It's been almost 2 years now since I started noticing the tightness, the twinge in my Achilles. I had just cranked out a personal best performance at the Notre Dame Cross Country Invitational and was now lying on the ground in pure enjoyment, as well as exhaustion. As I stood up to begin my cool down, I felt a certain tightness in my left Achilles tendon, one that was also sharp to the touch. After a couple of minutes of jogging around I thought a better solution would be to see our trainer, rather than aggravate it further. Following a deep massage on my calves, I was feeling slightly better but still had to limp my way to the team bus. This was the beginning of the "the limp."
This limp would follow me around for the next two years. Waking up in the morning, the first few miles of my run, after sitting down for any period of time, and following workouts and races. I was 21 years old yet would hobble around campus like an 80 year old man, the one you help across the street. Men in canes would look at me wondering if I need assistance. Runners are supposed to have extended lives due to their fitness level but what about hips, knees, Achilles? Are you to enjoy your 90 year lifespan sitting down after 40 because you have abused your body so much?
Back to the injury.
After seeing our medical training staff and finally researching the injury on my own, we concluded that it was Achilles Tendonosis. This is when micro tears occur in the Achilles tendon due to overuse, weakening the area and constraining blood flow. It is a disastrous injury to runners because with most being extremely OCD or already having race commitments, they often feel that rest is not an option. Instead they uncomfortably push through it, day after day, race after race, until it gets to a point where stopping is the only option. Otherwise serious damage will occur, rupturing of the Achilles.
I was one of those OCD runners who insisted on running day after day. After all, it was painful but tolerable. I could struggle through the first couple of miles, limping around, and then it would loosen up and I would be able to finish the run with only a slight twinge. Later that night however, i would be left with an extremely tight Achilles, very sensitive to the touch, and limping dramatically when walking. I always had another season around the corner: cross country to indoor track to outdoor track to summer base training. I felt that if I were to miss anything my performance would be hindered dramatically.
Meanwhile, I was trying anything possible to rid the problem. Here are some of the things that I tried:
Ice would bring down the swelling on the back of the Achilles, however, it would constrict the blood flow and make the area very sore, tight, and even walking would be a challenge.
Heat would be used before running so that the area would be warmed up. This helped a little in pain management but did nothing to actually get rid of the actual injury.
Ultrasound that is something that I tried but personally had minimal success with.
Strengthening the tendon, everything around the tendon, and everywhere else: Eccentric calf raises are the most effective thing in battling this injury, however, it just didn't work for me most likely because I was doing them along with 100 miles per week of running. You need to strengthen the weakened area to solve the problem and when I was doing the eccentric exercises along with running, I was most likely tearing down the area at a higher rate than the eccentric calf raises could strengthen it. After 6 months of calf raises with running, I gave up on them because they irritated the area and increased the swelling (which I didn't want to ice because it made it worse). I also strengthened everything imaginable around the tendon and anywhere else (including hips, it band, calves, soleus, shins, etc). I would do rigorous exercises to make sure nothing was putting extra strain on the Achilles tendon.
Massaging and "Scraping" the Achilles was not a fun process. With my Achilles inflamed and extremely tender to the touch, I would allow our trainers to massage the area and scrape it to try and increase the blood flow to the area and break down any scar tissue. This was an extremely painful task which often resulted in me gripping the massage table and sweat pouring from my forehead as I tried to deal with it. I noticed little/no success with this as it would further irritate the area and was just generally unpleasant.
Loosing up calves, soleus, plantar fascia before runs/workouts/races: Loosening up these areas through massage and stretching was something that we tried. With weak/tight soleus and calves most likely being the problem in the first place, I wanted to make sure that we weren't putting any further strain on the Achilles. Just like with strengthening everything around it, I didn't want the Achilles working harder than it had to. This was pretty effective in that it made running/working out/racing tolerable and eased the pain in the Achilles following workouts and races. Again though, it does not deal with solving the problem, just allowing for easier pain management.
Sleeping in a night splint was something that I tried for 4 months. This was completely ineffective for me and if anything made the injury worse/less tolerable. I would wake up in the morning even tighter because my Achilles tendon had been held in the same position all night. It restricted blood flow and made getting out of bed worse even worse than before.
Ibu Profin/Naproxin were drugs that I tried to deal with the issue. They would provide temporary relief as they would bring the swelling down slightly and make the pain slightly more tolerable. Over time their effectiveness wore off and I feel that my body began relying on them. I took naproxin consistently for over 6 months and ibu profin on and off for the 2 years that I had the problem.
