[Closed] Insertional Achilles pain and eccentric exercises

I would be seeing a physio if I were you. It may solve your problem, but there is also a bursa in that area that may have become irritated, so treating that would be more beneficial. Difficult to say without an assessment!! 🙂

I damaged my Achilles last April running Sheffield half.

I spent ~four months doing eccentric heel lifts, progressing up to sets of 4*20 weighted ones with about 30-40kg on the smith machine at the gym. In my opinion they did naff all.

I felt like I achieved more with non eccentric exercises - i.e. going up and down with just one leg - but these quite quickly led to pain in my big toe (I also have arthritic damage there). Basically getting the achilles better has just been a time issue. "Regression to mean", as my physio friend always says. It's been 18 months now and only in the past few have I felt semi-confident running quickly again. It's still far from perfect now though, and it does feel sore after any decent runs.

If the achilles is partially torn then yes, beasting it with weights is your friend. If, however, it is bursitis (chronic nature and no mention of trauma indicates a possible yes here) then you may be making it worse.

@Finbar. Thats interesting. Are the exercises mutually exclusive, eccentric and concentric? Concentric have the benefit of of a calf workout.

@Shermer. No trauma to speak of, only a longstanding running injury and I doubt there is any real damage (this was confirmed by the last physio I went to see) and the pain/discomfort radiates around the area. I had orthotics made however these just created pain around my outer foot/ankle around my peroneus. So after persevering for a month or so I gave up.

You ought to stretch more 👿

Egg in a cup 🙂

I've had Achilles pain in both legs for 2.5 years now. Can't cycle or run properly, added loads of weight on and pretty down about it to be honest. happened when I did a C2C with my saddle too high (I think) and has not been right since. Been to a very good private physio but I can't afford to keep going although they have had great results with my neck previously.

Don't know what to do now. Any resources online which might help?

Doing various stretches and exercises which basically just stretch out my calf and Achilles, they relieve it but haven't sorted it out so I still walk with a limp. very painful. I daren't try to start running again. Using a foam roller but that doesn't seem to do much.

The worst bit it an area between the Achilles and calf where the muscle is very tense and sore, painful to the touch.

I really dont want to get into a discussion about stretching but Newrobdog I dont think there is much/any evidence the the achilles can be stretched at all. People may claim the attached muscle ban be stretched but not the tendon itself. There is a lot on youtube about eccentric exercises which is where I came in and Finbar has answered (rather depressingly)

One thing that has been recommended to me and does help a bit is a balance ball to stand on.

I first had Achilles issues after doing a duathlon last August.

Mrs FD immediately wanted me to wear a walker boot thing. At first I thought it was OTT. In hindsight I wish I had.

I had got rid of it, but then I started doing weekly track sessions 3 months ago which changed / made things work.

Now its lost of stretching, heal raises, sports massage (not on the Achilles), using a ball to massage the underside of my foot.

Riding a bike is fine, I have run probably 10 miles in 2 months 😕 but it is getting better

I think the imflamed bit of muscle above my achilles is making it hurt more, the achilles is tender to touch for sure but not painful as much as the muscle is.

Whats a walker boot? (surely not an actual walking boot i.e. for hiking?)

http://www.runningwritings.com/2011/09/injury-series-flat-eccentric-heel-drops.html
http://www.runningwritings.com/2013/11/achilles-tendonitis-in-runners.html

These may be worth reading,he quotes a lot of studies and appears to know what he is talking about,I am following his recommended protocol for patellar tendonitis with good results so far.

@Finbar. Thats interesting. Are the exercises mutually exclusive, eccentric and concentric? Concentric have the benefit of of a calf workout.

I guess there's no reason not to do them both, though I think the reason eccentric ones are usually recommended is that concentric put more stress on the Achilles, which won't be ideal if you are in the early stages of recovery.

If the achilles is partially torn then yes, beasting it with weights is your friend. If, however, it is bursitis (chronic nature and no mention of trauma indicates a possible yes here) then you may be making it worse.

Interesting - thanks. How would one go about treating it if it were bursitis?

Are you sure its insertional?

I have a long standing achilles problem (which isn't insertional) and I have poor range of motion round the ankle. I also have a stiff big toe joint which seems to encourage my ankle to roll outwards when doing heel raises.

Having done a number of different stretches, toe mobilisation and static soleus strengthening exercises I'm seeing big differences already.

I also increased the heel drop in my road shoes (4mm to 12mm) but the improvements were already happening before then.

What does insertional pain mean?

