If you've been following this blog you'll know that I have been struggling with insertional Achilles Tendonitis for the past few months. I'm delighted to say (and I hope I am not speaking too soon) that I have made a near-full recovery, or at the least have experienced a dramatic improvement. I'm writing this blog primarily for my own records, and also in the hopes that it helps someone else out there. I am not a medical professional, but I thought I would share my experience and what helped me recover.Onset
This all started in mid-July when I noticed stiffness on the backs of my heels when waking up in the morning and taking those first few steps. I didn't think it was a big deal at the time because it wasn't painful (stiffness is the best term for it) and I really only felt it when I first got out of bed. After a few weeks, the issue became more noticeable while on the Great Alaskan Running Cruise. It still wasn't painful, but I felt the stiffness more frequently, like after running.
At this point, I consulted with Dr. Google and diagnosed myself with Achilles tendonitis in both feet. What I didn't realize, though, is that there are two types of Achilles tendonitis: insertional and midpoint. The treatment for each of these is different. However, without knowing this fact (and that's the danger of Dr. Google) I started doing the exercises that had proven to heal midpoint tendonitis.
Progression
I did these exercises every day throughout the month of August. The exercise was standing on the edge of a step, and doing heel drops so that my heel fell below the step. This was slightly painful to do, but the article I read said that these exercises should feel painful. I also stretched my calves thoroughly each day.
Rehab Exercises
My sports chiropractor told me that by stretching and doing those exercises, I was treating midpoint Achilles tendonitis, not insertional tendonitis. He told me that stretching my calves and sinking my heel below the step was putting additional strain on the tendon and making things worse! Oops! He told me that I should do eccentric heel drops on each foot, but on a flat surface. He told me that I should use as much weight as tolerated because the added weight would stimulate healing.
Ideally I would back off of the training, but given that I had a marathon approaching, he told me I could continue running, as long as I did the exercises every day. And once the marathon was over, he advised that I take a few weeks off to let the tendons completely recover.
I was very good about doing the exercises and I saw a notable improvement within just a few days. What a relief! I wore a backpack with 20 lbs worth of weights inside while I did the heel drops. I did 3 sets of 15 on each side, as prescribed, twice a day. As prescribed, I did these very slowly (lasting 3 seconds for the full drop) starting from half the height of full tippy-toes.
I continued training, running 60-70 miles a week, and sure enough, the pain worsened again a month later. Even though my actual runs were pain free, my heels really hurt afterwards. After a 22-miler, they hurt all day long, so I ended up taking 3 full days off from running. The most worrisome part about this was that my heels hurt when I was at rest, whereas typically they would only hurt when walking. The time off worked, with the pain diminishing significantly, and I was able to resume training, with just three weeks left to go.
The Smith Machine
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| I lower the bar and hold it in a relaxed position |
So, I discovered the Smith Machine at gym in my office building. This machine allows me to do the heel drops with a lot more weight, as it is easier to use the bar than wear a backpack. I simply hold the bar with my arms in a relaxed position down at my thighs. I started off with 25 lbs + the weight of the bar and after about a week, upped it to 30 lbs + the weight of the bar. I started doing the exercises twice a day, 15 reps on each side. And I am still doing them at this level.
Doing the heel drops with this machine has helped me more than anything. As soon as I discovered it, my Achilles felt dramatically better within just two days. I've now been using this machine for three weeks, and I am close to 100% recovered. By that I mean that most days are completely pain free, and on the days I do feel it, it's only for a minute at a time, like once or twice during the day. This injury developed gradually so I imagine it will take awhile to become 100% pain free 100% of the time. But I am very close to being there.
FAQ
Here are some questions I had about this injury, and the answers I discovered. Once again, I am not a medical professional so take this as one runner's experience and opinion!
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| Shoes I wear to avoid additional tendon strain |
A: My sports chiropractor advised me to wear a backless shoe with a chunky 1-2 inch heel, and that the heel height would relieve the strain on the tendon. While high heels are not a good long-term solution, they did allow me to be pain-free while walking around, and in order to recover fully, it's necessary to reduce strain on the tendon as much as possible.
Q: How do I know how much weight to use for the heel drops?
A: I started with a low weight (15 lbs in the backpack) and worked my way up. I think it's supposed to slightly hurt in the area of pain, but not horribly so. All of the articles I've read say "once you can do this without pain, then up the weight." So I assume there should be a little bit of pain or you aren't using a heavy enough weight. I saw the most improvement when I discovered the Smith machine and used 25 lbs plus the weight of the bar.
