Achilles tendon pain - related to new shoes and/or cleat position?

tfstrum

He didn't prescribe much so go for it. The pads are @ 8.00 and insurance should make the sonic therapy reasonable. While at the physical therapy office for the sonic therapy ask them about other doctors that people really like. If you don't get better through what this prescribed, try another doctor the therapist mentioned.

I was seeing another doctor for frozen shoulder that's in the same office as the guy I used for my achilles repair. Total night and day. This new guy is awesome. He talks to me, asks me more questions, called me at home early in the process. He makes the whole process better. I can't imagine having used the other guy. Lady at physical therapy also mentioned that the first guy doesn't get rave reviews for his interaction from other customers...

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noonievut

Sounds like the same doctor

I've already bought the pads and put them in my dress shoes (at work), he did recommend getting an open-heel shoe for work, but it's a little tough to find a nice pair with dress pants.

So is 'shockwave therapy' the same as sonic therapy? The physio place I called didn't know about shockwave...actually laughed about it.

I'm going to try this as I can get about 50% coverage, it's only 3 appointments over 3 weeks so I'll no soon if it's working/worked. Then I'll re-asses from there.

Thanks.

tfstrum

Never heard of shockwave, but where I'm going there's Ultrasound and electronic stimulation (4 pads with wires attached). Not sure which one your doc suggested though. Sounds like the PT will have to call the doc...

Good luck

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heyguy

A guy I know who does acupuncture recommends no stretching during the onset of the injury. It needs to heal. Maybe after a week, some light stretching is okay. I can see his point. Something is torn, not tight, so stretching could cause further tearing. Whenever you first feel pain or tearing, do not stretch. You're just doing more damage. If the calf is tight, I would think you'd be better off using your thumb to dig in with some deep massage as you wouldn't be putting your whole body weight into a stretch that pulls on the achilles. I did this for mine, and while it was a little sore the next day, the calf was much looser afterwards. Moving the ball of your foot just over the pedal axle will help prevent heel drop so keep that in mind as well. Ice after riding for sure. Treatments like ultrasound or Moxa from an acupuncturist help draw blood to the area. You want to bring warmth to the area before riding and during treatment but you want to ice afterwards and after riding to reduce inflamation. Orthotics and heel lifts help prevent heel drop while the achilles heals so I think that's a good idea as well. I put my orthotics in my slippers when I'm at home. I also bought a simple 8.00 ankle brace at RiteAid to prevent my ankle for rolling inward. The onset of my pain was on the inside not directly behind. You could also try taping.

noonievut

I've had this for 3 weeks and I wish I had known this sooner, because the day after it happened I stretched a lot, and I think made it much worse than it would've been. After that disaster day I read something here and decided not to stretch for a while. I've now been stretching a bit (week 3), and yesterday used heat before the stretch...felt good. This morning was very stiff though, but after walking a bit if feels better. I still have my dress shoes on because I can't find one's without the heel...I hope this doesn't hurt it more.

Thanks.

noonievut

Well tfstrum, again it sounds like we're going to the same office.

When I met the PT today she had a totally different approach. After assessing my injury by having me do many tests, she believes it's not very bad, and that the cause was other alignment issues with my body (si1, or some other term, related to the big bone attaching to the spine).

She believes she's fixed that, and after some deep theraphy she gave, now I just have a series of stetching to do at home before the next visit in a week.

I can already feel the difference based on what she did, and it didn't involve any advanced therapy...though we may use ultrasound or something else in the future if it doesn't progress.

She also said cycling is fine, so long as there is no pain during or after, and if the intesity is moderate with little standing on the pedals (fine with me).

teetopkram

When you start riding again, something that worked for me last summer (chronic achilles tendinitis due to running injury years ago), was learning to pedal with a toes down style. I came from the Lemond school where I pushed down through the pedal stroke, emphasizing almost full leg extension...resulting in my heel falling below the pedal axis...now when I feel any tightening I adjust the stroke to be more toes down, where the heel does not drop below the pedal. This reduces the total amount the AT is strectched. Seems to have worked, as I no longer have to worry about the tendinitis flaring up...

Now, if I could just do something about the patellar teniditis...

noonievut

Thanks.

I have been paying attention to pedal style as of late ensuring my toes stay below the pedal axis, however, I think when I hurt my achilles I was trying the oposite, having read somewhere it's a better style. Not sure it is but I know it's not for me, at least for now. I've had no pain with toes down since the injury.