Insertional is where the tendon is damaged / painful at the point it connects to the bone

@Pieface

Having done a number of different stretches, toe mobilisation and static soleus strengthening exercises I'm seeing big differences already

Thats interesting could you share them??

What does insertional pain mean?

As Pieface says. Its as oppose to the part of the tendon above which is clearly visible and apparently responds to different treatments.

To stretch my soleus I have a thin version of a thera-band, basically a large heavy duty elastic band. I put one end under the sofa leg and the other around my ankle, right at the point where my tibia(?) joins my foot / underneath the bones on the outsides of my ankle. I step forward until there's quite a bit of tension in the band. I then bend forward at the knee / squat with the affected leg to try and increase the range of motion at the ankle. Imagine your stood with your toes about 6cm away from a door frame and try to get your knee to touch the door frame without your heel lifting. The purpose of the band is to pull the joint apart slightly thus increasing the stretch - I'm sceptical about how much deflection in the joint this creates but it seems to be doing the job.

Toe mobilisation, basically pull the toe away from the foot and move it up and down / sideways etc. =

Physio did an endurance test based on bent knee heel raises, my problem leg is much weaker. I've started by standing on one foot with my knee bent. He says as its not insertional I can have heel dropped / flat etc. (with insertional if you drop the heel below horizontal it puts undue strain on the aggravation point). Progression on this (after holding for 3 minutes) is to put weights in a rucksack, eventually I can introduce raises.

I'm thinking more and more that my injury is caused by an unstable ankle joint and the achilles is being strained through my calves over-compensating as the day afer doing the exercises its the tendons / fibres around the ankle joint that feel worked rather than anything else.

When I do a heel raise with my good foot, most bits are all in line, however on my problem foot the ankle tucks inwards and the knee goes slightly outwards - the top of my foot drops - its like the line of my toe joints is one long hinge and the foot is bending diagonally rather than squarely.

If it hurts to touch I believe its probably insertional.

And also he had me on a treadmill and said my running form was fine, nothing overly problematic however I do have a slight hip drop on the problem side which he thinks may contribute to it, but thinks its more an area for general improvement / injury prevention to address that.

Thanks Pieface, I will try that.

Mid point achilles pain is very tender. The achilles often thickens (although this not swelling in the typical sense) and can also become "lumpy"

Sounds like it could be a build up of scar tissue within the achilles. Other people in my club have found that massage has helped to break this down, however what works for one may not work for another. I don't have any thickening or lumpiness, it feels identical to the other.

A foam roller is not sufficiently hard for Achilles / calf. This is the toughest most fibrous parf the body. I use a simple metal bike rack out side the office whenever a tight spot occurs in the area of shin, calf or achilles. A barbell is also an option. I started doing this based on Dr Kelly Starett's advice in his book and am successfully without running injury for last two years.

An anecdote which might help in your current situation was how I recovered from a plantar fasciitis problem in the past:
-Calf raises alone eccentric nor concentric worked
-Stretching didn't fix it
Was getting frustrated by this but 'cure' came from doing the raises after running after a 20 minute cycling warm up. Without the warm up the fasciitis would strike early in a run. Without the run the muscles wouldn't 'loosen' enough.
but if I warmed up then ran for 10-15 minutes then did calf raises it worked like magic. Keep at it!

@Funkydunc. I bought one of those boots but took it off after 15 minutes! I have heard good things though. Track sessions are killer, I assume you wear shoes as oppose to spikes?

I agree with you about the achilles massage, unless you are happy for a period of huge "inflammation" post massage I wouldnt touch it.

Thanks Digger I will look that up.

Surfer - Since I already know your thoughts about stretching from previous posts I was somewhat reluctant at first to comment.

However in the spirit for the forum:

What's worked for me is eccentric raises increasing load over time, following a regime from a physio that involves doing the required number of heel raises everyday, gradually increasing the number of reps and eventually adding additional [free] weights. The gradual loading process is key as there are no quick fixes.

From memory it was explained to me that what you are aiming to do is increase the muscle strength of the surrounding tissue inline with your 'bio-mechanics', thereby decreasing the load placed on the relevant tendons and ligaments (which can become more fibrous and spongy as we age). A similar approach was successfully taken when I suffered from patellar tendonitis a few years ago as well

Heel 'dips' (rather than raises) seemed to aggravate the insertion point(s) and the inflamed bursar (caused by rapid over extension whilst bouldering).

Like digger95 mentioned, a warm-up is always recommended - just to get the blood circulating and the body/muscles warm.