Time off is something that would be the most obvious but again for an OCD runner this is not what I wanted to hear. However, at the end of each season, I would attempt to take 2-4 weeks off to finally deal with the issue. During this time the swelling would be reduced, the limping would subside, and walking was an enjoyable experience as opposed to a challenge. Yet, when I returned to running at the end of this absence nothing had changed. Within the first 400 meters of running the pain was back, just as bad as it had been before. My Achilles reacted as if it had no time off at all. The reason, to my understanding, is because the time off allows for the swelling to go down because you are not irritating it with one hundred mile weeks. This reduces "the limp" and allows you to walk easier. However, you still have the weakened Achilles to deal with. The Achilles is just as weak 4 weeks later as when you stopped running. The only difference is the swelling has been reduced and it is less irritated.
So what is the answer?
Surgery is an option that is available to runners with this problem. It is an evasive procedure in which the weakened tissue is removed and the stronger tissue is stitched together. However, if you never find the underlying cause of why you got this injury then you could weaken the area again and have the same problem.
Platelet Rich Plasma (PRP) injections - An innovative treatment in which platelet enriched plasma is injected into the area (in this case the Achilles). It enhances blood flow to the area, as well as stimulates the healing of tissue. This is something I looked into at UF, however, because it is a new treatment, Shands was not insured for it and it was not offered. Also because it is a newer treatment there are not a great deal of studies done on it and its effectiveness.
Eccentric calf raises: a basic exercise that you can do on a door step or slant board. You raise yourself up onto both toes and then slowly lower yourself back down on one. With this, you focus on the eccentric part (the lowering) which strengthens the Achilles. This is supposed to be an extremely effective way to deal with tendonosis. I believe that with time completely off from running and 12 weeks given to an eccentric exercise program that most people can completely rid their Achilles Tendonosis. The key is to stay regimented with consistent daily exercises with increasing weights and not to resume running until completion of the program.
Finally after almost two years of dealing with this issue I am taking the necessary time off to deal with it. I am about 4 weeks into the eccentric calf raises and walking around is almost completely pain free. There are days where the Achilles is inflamed because of the exercises and sometimes a little tight but it passes. I do the exercises 3 sets of 15 reps, 3 times every day. Along with this I strengthen my shin muscles and other areas with Theraband exercises so that I do not over compensate one area. I am also looking into the PRP injections to see if this is a possibility to go along with my exercises.
Although I am almost pain free, I am going to complete the 12 weeks because I know that if I were to resume running now the injury would flare up. When I can finally run again, I am going to continue doing the exercises as part of my daily routine. I also want to look into the underlying cause of what caused the issue in the first place: shoes, bad mechanics, tight/weak soleus and calves, weak hips, tight hamstrings, tight plantar fascia, or anything else.
If you have just recently begun experiencing Achilles pain and believe it to be Achilles Tendonosis I urge you to stop running immediately. I am not a doctor and I despise doctors generic answer of "stop running", however, this is an injury that will not get better on its own. The worse thing about this injury is how tolerable you can make it. Over time it will simply get worse and worse though. So if it's a new injury, take a little time off, deal with it, and make sure it doesn't progress to something serious.
If you have been dealing with it for a while but insist on running through it then good luck. I am not going to tell you to stop because that would be hypocritical since I was in your situation and continued running through it. However, complete whatever training cycle you are on and then seriously look into dealing with it. Take the 12 weeks off necessary and knock it out once and for all. Just imagine how much more enjoyable running will be when you are not limping through runs, walking in agony around your house, and straining to get out of bed in the morning? Think how much faster you will be when you don't have to worry about a possible tear/rupture of your Achilles during workouts and races.
This is one of the most frustrating injuries for me because it allows you to run on it, it gives you hope. Instead of a stress fracture knocking you out of commission for 6-8 weeks, this allows you to run on it day after day but progressively gets worse. Eventually it reaches a point where running is not an option and you only hope that the recovery process that you have been putting off will cure it.
Almost two years after the Notre Dame invitational and many runs, workouts, race, and Personal bests later, I am finally taking the time off necessary for this injury. I am four weeks into the recovery and hope that I may run injury free in the future. Running over the past two years with this injury has been aggravating and unpleasant but I love the joy I have had from competition. Now, I just hope that I will be able to compete in the future. I hope that I didn't sacrifice the rest of my competitive career for something that could have been fixed in a matter of 12-14 weeks.
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