Q: How do I know if I should run?
A: This is a tough question, especially if you are pain-free while running. I think it really depends on how bad the situation is, and you should consult a medical professional. When my Achilles started to ache all the time (even when not walking) I knew it was time to stop running altogether until they calmed down. Recovery is not linear-- some days are better and some days are worse. It's important to look for a trend towards improvement and if you aren't seeing that, then it means you should reduce your mileage or stop running.
Q: What causes insertional Achilles tendonitis?
A: In my case, I think it was a change in footwear. I had been using a 10mm drop firm shoe for my speed work for the past decade, and then I changed to an 8mm drop cushy shoe in June. Even though this is only 2mm difference, my heel was getting even closer to the ground because of the cushiness of the shoe. My sports chiropractor cautioned me that those heel drop numbers can be deceiving because you have to take into account how stiff/firm the shoe is. I have limited ankle mobility, so I am not a candidate for a low heel drop shoe. Generally speaking, a high heel-to-toe ratio is best for preventing Achilles tendonitis.
Q: Should I ice or heat the tendon?
A: I've gotten conflicting guidance on this from multiple trusted sources. I tried icing my heels once after a run and 5 minutes in, they started burning really badly. So I nixed ice. Tendonitis means that the tendon is inflamed, so heat isn't a great idea either. However, heating the lower calf to get blood flow to the area is a good idea before runs.
Q: What's the best form of cross training?
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| Getting ready to go deep water running! |
Q: What about a night splint?
A: My podiatrist gave me a night boot/splint thing to wear while sleeping, but my sports chiropractor thought this was a bad idea. What to do? Since the boot didn't fit me anyway, I never used it, but I know some people have had relief with it. It basically keeps your foot in a neutral position overnight (not allowing the tendon to shorten/relax) so that when you get up and start walking around, your tendon has adjusted to being lengthened.
Q: Can the tendon rupture?
A: My sports chiro and my podiatrist both told me that this would not happen from long distance running. A rupture occurs from sudden force, which is more likely to happen in soccer or basketball. I ran a marathon with insertional Achilles tendonitis and it didn't rupture.
My best advice to anyone struggling with insertional Achilles tendonitis is to see a doctor, PT, or sports chiropractor. It's important to have a correct diagnosis and to pinpoint what caused the issue. It's also important to have a medical professional watch you do the exercises so that you know you are doing them correctly.
I haven't had this injury (knock on wood), but really like how you did this blog post to address it. I've had every other tendonitis it seems (peroneal, hamstring), and when I am injured, I always look for blog posts about it just because it's neat to have someone to bounce ideas off of or see what worked for other people. Of course everyone's injury experience is different, and no blog post is a substitute for seeing a doctor, PT, etc- but it's nice to read it from someone on your level and not feel so alone.
ReplyDeleteGreat that you were able to recover so well from this injury. Tendons can be tricky in my experience, but having such specific, targeted exercises definitely seemed to help.
ReplyDelete100% agree with your statement that runners who suspect an achilles injury see a medical professional! Glad you are on the road to recovery.
ReplyDeleteCan you explain how you performed your smith machine exercises..(specifically, how did you get into your starting position without doing a calf raise first?) Thank you....and glad to hear you made a great recovery...I'm hoping for the same results.
ReplyDeleteI started with both feet flat on the floor, no shoes. I raised both heels until I was halfway up to my tippy toes. Then, I lifted one foot off the ground, and did the lowering using the other foot. I then put the other foot back on the ground, raised both feet up to halfway, and then came down on one foot only. I hope that makes sense!
DeleteHi Elizabeth,
ReplyDeleteFirstly, what a great, informative post.
This sounds exactly like what I've been going through and I've really struggled with it. I was running around 80 miles a week consistently and all of a sudden I had pain in my heel which I originally thought was just a blister and ignored it for about a week until I couldn't run any further.
The pain was bad and after some research I just decided to have a good bit of time off to recover from it (8 weeks). I've tried absolutely everything, heel raises, ice, heat, physio, stretching, heel lifts in shoes etc.
8 weeks later, I was pain free walking and was sick so I decided to start jogging again. I was happy with how I felt and managed 3 weeks upping the running to around 30 miles per week where I'm at now. However, I've just started to feel a burning sensation again in the heel area so I'm worried it's flared up again.
