Anyone had it? Apperantly they don’t call it Tendonitis anymore according to the Orthopod i saw on monday.

Got to have an Ultrasound of it tommorow and then back to see consultant on monday. Been told to stay off it till then.

Any ideas on the recovery time?? My Gp thought it was bursitis as there was a big lump where the achillies attaches to the heel bone. Ive no idea how this came on. I felt twinges while working, then a lump appeared a few weeks later and then i woke up on my day off and could hardly move my foot up and down.

I take it cycling is out for a few weeks?

Good luck with that. I await people telling you to do eccentric exercises AKA Alfredson Protocol…. You might be better off not listening to them.

Been told it maybe physio after the ultrasound. I thought it was poor footwear but im limping even walking round the house. Like someones booted me in the back of the heal very hard.

I knackered both my Achilles’ tendons a couple of years ago training for and doing the GNR.

They’ve never been right since, despite rest, stretching, balance boards, NSAIDs, and running is still impossible.

Fortunately walking and biking are fine.

I suppose what I’m saying is, they’re a fickle part of the body.

Did my right one 18 months ago. Got a lump on the tendon now. Physio recommended exercises, similar ones found by Google. Didn’t seem to provide much short term relief. Gradually improved over about 9 months. Didn’t stop bike riding but walking was painful esp uphill.

Felt good until recently when it went again.I think brought on by long walk, appeared next day. Guess it’s one of those things that never go away.

Alfredson Protocol…. You might be better off not listening to them.

Or you could ignore this and look at the evidence.

Or you could ignore this and look at the evidence.

OK lets looks at the evidence:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658946/

Alfredson’s model of eccentric training involves no concentric loading and emphasises the need for patients to complete the exercise protocol despite pain in the tendon. If patients experience no tendon pain doing this programme, the load should be increased until the exercises provoke pain. Good short?term and long?term clinical results have been reported.35,36,37 This 12?week programme is effective when the other conventional treatments (rest, NSAIDs, change of shoes, orthoses, physical therapy and ordinary training programmes) have failed and is successful in approximately 90% of those with mid?tendon pain and pathology. Insertional Achilles tendon pain is not as responsive, and good clinical results are achieved in approximately 30% of tendons.38

http://rheumatology.oxfordjournals.org/content/47/10/1493.long

The exercises frequently cause discomfort and, although highly effective for tendinopathy of the body of the Achilles, are more usually ineffective at treating insertional tendon lesions of this tendon [22].

http://www.running-physio.com/insertional-achilles-tendinopathy/ This link here tells you all about insertional achilles tendinopathy.

There is good evidence to show that the Alfredson Protocol is effective, including his own studies. Thats not to say it is appropriate for all symptoms and the effectiveness may vary however it appears to me to be one of the most effective treatments. As a competitive runner of 30 yrs+ I have had success with it and although anecdotal, friends have to.
There have been studies to indicate the excessive number of reps and the recommendation of Alfredson to load until painful is unnecessary and studies have shown that a reduced number of reps and avoiding pain is just as successful.
I suppose it comes down to do you think the exercise is harmful? It is not an unnatural exercise or excessively stressful one for an uninjured Achilles so why would you not include it?
There are often contradictory studies for many physiotherapy treatments no doubt given the number of variables and I can get into a “cut and paste athon” which summaries my point also.

As a physiotherapist I appreciate the difference between mid-portion achilles tendinopathy and insertional achilles tendinopathy, the mechanical processes which lead to each injury and which evidence based treatments are best in each case.

If you have injured yourself by crushing your achilles as in insertional achilles tendinopathy, it seems a bit daft to wind it up more by continuing to crush it further by using the Alfredson exercises unmodified does it not?

unmodified

?

I’ve been doing the alfredson exercises for over 6 months and they have greatly helped but it’s been a very slow recovery and I seemed to of plateaued. I’ve just been to see a sports specialist yesterday and have had a procedure done where they imject saline into the affected area. I’ll update you in aday or two to see if anything has improved.

