Achilles Pain and Treatment

[Big John]

Hi all,

 

I recently purchased a new MTB and as a result of the excitement, I have substantially upped my MTB activity . After around a week of riding hard almost everyday, steep climbs etc. I found that my achilles was sore at the start of one ride. After about 10mins it was still sore (so not stiffness/fatigue etc. - I figured) so i turned back. The next day I struggled to walk without a limp. It is now approx 6 weeks on, and the pain is still there - not too serious, but definitely not gone. The best i can figure from my reading is that this is an overuse injury. I have ensured that my bike fit is correct - with tapes, plumblines, side-on photos etc. you name it!

 

Have any of you experienced prolonged Achilles pain and what did you do to sort it out? I understand that (most of) you are not medical professionals but from what i have read about Achilles tendinitis and tendinosis the treatment of these two conditions appears to be the similar - stretching and eccentric strengthening exercises and perhaps massage. I have been doing 1 x 15 reps of eccentric strengthening exercises twice daily. Having read how frequently these two conditions are mis-diagnosed I am hesitant to spend moola consulting various pros who may just tell me the wrong thing in any case... What do you think - perhaps time just to bite the bullet?

 

After reading the following article (from a journal) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/ . I am under the impression that i may be suffering from Achilles Tendinosis.

 

I do try to rest it - resting for one complete week once - but sometimes my excitement and urge to ride the new toy get the better of me - or upcoming XC races mean that i need to do at least one ride in the week + the race. So i strap the achilles (learnt the strapping technique from my old rugby physio). Once strapped there is no pain at all, and plenty of support - i dont feel uncomfortable in any way.

 

I would appreciate any constructive advice. Cheers.

[Rolfalps]

If it is tendonitis , it will not heal with a weeks rest . Go see a physio and check out what's going on . With tendonitis you will typically feel a "grittiness " around the tendon when you flex it . My tendons do get painful at times if I don't get regular massage and stretch . The pain in the tendons I experience is due to the Soleus muscle in the calf getting tight . With effective massage , the relief is immediate and I can ride with no discomfort .

[V12man]

You are going to have to give a better history: Age, weight, height, previous orthopaedic injuries, have you had a professional bike setup done, have you had previous injuries in the area, have you been taking medication/antibiotics, what sports do you routinely play etc. If I might make a suggestion, go and visit a physio as a first cut - internet based self diagnosis is at best risky.....

[BarHugger]

You are going to have to give a better history: Age, weight, height, previous orthopaedic injuries, have you had a professional bike setup done, have you had previous injuries in the area, have you been taking medication/antibiotics, what sports do you routinely play etc. If I might make a suggestion, go and visit a physio as a first cut - internet based self diagnosis is at best risky.....

 

......what THE DOC said.......and also include any chronic medication you are on. Achilles pain is definitely not a "no pain, no gain" approach. From what you have stated so far, you are still in the save zone, but it will be better to spend some money and have this properly checked out (and proper diagnosis). You definitely do not want this "weekend warrior" situation (not that I am implying you are a weekend warrior).

 

If you ever experience as if someone just gave you a moorse P-K behind the head, while simultaneously hearing a gun shot with accompanied ringing noise in the ears and a sudden unexplained wobble in your step.........IT IS TOO LATE!!!!..........you have a ruptured Achilles tendon.

 

(Personal experience as reference........after too much beach running (soft sand) during a December vacation.......4 months later........BAM!)

Edited July 28, 2014 by BarHugger

[Eugene]

I've had mine for years. I've learned to live with it. It normally flares up with a long ride on my road bike or if I do a step class at gym.

 

I stretch it a lot before and after excersise which does help

[Big John]

Thanks a lot for all the info/input guys. I thought there was no interest in this post at all, but when i came to look this morning I saw all the replies - didn't realise that you aren't automatically subscribed to a topic if you start it!

 

First off, I will bite the bullet and go see the physio - I always advise against internet self-diagnosis but then I go and do it myself .

 

With regards to other information:

 

Age: 25

Medication: None

Previous orthopeadic injuries: Torn ligaments around outside of ankle in rugby roll-over injury - approx 5 years ago - if I'm not mistaken, same foot.