There is zero pain when I run or walk but when I sit around I'm well aware of it tingling. When you came back to running were you aware of it for a while or should I back off?
I can do the heel raises with no pain but when I do them off the step it still hurts and I still can't stretch the achilles as it feels like its tearing. I've never really had any swelling.
Sorry for the long post but this is the first time I've came across that someone has the same issue as me.
Sorry you are going through this. I'm not 100% sure you have exactly what I had, but it is possible. For me, recovery was not linear. It wasn't like it suddenly vanished one day, never to return. I just had fewer and fewer days of it hurting, and more and more days where I was pain free. I think the key is to make sure you are using enough weight when you are lowering your heels to the ground. There is no need to do it off of a step; flat ground is perfect as you don't want your heel dropping lower than your forefoot. I hope this helps!
DeleteHi Elizabeth,
ReplyDeleteGreat blog post, very helpful.
Just a couple questions:
How do you deal with your tight calves after running if you can't stretch them? I have insertional achilles tendonitis as well and stretching does aggravate it, but now i have very tight calves.
And secondly, just to confirm, are you doing three sets of 15 on each leg, twice per day, on the smith machine?
Many thanks,
Nick
Hi Nick. I use the stick to massage my calves or ask my husband to massage them. I find that massage is more effective for loosening muscles as opposed to stretching. Yes. The protocol I was given was three sets of 15 on each leg, twice per day. As I started to improve I decreased it to once per day.
DeleteHi Nick. I use the stick to massage my calves or ask my husband to massage them. I find that massage is more effective for loosening muscles as opposed to stretching. Yes. The protocol I was given was three sets of 15 on each leg, twice per day. As I started to improve I decreased it to once per day.
ReplyDeleteThanks! Much appreciated
DeleteHi! I just came across your post and I’ve actially been a follower of yours on Instagram! I ran Boston in April and after both achilles were extremely sore. My right one seemed to heal quickly but the left one ended up having a bump right on the heel (at the insertion where the heel connects to the achilles). I’ve been struggling getting back to consistent running, it’s been really hard. I was wondering if you also had a bump on the back of your heel and if the exercises helped decrease it in size along with the associated pain?
ReplyDelete
DeleteHi Rachel. I suggest doing a Google search for "Haglund's Deformity" and seeing if that's what you have. I always have a bump there, but it became more noticeable with the tendonitis. After doing these weighted heal drops, the bump got smaller and became less painful. I'm not sure if this is what you have, but worth considering!
Thank you! I’ll definitely check that out and try the exercises. :)
ReplyDeleteVery informative post. Ive had similar problems with insertional achilles pain, Its back and fourth between my feet every 3 to 4 months and i get lots of morning stiffness.
ReplyDeleteQuestion:
How did you alleviate your morning calf stiffness and the stiffness that occurs after sitting for periods of time? When this occurs i know something isnt right and i dont even run or play sports. Anything that worked for you or you suggest?
Thanks
Bob, get shockwave therapy from a physio or podiatrist - also when doing the heel drops you need to go heavier and heavier - your Achilles should be able to take 1.5x your body weight. Obviously don't try that at the start instead build up to that. Try 3 sessions per week with smith machine 3x6-8 reps. Shockwave has proven results for many who have chronic IAT. FYI I'm not a professional but I've learned the above and put it in to practice to good effect from professionals (podiatrists and physics). Good luck
ReplyDeleteThanks. Going to start these heel drops once my foor gets better.
DeleteGreat write-up for rehab, and thank you for sharing your experience! Been dealing with this for a while, and wearing a heel lift helps reduce much of the day-to-day strain. I'll be trying to do more of the modified eccentric heel drops, thank you!
ReplyDeleteI did the isometric heel raises w/o much relief. I realized later my homemade orthotic had the affected limb 1/3 inch higher. I corrected that. After about 5 months I went from 200 gm daily protein to 350 gm with bulk foods whey isolate included and pain went from a 8 to a 1/10 post run. I had read as well that the calf start h was counterproductive but I'm not sure that's correct ie as it seemed to relieve the pain. I can't prove it but feel the 350 gm protein a day from 200 gm was the clincher.
ReplyDelete" calf stretch not start h"
ReplyDeleteCorrection. I had been using a orthotic with the opposite heel 1/3 inch higher. That was corrected 2 months prior to resolution. The protein increase was 5 weeks prior to resolution
ReplyDeleteThanks for sharing your experiences, very helpful indeed. Any suggestions you could offer regaridng best running shoes for Insertional achilies tendoinitis?
