[Closed] Achilles tendinopathy and intensive eccentric calf raises?

Alfredson protocol works well if the tendinopathy is mid tendon. Not so well at the insertion where you risk complete rupture.

My problem is, I'm struggling to find someone to give me a hands on diagnosis. Saw a sports therapist recently who decided it was all due to an inflexible pelvis.

It feels like a sprained ankle but I've not gone over on it. Hurts first thing in the morning but not at all once it warms up to a bit of exercise. However, the more I exercise, the more it hurts in the morning.

yeah i had this for over a year , and it resulted in surgery (decompression of the achiles).i did the phisyo,orthotics,injections and didnt work ,

🙁 😯

all the current research indicates that loading the tendon is the most crucial part of rehab and the 12 week eccentric program is a good starting point (as long as its mid tendon as glupton said) but I find it does need tweeking depending on the irritability of your symptoms.
However, I wouldn't want to invest 12 weeks on a rehab program if I didn't have a definite diagnosis so its worth getting it properly assessed. Its an easy normally problem to diagnose

In my area of physiotherapy I get the opportunity to throw the kitchen sink at people to get them back to fitness in the minimum time scale. I tend to use a three pronged attack - eccentric exercises, deep tissue massage and dry needling.

I had it personally a couple of years ago. It was the dry needling that worked best for me - bloody sore though.

Ah that's interesting, Im a physio and had a spot of lateral epichondylitis that improved with the same approach.I always do this for my patients but having the treatment work on me really does a lot for my faith that a treatment works. It was the needling that really made the biggest difference in pain and allowed ne to get on with the strength program. your right it is bloody sore though. I was sat wincing in front of the TV every night feeling a little more empathy for my patients

Thanks guys. From the sounds of it, I might need to switch therapist. It's expensive trying to find the right one. Any chance one of you guys in the trade could recommend someone in or close to Nottingham?

(or fancy doing an online diagnosis).

If you ca travel then i can recommend one in London who are part of the same clinic as Alfredson, they've been treating me.

Onzadog - Email me.

Cheers glupton. I did mail you.

One other question has sprung to mind though. How widely know about is the Alfredson protocol in sports therapy circles? Would someone not knowing imply that they're not that current?

The Alfredson protocol should be well known by any sports interested physiotherapist. There is a good body of evidence proving its effectiveness.
Far too often physiotherapists trot out the same advice, drop heel stretches etc which can sometimes exacerbate the problem. If you have to prompt your physio I would be concerned.

Its a pity you are so far away from me Glupton 🙁 but I have dropped you a mail anyway

That's a bit worrying. He didn't seem familiar with Alfredson at all. Time for a new therapist I guess.

If you can get in to London and are serious about getting it sorted then it's worth checking out [url= http://www.puresportsmed.com/Services/tendon-clinic.htm ]Pure Sports Medicine[/url].

Hurts first thing in the morning but not at all once it warms up to a bit of exercise. However, the more I exercise, the more it hurts in the morning.

I have had this for a couple of weeks and it's now gotten to the stage where my symptoms are exactly like the above and I'm thinking it's time to do something about it.

Should my first port of call for an assessment be a visit to my GP or should I just head straight to a sports physio?

I have had this for a couple of weeks and it's now gotten to the stage where my symptoms are exactly like the above and I'm thinking it's time to do something about it.

Stop running/riding and go get it sorted. The worse it gets the longer it'll take to sort out.

Should my first port of call for an assessment be a visit to my GP or should I just head straight to a sports physio?

It's a shame that it seems to be an either/or choice and they are not more joined up really as sometimes it needs a combination of both. If I was starting from scratch I'd go see GP first.

What's dry needling?

Thanks mrblobby ill have a look at that.

its not always necessary to stop training i have "managed" achilles pain for years and if you are sensible and reduce and modify your training that may be enough. You have to err on the side of caution though.
i have found that pain is never far away and been symptom free for months. Experienced pain and reduced my mileage and removed speed and hill work until it settles then ramp jt back up again whe pain free. It reduces the amount of fitness you lose.

Any chance of getting an MRI to be sure of the issue?

Not so sure about Pure Sports - not heard great things about them & they missed my Chronic Patellar Tendinopathy!

Try this:
[url= http://www.parkside-hospital.co.uk/consultants/dr-simon-kemp/ ]Dr Simon Kemp[/url] He's head of Sports Medicine at the RFU

I'm doing this on my knee [url= http://www.ncbi.nlm.nih.gov/pubmed/22433113 ]Shockwave Therapy[/url]

Onzadog - Didn't get your email, but have sent one to your address in your profile - reply to that and I should get it. Alfredson is considered the gold standard for treating mid-portion achilles tendinopathy. A good therapist should know of it.

Surfer - I've sent you a reply.

Debaser - go to either one. Either should be able to set you off on the right path.

Thegreatape - similar to accupuncture -stick some needles in trigger points, wiggle them about a bit. Forces the muscle to relax and promotes healing.

Thanks glupton. [s] Presumably not something one can do at home (like foam rollers, wobble boards etc.) ?[/s]

Didn't take much googling to find the answer to that is no.

Not something you should be trying at home unless you're trained in it. 😀

I'll stick to DIY toenail surgery then

Thanks folks, booked an appointment with my doctor, though the first available was 22 October 😯

I might well give FASIC a call as they were decent when dealing with a rotator cuff injury a couple of years back.

Any other Edinburgh options worth considering?

Debaser - I'm in Edinburgh. Email me.