Iain

I hope its successful Iain. Recovery is often slow and I know of a number of athletes who never fully recover or are clear of some pain I think in some instances its a case of careful management.

?

Yip, unmodified.

Elma/Iain – not a chance I’d be letting anyone do that to me, but it’s your leg.

by using the Alfredson exercises unmodified

If your against the treatment why would a “modified” version be an option?

Modified eccentric exercise for insertional AT is do only do it to the floor and not on a step so the ankle does not go through its full range of movement.
I think this might be what Wanmankylung means but could be wrong ….

Nowhere did I say that I was against treatment – that would just be daft and put me out of a job.

Treatment for midportion AT is usually Alfredson’s eccentric approach which usually involves going past 90 degrees. That approach would be pretty bad for insertional AT and would likely make things worse due to crushing forces increasing on the gammy bit. A better approach there is to do concentric and eccentric exercises which stop at 90 degrees. The concentric part of that would however probably be detrimental to midportion AT. So two totally different approaches to two totally different injuries.

Could you direct us to the evidence for this better approach?

Could you direct us to the evidence for this better approach?

I have already provided evidence – look up there ^. Also there is no “better” approach. There are different approaches for different injuries.

Then maybe you should have been a bit more helpull in your original post when the OP asked for help.
Instead of

Good luck with that. I await people telling you to do eccentric exercises AKA Alfredson Protocol…. You might be better off not listening to them.

I think you’ll find that I was more helpful than you were. My comment sparked a discussion which lead to the thread now containing information on how to treat both mid-portion and insertional achilles tendinopathy.

My prediction was also correct.

What did your comment do?

My comment sparked a discussion which lead to the thread now containing information on how to treat both mid-portion and insertional achilles tendinopathy.

I suspect you wouldnt have offered this information if your professional expertise hadnt been questioned. Dont think you were going to give it willingly otherwise your first post would have been more constructive. Anyway, all is well that ends well 🙂

My prediction was also correct.

Is the OP cured?

Cured? The OP isn’t even properly diagnosed yet. I’d be surprised if it does turn out to be Insertional AT.

Been diagnosed as insertional Achillies Tendonopathy with some tiny tears in the tendon also. There is now a big lump, which is painful on palpatation. Next step is a x Ray to check for bone spur.
See the consultant in three weeks, got two weeks of annual leave.

Would I be wise to just push through the pain? If I walk its a burning sensation where the lump is and skin red and inflamed. Walking with no shoes in the house the same. Stairs going up is painful , down not as much. If I do nothing it stings but doesn’t hurt but as soon as I walk it starts hurting again.

Hoping to be back in work in two weeks, but the pain was making me limp badly.

I wouldnt recommend pushing through the pain no. You dont want to rupture the thing.

I had it terribly in mine after riding 200 miles in a few days.
Would settle then flare up again. I rested it properly for 2ish weeks, which seemed to fix it.

Was so painful and creaky it made me feel sick!

DrP

Would I be wise to just push through the pain?

As Wanmankylung says, no. You do risk a rupture.
I have suffered with it over the last few years (mid point not insertial)Its not unusual to have some tenderness and stiffness when warming up or getting up from seated/bed for a minute or two but not really “pain” and you need to judge it carefully. I made the point about “management” and I know lots of runners who train and race with what many people would call an Achilles “injury” it doesn’t have to be totally debilitating however you would be stupid to train/race though pain. knowing the difference between ongoing manageable slight “discomfort” and “worsening” “pain” is dificult!

If I rest as in park my bum, walk to kitchen it stings 15 mins of walking on the flat slightly more painful. Uphill walking /stairs or anything longer than half hour I’m reaching for the pain relief.

First thing in the morning is limptastic and feels like it’s about to go bang.

Avoid barefoot walking, try a heel raise in your shoes to reduce the stretch on the Achilles….you don’t want it to go bang (well, its more like a champagne cork leaving the bottle:))