I haven't been on a hill for a while (weather...) but when going uphill and standing to pedal (or seated), would the natural position mean maybe hurting the achilles, because I know running up a hill could cause pain for the achilles, not sure about biking though?

teetopkram

I am certainly not a certified trainer, physical therapist, etc., but can only tell what worked for me. But my physical therapist told me to avoid running up hills for two reasons; one, it simply puts greater stress on the calf muscle and tendon, thus risking further tearing; second, the angle of the ankle bend is much greater (i.e., significantly more than 90 degrees) when the foot is on an uphill plane compared to a flat plane (i.e., 90 degrees) - this causes further stretching of the tendon and when combined with the extra exertion to run up hill, can further damage.

With climbing in cycling, as long as you are pedaling with toes down even when standing, I think the second factor mentioned above (i.e., greater ankle bend) can be more controlled. But I think the first factor dealing with greater exertion of the calf muscle and tendon would still be a concern...this is why my therapist recommended "easy" cycling as an exercise for achilles tendinitis...mashing hard gears and doing intervals, even with toes down, would still put maybe too much stress on the tendon. Even now I no longer have any pain, but the day or two after a hard race or weekend group ride it's definitely "tighter" (which is resolved with stretching).

And for what it's worth...my patellar tendinitis (in the knee) doesn't bother me that much after a 2 L2 endurance ride, but after doing a 20 minute L4/L5 interval or after climbing some of rolling hills around central florida, it will definitely be soorer the next day...those tendons just don't like to be stressed too much when they are damaged...I think the same logic applies to the achilles tendon.

I think after this weekend's races I am going to take 3-4 weeks completely off the bike, go swimming to keep up aerobic health (much less stress knees), ice and stretch like crazy, then re-enter cycling doing nothing but easy miles for a long time. I won't win any races later in the season, but hopefully will keep the fat/weight off and not fall back into the trap of going too hard too soon (which is what caused this injury - Monday a second LBS confirmed my bike fit is spot on).

Again, good luck.

Mark

noonievut

Thanks. And good luck to you on and off the bike.

noonievut

I've heard when you initially injure the achilles tendon you shouldn't stretch right away. I've now had this for 3 weeks and have had one physio session (another on Monday). When the PT gave me the list of stretches as homework, one in particular (stand in front of wall, one leg straight and behind, other bent and in front) is where I really feel the tendon (not pain, just strange stiffness). I voiced my concern because this is where I feel it, she said that it's fine to feel the 'weird feeling' but there should be no pain while stretching.

So, during the stretch I get that feeling early while settling into the stretch so I don't go too far, but after holding it for a bit, I can slowly move forward more and get a deeper stretch. Is this fine to do? Will it help the tendon heel, or do more damage.

I'll clarify this on Monday but for now wanted to hear what you think.

teetopkram

When I was receiving PT for achilles tendinitis about 4 years ago, they had me stretching as well. I believe they don't want you doing stretching it when the injury first occurs or when there is swelling because it is at this point that the tendon is most damaged and further damage could be done.

Once the swelling has gone done and the tendon starts healing, the tendon will form scar tissue if its a relatively serious injury. Over time and unexercised, the tendon will become less flexible than it was before, and even more open to injury if flexed too much. So, the stretching you are doing, I believe, is to encourage some flexibility while it's healing. In fact, I remember my therapist actually rubbing the tendon a bit forcefully to break up old scar tissue, encourage more bloodflow, which would help healing and form new scar tissue...repeat process until the tendon is strong.

It's like stretching a sore muscle, doing it enough to feel the stretch is good, loosens up fibers, flushes the crap out, encourages blood flow, etc. But, stretch that muscle too much and you'll tear it slightly, causing damage. The same works for tendon I believe.

sportfactory

I would have an coach look at your fit and video your mechanics. If you have a leg length discrepancy or condition such as scoliosis you may be putting more pressure on one side and "ankling." This coud very well be a biomechanical problem.

kaian

Well...I am still having my AT issues. I had my chiropractor doing ART (active release technique) and that seemed to help for a while, but now it's feeling really sore. I had a week when I was sick (flu or bad cold) and I didn't do much stretching of my calves. My AT felt fine. Yesterday, I did some stretching and it started hurting pretty bad. It's still sore today. So it's been roughly a couple of months or so since I've had this. I guess I should go to PT, but I've already been to PT 3 times in the past 3 years for 3 different body parts. I'm only 33 and already I feel like I'm falling apart! My calves don't seem weak - they've actually gotten stronger with the cycling and running I was doing. I haven't run in over 2 months because of this problem, but I have continued to do some biking on the trainer 2-3 times a week. I don't know how to find out if this is a biomechanical thing or not. I had a sports med doc check me over and look at my orthodics. ????? Frustrating!

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