Thanks Glupton I really appreciate the time you have taken and the excellent advice you have given. Thanks 😀

I've been suffering for several years now with a sore tendon on the back of my ankle and can no longer run, if I walk to far then rest it tightens right up and causes me to limp quite badly.I went to the doctors 3 weeks ago(again!!!)and he diagnosed tendonitis,there's also a lump on the back of the tendon.

He has put me on an exercise plan and told me to apply Ibuprofen and ice.
For those of you in the know in this thread is this the way to go as he appeared very vague

Sorry for piss poor spelling and grammar but having to rush as im at work.

Glupton, thank you very much for giving your time so freely.
Cheers.

gee68 - as above, look up Alfredson and maybe consider getting a deep tissue massage to your calf muscles.

Surfer & Onzadog - no bother. Happy to provide advice, because I know just how annoying this type of injury can be and how difficult it sometimes is to figure out if it's not your area of speciality in life.

Let me know how you get on.

No idea if I have the same issue but my symptoms are very similar right down to the pain as I walk along the bedroom corridor & the pain has gone by the time I get down the stairs.

but I do those same exercises combined with streches lasting 2 minutes on each achillees.

& after a good few months the issue appears to have abbated.

Thanks glupton, I'll do a bit of googling tonight. 😀

@ Onzado. Did you find anyone local as im also in Nottingham?

Gee68 - a mate suggested that I recommend http://www.keyworthphysio.co.uk/ for a nottingham physio.

Thanks glupton 😀 I'll take a look but im more north Nottingham(Mansfield)than south.
Might of helped if i'd mentioned that earlier,sorry. 😳

Hey,

Nearly a year ago I had an op due to long standing insertional tendinitis but I'm still not able to do any explosive movements without pain.

I have recently started on the Alfredson method (not that I knew that was what it was called until just now). I've just read the link below and it mentions about "not lowering the heel below the level of the step" so recommends heel drops on a flat surface. Can anyone tell me how you drop the heel without being on a step????

Cheers

http://www.theglobeandmail.com/life/health-and-fitness/sore-achilles-things-have-to-get-worse-in-order-to-get-better/article551003/

My understanding was you lift onto your tiptoes using the strength of the good leg, then lower slowly using the bad leg but do the whole thing on flat ground.

I'm not expert though.

I wouldn't worry about doing the exercises in a way where you don't drop your heel below the level of your toes.

But aye - use the good leg to lift you upon to your tip toes, then lower on the gammy leg. Pain is to be pushed through for once (within reason).

HOWEVER - if you have insertional achilles tendinopathy you need to find a different solution. You'll need to see a good physio to sort that out.

http://www.running-physio.com/achilles-risk-factors/

There's a wee link to a post about the risk factors of achilles tendinopathy.

Some of the more recent literature suggests that probably don't need to worry about loading purely in a eccentric fashion so I wouldn't necessarily bother using the good leg to lift your bodyweight if you can manage to do it with your bad one.

@Kurt

Do you have any references? I have been following this method with some success and my Achilles is pain free when doing the eccentric stretches. I have avoided pushing back up using the injured leg but I know I could do it pain free.

From what I can gather the therapeutic effect comes from high-frequency oscillations which are present in eccentric but not concentric contractions.

I think that most people follow the eccentric only exercises as treatment due to the idea that doing the concentric part would simply load up the tendon, increase wear and tear and tighten up the calf muscles.

That is certainly why I get people to only do the eccentric part.

However, I am open to any new evidence which might change my practice.

Would you advise no riding during the 12 week period?

Onza/scholarsgate - I went through the whole 12 week eccentric thing with regular physio + ultrasound - ended up with TOPAZ radio frequency surgery 2 month non-weight bearing -followed up by months of physio - and that ankle is a lot better now - but not 100%.

I'm seeing a Dr about shockwave therapy and maybe glyceryl trinitrate patches.
Without an ultrasound scan & MRI - GP was happy to keep giving me pain pills for years (?)

I can cycle a little 10-20 easy miles - it helps. I have to use flats or mid foot cleats.

I'm surprised no one has linked to [url= http://www.runnersworld.co.uk/forum/health--injury/achilles-tendonitis/188083.html ]this thread[/url] in all this.

Any advice welcome though. I'm currently trying Alfredson properly having done it half heartedly in the past, coupled with icing and getting my wife to do some deep lateral massage of the Achilles and calf.

@scholarsgate I would have thought that pain would be your guide on this however last weekend has made me question this. I have had tendon and lower calf pain for a while and had 2-3 weeks off running but biking at the weekends. Biking for me is usually only around 2.5 to 3 hours but is pretty much flat out in an attempt to retain some fitness. Biking causes no symptoms whatsover.
Last week I started to feel like I was recovering and was running between 4-5 miles each day at an easy pace with only very mild symptoms and continuing to follow Gluptons excellent advice! On Saturday morning I rode for 3 hours hard with again no symptoms at all but later that day my tendon and lower calf area where a bit sore again. I ran about 5 miles pm with a slight recurrence of pain but not much. Same pattern on Sunday but with slightly more discomfort in the afternoon.
It may well be that the bike is aggravating the injury even though I am symptom free when performing it. I have decided to stay of the bike for a few weekends and see if it settles once again.

Saw a physio last night who is doing an extensive research project on ankle injury at the university he lectures at. His diagnosis was posterior ankle impingement.

Seems I might be over pointing my toes both swimming and toeing off while running.

Onzadog - good that you've finally got an accurate diagnosis and you can set about treating in now.

Some of you may be interested in this podcast:
[url= https://soundcloud.com/bmjpodcasts/treating-tendinopathy-with ]BJSM interview with Alfredson[/url]