ReplyDeleteChoose a shoe that has a 10mm drop or higher.
DeleteWas your heel painful to touch? Mine is not painful to touch but it hurts when im running
ReplyDeleteYes, mine was very tender. And it did NOT hurt while running. You might have a different kind of Achilles tendonitis.
DeleteThanks for your reply i only had my heel stiffening in the morning and hurting when i start to run. I actually got rid of it after visiting your blog and following your regime. I just did calf raise with smith machine 3times a week on a flat floor. It took me 1month to get rid of it. But since my heel didnt feel tender to touch i was just wondering if you had same symptoms as me.
DeleteAnyway your blog helped me a lot with my recovery thanks!
Hi Elizabeth, how long did it Take you before the pain was gone? Did you continue running in the mean time? Greetz, Peter
ReplyDeleteThe pain began in July, and I started doing the correct exercises in November. The pain was about 90% gone by mid-December. So, it went away quickly with these exercises. I ran all the way from July to November, but then after my race in November, I did easy running only.
DeleteThanks, this gives me hope 😎👍
DeleteHi Eizabeth:
ReplyDeleteI have a similar issue. Change in shoe caused the insertional tendinitis. Regarding the weight usage and the shoes - you said you did it without shoes and that it should hurt a little. When you say it hurt a little, you mean at the point where the bursa is - i feel like a little nail poking at the bottom of my heel when i do this without shoes. And is it better to do with shoes or without
I did the exercises without shoes. It did not feel like a nail poking for me, it was just a general tender sensation. If it's really painful, then don't do it. But you should feel some mild discomfort.
DeleteHey everyone,
ReplyDeleteThis has been a great thread. I've had insertional tendinits and want to give my feedback on how I solved mine. I tried a bunch of things but ultimately I would have to say that getting on the smith machine and getting progressively heavier with single leg heel raises (flat ground, no drop) slowly up, slowly down (can do 3 sets of 6-8 reps). That worked a charm. I also did shockwave therapy on it which I'm sure helped but definitely the weights won it for me. The key is to keep going heavier. They say you should be able to get up to 1.5 times your body weight on those heel drops - I'm not there but I basically do my weight (90kg) and it's pretty much cured it. Also once it's settled down stretch the calf. Hope that helps :)
Hi, it's been a year since I had any achillies pain and now it came back. I have an issue with insertional tendanitis, I am not a runner or play sports. Pain alternates feet for some reason over time Not sure why I get it. This time I did incline walking (setting 11) on the treadmill for 15 minutes and starting the next couple of days my right heel became sore. It use to come back every few months but I was prescribed orthotics and i had no pain/soreness for a year now. Anything anyone can recommend, I'm 34 years old and this seems to elbe becoming chronic now and very annoying. Any help how to solve this.
ReplyDeleteBob
Bob, use the Smith Machine in the gym - 3 sets x 6-8 reps. Slowly up, slowly down, single leg, standing calf raises (stand with bar behind head, on top of shoulders as if you're about to do a front squat). Build up the weight. The achilles should be able to withstand 1.5 times your bodyweight - in saying that I've been doing this exercise for a year now once or twice a week and the max I've done is 100kg (I'm 90kg). The key is control and to go as heavy as you can so you are tired come the 6th, 7th or 8th rep. It works a charm.
DeleteShockwave therapy is also helpful, but expensive so try the gym first
Thanks. Will do. I may even do shockwave therapy as my insurance helps out on cost.
DeleteHi Elizabeth,
ReplyDeleteI am glad I found your post. I am literally experiencing the exact same situation. I started having the insertional pain about two weeks before the Indianapolis Marathon this year (Congrats on your half, I was there!).
I was desperate, I tried everything, took some days off (it was ok since I was tapering), ice, heat, calf drops below the step, etc. I was able to run painless once I warmed up. However, it became very painful about 5 days before the marathon. I found out some relief if I added a padding to the back of my shoe, it worked great and had to run Indy with that cushion, didn’t bother at all since I got used to it. I had to adjust my goal and ended up running 3.05.
It hasn’t got any worse since then and almost no improvement. I have been swimming and pool running, maybe I ran easy a couple of times. However, I never tried the drops as you described. I literally started with the Smith last night after I read this. This morning, I soaked my legs in the hot tub, ran three easy miles painless on the treadmill and did the Smith for the second time. Tonight, I am coming back to the gym to lift weights and to visit the Smith. I would continue doing some isometric raises at the office while also wearing heel lifts. Plus rolling my calves like crazy, (part of the problem was because I got a pair of shoes with smaller drop but also my calves are always sore and tight, plus increase on mileage too fast).