Tight calve muscles (with quite a bit of 'scar tissue') were also an issue in my case. These were alleviated by stretching & yoga. In particular 'Downward Facing Dog'.

I also used ultra-sound. A foam-roller didn't seem to help much in this instance, but a 'lacrosse' ball (although very painful) did help with the 'trigger points'.

I suggest seeing a good sports physio - leave your preconceptions at the door ... we possibly only have limited time remaining doing the things we enjoy so make the most of your time and if seeing a good sports physio and doing the recommended exercises every day gets you back doing the things you love, then in and of itself it will have been worthwhile - and certainly more positive than arguing on a forum! 😉

Good luck with the rehab.

Oh ... and anecdotally Kilian Jornet stretches. 🙂 🙂

@Digby

Cheers for that.

I suggest seeing a good sports physio - leave your preconceptions at the door ... we possibly only have limited time remaining doing the things we enjoy so make the most of your time and if seeing a good sports physio and doing the recommended exercises every day gets you back doing the things you love, then in and of itself it will have been worthwhile - and certainly more positive than arguing on a forum!

I dont have issues with Physio's or pre-conceptions where they are concerned. My issue is only that not all of them are good (some I have met are very poor IMO) If I could find a good one nearby then I would absolutely use them.

 

I have no idea what to do - don't understand what most of you have written above!!

My work is now paying for a private physio as I am struggling to drive more than 30min without getting shooting pains up my right leg. My knee is now starting to be really painful too on the same leg which might be linked but I have put on a fair bit of weight with not being able to exercise and trying to eat my way out of having no energy etc as a result.

My private physio I went to - who was excellent and has amazing results - gave me exercises to do but they aren't making much difference now. I did some "stepping forward" exercise on the affected leg to get it used to bearing weight again, then calf type "3D" stretches.

Unfortunately most of the physios ive been to are hopeless and only treat the symptoms rather than the underlying issue - this has been the case with the ones my work has paid for. The one I paid for was a local sports physio who properly sorted my neck out after 4 different other private physios just gave me nice massages - worked for a short while but never sorted the problem out. It's a shame I can't afford to pay my private physio anymore (£50 a time) now.

All a bit depressing really, I would like to ride my bikes again one day or at least be able to stand up from a sitting position and not have to stifle a pathetic scream each time.

I dont have issues with Physio's or pre-conceptions where they are concerned. My issue is only that not all of them are good (some I have met are very poor IMO)

Sadly I'm inclined to agree - it would appear not all physios are equally competent at dealing with specific sporting injuries - their 'bread & butter' is still probably whiplash claims etc. although I've noticed an increase in Sports Physios in parts of the country associated certain activities, so perhaps things are changing.

Personal recommendations are always a good starting point though.

I do think though that Physio treatment is still unfairly maligned and dismissed in this country ... on numerous occasions I've heard people say "oh yeah ... I went to the physios but it didn't really do much good". When asked whether they actually did the suggested exercises etc religiously on a daily basis etc, they usually have to concede that they didn't ...

Frequently I think there is an expectation that a miracle pill or pain killer etc will sort out whatever the issue is - whereas the reality is the solution is likely to involve time, graft, pain and discomfort.

I'm not for one minute suggestion you wouldn't put the work in to rehab your injury surfer ... I'm just reflecting on situation vis-à-vis the apparent lack of good Sports Physios.

@Newrobdog. That sounds awful. My issue is trivial really and just limits my sport, yours sounds quite debilitating. Hopefully your new physio will be better. Have you tried scouring the web? Often their are useful videos which may help.

@Newrobdog. That sounds awful. My issue is trivial really and just limits my sport, yours sounds quite debilitating. Hopefully your new physio will be better. Have you tried scouring the web? Often their are useful videos which may help.

Went to another physio yesterday paid for by work. He said I needed to get some £45 insoles (I use Orthoheel sport ones at the moment due to plantar fasciitis issues in the past), heat it up and do some stretching. I've got 4 sessions paid for where my Achilles will be worked on to help remove the lumps in it plus the muscle above which is all jacked up.

Left a bit despondent as I will struggle to afford £45 on some insoles (which I am not convinced will do anything - apparently I need to have my heel raised for some reason) and what he said was completely different from the other private physio I went to.

You could just fashion something yourself to simply raise your heel slightly by cutting some old insoles into half circles. Heath Robinson but often this is only what the pro's are doing!

apparently I need to have my heel raised for some reason

It's quite frequently recommended for achilles pain

Decathlon do some heel cushions for £9

[url= https://www.decathlon.co.uk/heel-cushions-id_8305787.html ]Heel Cushions[/url]

Those heel cushions look good, thanks.

