mixing with people who speak a few languages. Where I live I know maybe 2 people who I can talk to in English and not very well so I speak French.

Anyway any good videos or tips on self massage etc to loosen up that area... my calves are always pretty painful to touch, more so below the calf. Definitely my achilles issues are to do with my tightness. You could fire arrows off my hammies :lol: .
Sounds like you need a 6ft6in baker with powerful hands to get into your calfs. There's no need to learn 'special' technique. It's just a matter of softening the tissue up over 10-15 minutes with softer technique, and progressively moving in deeper, and hammering the hard scar bits. He could even use his rolling pin in the later stages. In this day and age, massage is highly underrated for keeping muscles in good condition.

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g-boaf
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Re: Achilles Healed???

Postby g-boaf » Fri Jan 30, 2015 10:23 am

toolonglegs wrote:Yeah the language is pretty tough... and NO ONE speaks English. Sure they might when you are on holiday but when your a tourist you are more likely to mixing with people who speak a few languages. Where I live I know maybe 2 people who I can talk to in English and not very well so I speak French.

Anyway any good videos or tips on self massage etc to loosen up that area... my calves are always pretty painful to touch, more so below the calf. Definitely my achilles issues are to do with my tightness. You could fire arrows off my hammies :lol: .
Hi,

This is the only one I know of:



Using a foam roller. I find you can use the rumble roller for better effect. They work quite well - provided you use them regularly and the right way. If your calves are painful to touch, a rumble roller will really, really hurt like hell. There is no way around it. If you feel a really painful spot - just keep the roller and pressure on that spot and the pain should ease a bit. Hope that is somewhat useful.

I find that I am my own worst enemy in not using the roller enough.
toolonglegs wrote:5mm will help... it does take some pressure off. Placing cleats all the way back helps as well.
Thanks for the suggestion - I will take out a spacer and see how it goes.

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Re: Achilles Healed???

Postby vosadrian » Fri Jan 30, 2015 10:35 am

Where abouts are you CK, and are you a physio or some other practitioner?

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Re: Achilles Healed???

Postby CKinnard » Fri Jan 30, 2015 4:50 pm

vosadrian wrote:Where abouts are you CK, and are you a physio or some other practitioner?
I'm a physio in Brisbane.

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Re: Achilles Healed???

Postby vosadrian » Fri Jan 30, 2015 5:04 pm

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.

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toolonglegs
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Re: Achilles Healed???

Postby toolonglegs » Fri Jan 30, 2015 5:48 pm

g-boaf wrote:
toolonglegs wrote:Yeah the language is pretty tough... and NO ONE speaks English. Sure they might when you are on holiday but when your a tourist you are more likely to mixing with people who speak a few languages. Where I live I know maybe 2 people who I can talk to in English and not very well so I speak French.

Anyway any good videos or tips on self massage etc to loosen up that area... my calves are always pretty painful to touch, more so below the calf. Definitely my achilles issues are to do with my tightness. You could fire arrows off my hammies :lol: .
Hi,

This is the only one I know of:



Using a foam roller. I find you can use the rumble roller for better effect. They work quite well - provided you use them regularly and the right way. If your calves are painful to touch, a rumble roller will really, really hurt like hell. There is no way around it. If you feel a really painful spot - just keep the roller and pressure on that spot and the pain should ease a bit. Hope that is somewhat useful.

I find that I am my own worst enemy in not using the roller enough.
toolonglegs wrote:5mm will help... it does take some pressure off. Placing cleats all the way back helps as well.
Thanks for the suggestion - I will take out a spacer and see how it goes.
I have a foam roller... works fine higher up the legs, but below the calves it doesn't do much. Probably because you can't get enoug weight on it. I dig pretty deep with massage which is a hell of a lt more painful than a roller in that area. Maybe I just need to stick with it more.

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Re: Achilles Healed???

Postby Calvin27 » Fri Jan 30, 2015 6:38 pm

Foam rollers are next to useless on the calfs. You can get into it yourself and have a dig but that is hard to do if you heave weak fingers/thumbs and don't know what you are doing. Alternatively I used to ask my other half to use the rolling pin on my calf. The outer was and still is super stiff.
CKinnard wrote: That's the sort of therapy required, but it is rare to find someone prepared to do it. We are living in an age of denial and low pain thresholds.
I spent several months volunteering in a Tibetan refugee camp in the 90s, and by comparison, the typical pain threshold I see in Australia disappoints me profoundly. I am not ragging out GPs, but they are the greatest obstacle to "conservative" therapy such as this, because they reinforce that therapy should not hurt, even a little bit, which makes getting to the bottom of old issues like this impractical and fraught with litigation risk. Their preference is for cortisone shots and anti-inflammatories, whenever pain is an issue, for the rest of your life!
I found the opposite. It took me ages to find a physio that a) knew what they were doing and b) had enough strength. A lot of them would just keep asking is that too hard when I flinched a bit. Even when I told them to go harder, they usually ran out of strength or juts didn't go hard enough. It's like when you show signs of pain all they can see is lawsuits. Probably due to the low pain threshold of Aussies like you said. Like those hot stone massages are a joke.
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Re: Achilles Healed???

