Update on My Progress with Insertional Achilles Tendonitis – Week Five

By | August 26, 2013

So it’s been about five and a half weeks since I re-injured, or should I say “re-aggravated”, my achilles tendon at the insertion point.

A couple of weeks ago I was starting to wonder whether I was making a mistake in ditching my Sports Medicine doctor and Physical Therapist’s advice. They wanted me to do the standard Achilles Tendonitis protocol: eccentric heel raises, lowering all the way down (below parallel), along with a battery of stretches to lengthen the tendon.

As I wrote at the time – this didn’t make sense to me. On one hand, it makes perfect sense: the tendon was stressed/ripping at the insertion point because it is too short/too much tension. Obvious, right? But why, along with the “you need to stretch it out” advice from the professionals were they also telling me to use heel inserts in my shoes during the day? And when I would ask whether I needed to push beyond the initial pain or if pain was a sign I was going too far, I’d get blank stares followed by more non-committal responses.

So, knowing that it took five full months to recover the last time I injured this thing, and knowing that it obviously didn’t fully work (or else I wouldn’t have re-injured it just two months later!), I started researching and found lots of misinformation out there on the Internet.

But I also eventually found some great info. Particularly, the Johnson protocol. For the past 3 weeks I’ve been doing the eccentric heel drops as outlined previously. Along with that, I’ve been doing some light stretching.

The outcome so far? I am mostly pain free now. The achilles feels structurally strong. I have the tightness and pain in the morning when first waking up still, but it is getting less and less every day. And once I get out of bed and start walking, the pain goes away within a minute now. Very encouraging.

To contrast: under the traditional protocol consisting of physical therapy 3x per week along with eccentric heel raises every day 3 times per day on my own, it took FIVE MONTHS to fully recover. It took about 4 months to get to the point where I had just some pain the morning when first waking up, like I do now after only FIVE WEEKS of doing the following on my own:

  • 10 minutes light warm-up on an elliptical or stationary bike
  • Straight-legged gastroc stretch, 3x per leg, pushing to slight pain but not more than that
  • Calf stretch
  • Quad stretch
  • 3x eccentric heel drops on the floor – no steps or going below parallel
  • 20 to 30 minutes of elliptical trainer
  • Finish the “workout” by doing the above stretches again, but quickly (a minute)

That’s it. Note that the Johnson study does not talk about elliptical trainers, and does not recommend stretching. In fact, some folks on the Internet believe the stretching is counter-productive, and I am not going to debate that – I simply don’t know. But the primary difference between the protocol this time and the protocol I used last time, where it took 10 times longer to heal, is the eccentric heel raises. This time I’m doing *drops* alone, no raises. Big difference. I attribute that to the primary reason for the quick healing.

That said, I do believe that the stretching has helped. The elliptical trainer in particular – it is a fairly gentle stretching/movement that I wonder if it causes increased bloodflow to the insertion point, speeding up the healing.

Also doing the Active Release Therapy on my own, where I simply dig into the tendon and aggravate it as painfully as possible with my thumb, has helped I think. When I do it, the tendon is more painful the following day or two, but then drastic improvement the third day after. And the last two times I’ve done the ART (I’ve been doing it 2 to 3 times per week), the pain at the tendon while doing it is greatly decreased (it’s really not that painful anymore and i have to really dig in to get some aggravation).

In a nutshell: the “easy” and cheap way I am trying is working. Working as well as I could have hoped.

Last night I went to the field with my kids and kicked the soccer ball around (primarily just passing with side of foot – I try to avoid shooting/kicking). My kids were kicking it past me at times, forcing me to react by jogging/running some to the ball. While I felt some pain, I could also feel that the tendon was structurally sound and by doing the light running, so long as I didn’t put all my weight on it with each stride, I wasn’t/didn’t do any additional damage. This morning and today it feels good.

I think I’m one to two weeks away from starting a jogging/”couch to 5k” type protocol, in addition to the heel drops/stretching I’ve been doing. Running a 5k without pain, either during or the day after, will be the confirmation that the protocol worked. Mind you, I will continue to do the eccentric heel drops for the full 12 weeks as Johnson et al prescribe. Hopefully that will ensure this problem stays away!