I think he said I needed my heel angled a bit too. Bit rubbish feedback from him as I asked him to email his advice so I had a record of it to show my manager but he refused to do so, just scribbled a few words on the back of a leaflet and emailed the link to the insoles he recommended which seem crazy expensive and the description on the website is poor with no idea of specs or anything. Consulting room was grubby and battered, kit (and his PC) all damaged and broken. Ok its his expertise is what I need but I didn't have much confidence in what he was saying to be honest, seemed very rushed.

I said I had insoles in when I had plantar fasciitis and use them in my shoes - I did say I've been wearing them for years with no problems but he seemed to think they were rubbish and weren't helping (orthaheel sport insoles).

these are the ones he recommended: http://www.physioworldshop.co.uk/foot-care/orthotics/physioworld-full-length-custom-orthotic.html

Holy thread revival batman.... Surfer, I was just wondering how you were getting on with your achilles injury?

Mine has flared right back up again over the past month. Shame as I was starting to get fit-ish again (got back down to a 16:47 5km).

I think a combination of stretching the calf and heel drops made a small niggle worse (I know now it's insertional, and probably accompanied by heel bursitis - which stretching and overextending can aggravate). I'm now doing weighted heel lifts from a flat foot, which I'm hoping will help...

Dont say the S word..... I do think this is one injury stretching does seem to aggravate (I dont think it exacerbates anything else BTW) particularly if you are doing heel drops off a stair.

Mine has largely disappeared but so has my training volume! I learned a few things and who knows if they helped or not.

1: keep active and keep the Achilles moving. If you can run gently continue too, if not walk and dont allow it to be inactive for more than a short time as it will stiffen up.

2: A liitle bit of pain is acceptable and it will still get better, judgement call on how much pain. Continuing to run through injuries like shin splints is a no-no imo. They only get worse but I found it useful with Achilles pain. If it is tender at the start then disapears as you get going that is generally a good sign. If you have pain for most or all of the run I would stop and rest.

3: Ice is good/NSAID's bad

4: dont even think about anyone prodding it unless you want pain x 10. IME massage/poking/rubbing just made things worse.

5: Did I mention ice?

good luck, it can be debilitating...

Google trigger points calf. Then buy a trigger point ball from Amazon or find something pointy (like the edge of a low table or chair ) and go to town on finding the sore bits. Trigger points in calves lead to all sorts of pain under the foot, knee pain and general tenderness in the calf. I find foam rollers to be too big for calf work.

A very timely resurrection of this thread for me.

ive suffered with insertional Achilles issues for 5 years now I think. Also a haglund deformity (bump on heel) and bursitis. I’ve always been able to continue with a bit of running - if managed, but seems to have degenerated over the last year to the point where it even starts to hurt when I walk. Which is making me consider surgery.

I tried everything- footwear modifications, bigger heel to toe drops, massage, ice, eccentric loading and even a cortisone. Which I definitely don’t recommend.

additionally I’ve done yoga for 3 years. And religiously do physio prescribed exercises - to no avail.

my operation option - resection of a chunk of calceneus and my heel screwed back in place.

Seems pretty extreme to me- and also having an arm full of metal- more certainly doesn’t appeal. The logic being that the bone will mend quicker than if the Achilles detached and heel polished down to remove the bump.

any surgeons on here with better ideas? Help!? This is depressing me so much- but feel I’m out of conservative options

Hey - thanks for the additional comments/ideas Surfer and swedishmatt - dishearteningly I've been doing all of that (except for occassionally having a stretch) for the best part of two years. My calf muscles are remakably knot-free and (if I do say so myself) strong.

Mccraque, I'm going to try and go to the doctors tomorrow and see if I can start the ball rolling to see if I can get some x-rays to see if I too have a Haglund's deformity. My left heel is notably bumpier than my right, so I suspect I may.

Have you had you op suggested by an NHS doctor?

From what I've read, if you have Haglund's deformity severely enough, surgery really is the only option. Left alone the heel spur is scraping the inside of your tendon every time you dorsiflex your foot, so it doesn't matter in how good condition your quads are, or how strong your achilles otherwise is, it'll continue to stay sore/get worse 🙁

Have you looked into shockwave therapy? I've been reading good things about it for Achilles issues, and it may be available on the NHS

Right - I have some good news!