At some point I was afraid of having some tendonisis, since ice and ibuprofen never helped inflammation (if I had any). I am very hopeful right now. I will keep you posted on my progress. Can’t wait to fully heal and get back to running. I promise I will be patient and disciplined.
Gracias!
Emmanuel
Hi,
ReplyDeleteI had the same issue - it started in September 2019 but the difference between mine and your case is that I visited the Ultra-sound specialist quite soon and the imaging showed that a part of the achilles tendon attaching to the heel has been ruptured. I didn't feel pain when running, only afterwards and stiffness in the morning plus a bump on the heel. I stopped running and did a lot of biking, swimming and crosstraining which did not affect my achilles (pushups on knees, etc.). It healed after 3 months according to the second ultrasound. Unfortunately, I came back to running and it seems no that problem returned. I am so angry. Do you think I should try weighted heel raises if there is a possibility of a tiny rupture. You might have had that rupture too (we had identical symptoms) but you didn't do the ultrasound, am I right? So maybe the solution is to strengthen it like crazy every day :)
If there is any possibility fo rupture I would do nothing until talking to your doctor. I did not do an ultrasound, but mine was not that painful. Strengthen it like crazy every day is a good solution if you are sure that you are doing it correctly and there is no tear.
DeleteHi Elizabeth - I have a question about this technique (if you are still responding on this issue). After raising yourself up ("halfway up onto your tippy toes") on two feet, you are able to shift to one foot and lower yourself on one foot even as you hold weight? That's somewhat difficult for me even without holding weight. In the videos that you link to above (eccentric heel drops), the guy is holding onto a wall while doing this exercise, so I just wanted to make sure I am trying to do it right. Thank you!
ReplyDeleteYes, you will likely need to hold onto something to balance. The Smith Machine is ideal because the weight IS what you use to balance yourself on. But if you do not have a Smith machine, then hold a weight in one hand and use the other to keep balance.
DeleteGot it! Thank you!!
DeleteGreat blog. I've been suffering insertional AT since mid of last year, so nearly a year. Stopped running around 2 months, with just hiking (all the gyms were closed cos of COVID), and slowly got back to running around November last year. Went to physio and rehab for strength training during that time. Increased my mileage during April 2021, and it's flared up again - one run I experience sharp pain. So back to rehab, heel raises and hiking, and now can swim, so that's good. Hope it's just a short relapse. But there is a bump of calcification, and sore to touch, some shoes not comfortable again. VERY FRUSTRATED!
ReplyDeleteSorry to hear this. Mine does flare up if I am not consistent about doing the heel drops!
DeleteHi Elizabeth..
ReplyDeleteHow
Much does the smith bar weigh on its own..
Also do you feel it more effective holding bar at thighs rather than behind neck??
I have no idea, but the standard weight of a bar is 45 lbs I believe. I don't have upper body strength so I need to hold it low.
DeleteAlso do you do these with knee slightly bent??
ReplyDeleteThanks for the advice.
Duke
Yes.
DeleteHi Elizabeth, thanks for sharing your experience! I'm curious... do you still have irritation several years later? And if so have you had any scans on it? Mine is similar... insertional, very mild, no pain when running but just 'there' occasionally. I injured it back in 2019 and have had intermittent pain since (I'll feel it for several months and then it'll go away and then come right back). I'm a little paranoid of the potential long term damage, especially since it seems to come back if I'm not doing eccentric calf strengthening.
ReplyDeleteOn a side note, I read that Jos Hermens had ruptured his achilles during a 10,000m race in the 70s. However his had already been massively weakend by a poor surgical decision (injecting cortisone for short term relief) which was then followed by a decade of regular 100-200 mile weeks and elite competition. So, as runners, it ain't easy to rupture.
My doctor told me that insertional Achilles does not present a rupture risk. I do still deal with Achilles pain. I have occasional flare ups where it's hard to walk around the neighborhood (yet I can run), but most of the time it's an annoyance. I do the heel drops, but not as often as a should and I don't use as much weight as I used to. I find that doing the heel drops pre-run really helps loosen everything up so running is not as painful. I also stick with a higher heel-drop shoe, or I put a small heel lift into the shoe. Just lifting it up a few mm really helps.
Delete