Postby CKinnard » Fri Jan 30, 2015 6:38 pm

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.
Last edited by CKinnard on Fri Jan 30, 2015 6:50 pm, edited 1 time in total.

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Re: Achilles Healed???

Postby CKinnard » Fri Jan 30, 2015 6:48 pm

Calvin27 wrote:Foam rollers are next to useless on the calfs. You can get into it yourself and have a dig but that is hard to do if you heave weak fingers/thumbs and don't know what you are doing. Alternatively I used to ask my other half to use the rolling pin on my calf. The outer was and still is super stiff.
CKinnard wrote: That's the sort of therapy required, but it is rare to find someone prepared to do it. We are living in an age of denial and low pain thresholds.
I spent several months volunteering in a Tibetan refugee camp in the 90s, and by comparison, the typical pain threshold I see in Australia disappoints me profoundly. I am not ragging out GPs, but they are the greatest obstacle to "conservative" therapy such as this, because they reinforce that therapy should not hurt, even a little bit, which makes getting to the bottom of old issues like this impractical and fraught with litigation risk. Their preference is for cortisone shots and anti-inflammatories, whenever pain is an issue, for the rest of your life!
I found the opposite. It took me ages to find a physio that a) knew what they were doing and b) had enough strength. A lot of them would just keep asking is that too hard when I flinched a bit. Even when I told them to go harder, they usually ran out of strength or juts didn't go hard enough. It's like when you show signs of pain all they can see is lawsuits. Probably due to the low pain threshold of Aussies like you said. Like those hot stone massages are a joke.
Yes I agree a lot of physios don't have the sports background or strength to go hard when required. But the lit risk also effects how they are educated at uni, and the fact that the profession is dominated by a females these days (meaning there's an excessive focus on not causing pain whatsoever). And our professional association is very biased against physios who use a lot of force and cause pain. A client can easily get me professionally disciplined or suspended for causing unreasonable pain. When you work a general practice, where 98% of people either don't want to be hurt in any way, or tell you to go hard, then walk out and bad mouth you, it's a tough gig being a physio these days. As I alluded earlier, this happened to me the other day with a cyclist who gave me a serve away from the clinic in front of others for hurting her last week. On that basis, I won't treat her again. She can go off and get feel good therapy until the cows come home!

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Re: Achilles Healed???

Postby toolonglegs » Fri Jan 30, 2015 6:50 pm

CKinnard wrote: I see so many people's musculoskeletal problems disappear when they up their vege and fruit intake, and get their hydration right.
Thats one thing I can't improve on :mrgreen:
Sitting at my ordi feeling the burn in my calves ... a good burn though.

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Re: Achilles Healed???

Postby greyhoundtom » Fri Jan 30, 2015 10:31 pm

Buy a Homedics Hand held percussion massager, use it daily with a good massage oil for about 10 minutes on each tight muscle group, and each night before retiring rub Lasonil or Hirudoit cream into the area.

While it is unlikely, if the skin becomes sensitive or inflamed give it a weeks rest before continuing treatment. About four weeks of treatment will see a noticable improvement in muscle flexibility and softening of any scar tissue.

Worked great on my legs, and with that method I have kept a lot of greyhounds with gracillis muscle, hamstring, calf, and achilles injuries racing at their peak over a period of forty years. :lol:

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Re: Achilles Healed???

Postby CKinnard » Sat Jan 31, 2015 12:54 pm

toolonglegs wrote:
CKinnard wrote: I see so many people's musculoskeletal problems disappear when they up their vege and fruit intake, and get their hydration right.
Thats one thing I can't improve on :mrgreen:
Sitting at my ordi feeling the burn in my calves ... a good burn though.
yes, you seem to have a good clean diet....though i wonder what you eat that sees your weight yoyo-ing.
there's a view that degenerative tissue changes are due just as much to overeating as to eating the wrong things.

ordi?

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toolonglegs
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Re: Achilles Healed???

Postby toolonglegs » Sat Jan 31, 2015 8:18 pm

Ordinateur ... computer.
Yoyo diet is down to life style...my summers and winters are polar opposites. In summer the fridge is far away. In winter it is in the next room :lol:

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Re: Achilles Healed???

Postby CKinnard » Sat Jan 31, 2015 9:23 pm

toolonglegs wrote: In summer the fridge is far away. In winter it is in the next room :lol:
haha...good come back...
Although, Qld is having a scorcher summer, so vice versa here. I am hanging around inside after 930am.
I've never seen so many mates can big rides, as in the last 4-6 weeks.

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Re: Achilles Healed???

Postby foo on patrol » Sat Jan 31, 2015 9:36 pm

The heat and humidity has been very draining and if that happens to you, then the smart thing is to can. :wink:

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