I was referred to a private physio by my work as it was impacting on work. Thankfully we have a different provider now so I got some excellent care.

After a long first session of tests the physio found that as I had a weak right leg. Basically I damaged both Achilles - the left one got better quickly but the right didn’t. As a result he thinks I’d been favouring that leg for so long to reduce the pain it had been underused and become weaker. I could definitely tell very easily that I couldn’t do the exercises he was giving me on my right leg even half as well as my left.

He gave me exercises to strengthen the leg and to also re-learn my tolerance to pain in the affected area. He said that Achilles exercises alone wouldn’t work which was very true!

So after 4 sessions and putting in a lot of work myself I’m pretty much sorted and have ridden quite a bit on holiday and hoping to start running again.

I think this is a warning to people who try to self-diagnose. I would never have found out myself that this was the issue, and could have done long term damage if I went down the wrong path. I’ve had a similar experience with a damaged neck too.

I would say if you are treating the issue as soon as it happens the internet research and exercises based on that might be much better than waiting weeks for an NHS physio and worth a try before you pay for one. However if you’ve had the issue for months or years you need to see a good physio who will treat the problem at its source and correct all the issues which exacerbate the problem.

Unfortunately not all physios are good. Out of the 7 I have seen over the years only 2 treated the root cause of the issue to eliminate the problem, the other 5 treated the symptoms so the issue was relieved for a while then came back (I have a 10 year long story about my neck which I won’t bore you with!).

The best physio I went to I would gladly pay the £50 a session fee myself for the wonders they did with me.

3: Ice is good/NSAID’s bad

4: dont even think about anyone prodding it unless you want pain x 10. IME massage/poking/rubbing just made things worse.

5: Did I mention ice?

good luck, it can be debilitating…

This is competely opposite to my experience and advice from the physio who treated me successfully.

He said Heat up and gently massage the Achilles - this did wonders for the scar tissue (might not be right term- painful bumps basically) I had and they were reduced after a few days and pretty much all gone after a few weeks.

Ice reduces swelling but heat allows things to move better and increase the range of movement.

I’ve seen a couple of surgeons. Both want to operate. they’re so blasé about it.

My osteo on the other hand insists I persevere with conservative treatment. But now it’s starting to inhibit walking and every day life - the op becomes more likely.

i can ride pain free. Except for drops to flat. That stings it.

Ice is good during the injury phase particularly if your are still training. As I said I have found it is one injury which you can recover from by reducing your training type and load. If you are training then icing after a run is extremely helpful. Warm treatment may feel good but I dont think it has a benefit. If you continue to train you may find that the injury clears up (as did mine) without ever having used heat treatment which is really recommended once the pain/inflamation has passed. If you are training regularly you are always in the "icing" stage in my view.

The lumps on your achilles are unlikely to be scar tissue, I recall having lumps and bumps but they moved of their own accord. I dont mean they floated but they appeared then disappeared over weeks and the lumps themselves weren't particularly painful, even when the area around them was. Unlike muscle scar tissue, which I think really benefits from painful cross frictional massage, the blood flow to tendons is very poor and they react in a different way. Never known any massage techniques that have done anything but make the area considerably more painful.

@newrobdob, any chance your physio is near Sheffield ?

Huddersfield - but if he was in Sheffield I’d travel there!!

Never known any massage techniques that have done anything but make the area considerably more painful.

Had to be heated a fair bit and regularly and lightly massages and it worked a treat. Benefit of a good physio who knows their stuff!!

I had a long running Achilles problem and ended up being treated on the NHS with a couple of high volume injections in each over a period of 2 years, and a long period of eccentric stretches/ strengthening.

I still get a niggle now and again but it's been really good, I don't run as much as I used to so maybe that's helped too.

Read about them - https/www.google.co.uk/search?source=hp&ei=4XAZW_7sJsiogAatgoLQDA&q=achilles+high+volume+injection&oq=achiles+high+volu&gs_l=mobile-gws-wiz-hp.1.0.0i13i30j0i8i13i30l4.1386.5458..6751...1....688.2531.12j3j5-2......0....1.......3..0j35i39j0i67j0i131i67j0i20i263j0i10j0i10i70i249j0i13j0i13i10j33i160j0i22i30.SFKARXh87TQ%3D

Huddersfield isn't too far away, plus I've a riding buddy up there. Got any details for this chap?

PM sent!

The more recent evidence suggested that heavy slow contraction is most effective with less emphasis on eccentric contraction. Load to the point of pain and moderate if base line pain is worse 24 hours after exercise