Height, weight: 1.82m, 105kg

 

You definitely do not want this "weekend warrior" situation (not that I am implying you are a weekend warrior)

Not worried about this at all - I probably am a weekend warrior!

 

Never done a professional bike fit, but have read in depth on the subject, discussed it in-depth at LBSs, and I am satisfied that this is in order.

 

Again, thanks for the advice. Will go see physio, continue with stretching and exercises...

[TALUS]

If you start to experience pain when getting out of bed (before warming up) - get a Pro opinion ASAP. Palpable nodule is another strong indication. NEVER cortisone injection. Be careful of coincidental ciprofloxacin treatment.

[Superfly1]

If you start to experience pain when getting out of bed (before warming up) - get a Pro opinion ASAP. Palpable nodule is another strong indication. NEVER cortisone injection. Be careful of coincidental ciprofloxacin treatment.

Why never cortisone injection? I was told today by a doctor and physio to get one. What do I need to know?

[V12man]

Why never cortisone injection? I was told today by a doctor and physio to get one. What do I need to know?

The cortisone stays in the sheath for a very long time - it may take the pain away, but it does appear to lead to MUCH worse ruptures.... not a place you want to be....

[Sulli]

I am busy struggling with quite a sever case. Most physio's dont know what they are doing with this injury so you need to see a specialist and have some scans done.

 

Mine has been diagnosed as degeneration in the tendon, it feels like a lump almost at the thin point behind my ankle, and all I can do is massage it to disperse the fluid in the gaps. DO NOT STRETCH it. If you can do some reverse calf raises, going down very slowly but not past negative (stretching the tendon)

 

I am still riding but just taking it easy, my sports physio said it will take 3-5 months to heal.

 

Wish there was a quick fix.

[Sulli]

The cortisone stays in the sheath for a very long time - it may take the pain away, but it does appear to lead to MUCH worse ruptures.... not a place you want to be....

 

An injection may cause a rupture or snap. Been told to keep needles away from my achilles!!

[V12man]

An injection may cause a rupture or snap. Been told to keep needles away from my achilles!!

The injection itself won't cause it to snap - well, not immediately anyway.... sounds like you already have a partial rupture and need to visit a good orthopaedic surgeon - those don't heal quickly at all - sometimes they never heal without an intervention.

[Max Headroom]

Extra work for the calf muscle and achillies could also be due to your cleat being too close to the front toe end of your shoe. Check cleat position and move it back as far as your shoe allows. This will reduce the leverage which transfers to the calf and achillies. On most shoes, it will place the cleat in a better position related to your foot

[BarHugger]

The injection itself won't cause it to snap - well, not immediately anyway.... sounds like you already have a partial rupture and need to visit a good orthopaedic surgeon - those don't heal quickly at all - sometimes they never heal without an intervention.

 

Very important!!!!

 

.......was treated conservatively by an Ortho after Achilles rupture with a "Moon Boot" for 8 weeks in neutral position. Ended up with Achilles tendon elongation. Needless to say, I have impressive flexibility on the ankle joint, but in terms of mechanical functioning (strength and power) not the same as before the injury. Can be surgically repaired, but do not really fancy going under the knife now.

 

(in simple terms......the cable going to the RD on your bike has stretched and precise gear shifting is now a problem)

Edited July 31, 2014 by BarHugger

[TALUS]

Very important!!!!

 

.......was treated conservatively by an Ortho after Achilles rupture with a "Moon Boot" for 8 weeks in neutral position. Ended up with Achilles tendon elongation. Needless to say, I have impressive flexibility on the ankle joint, but in terms of mechanical functioning (strength and power) not the same as before the injury. Can be surgically repaired, but do not really fancy going under the knife now.

 

(in simple terms......the cable going to the RD on your bike has stretched and precise gear shifting is now a problem)

The pre-load on a muscle determines the power of contraction. The length of the tendon is paramount. "Conservative" treatment often is a misnomer. I don't know the Hub rules on pics of this nature but I have many. The tendon doesn't slowly rupture - it explodes. The Americans coined a term "frustrated healing" for the very chronic cases. I believe it is accurate. Too tired to lecture now but suffice to say all Achilles Tendon problems are not the same.

[TALUS]

Why never cortisone injection? I was told today by a doctor and physio to get one. What do I need to know?

NOOOOOO!