Achilles is becoming an issue

[merlinmurph]

I'm looking for a little help from anyone who has had achilles tendon issues while riding. My left achilles is getting to the point where it's affecting my rides. I did a 40+ mile ride last week where I basically limped home from about mile 25. My last couple of 25-mile rides got bothersome near the end. After yesterday's ride, I took ibuprofen a few times, and today's 30-miler was fine. Go figure.

A little background.
My left achilles has felt tight for about the last 10 years, and more so in the last 2-3 years. I'm not sure you would call it pain, but it did let me know it was there. I would feel a little pain sometimes, but it never affected my riding at all. I tried running in the winter a few years recently, and that's where it would flare up, and I'd stop running. Too bad, because I would like to do something in the winter during the week.
This year has been a little different where the tightness has escalated to pain while riding, mostly while climbing.

It feels like there's swelling of the tendon about 4" up from the floor. There's a bump there that's pretty sensitive.

I'm a 56-year-old male that does a lot of outdoor stuff - bike, hike, ski, kayak, etc. This year has been great mileage-wise, as I've got 2300+ miles in and have felt awesome. In addition to my daily 25-30 mile noontime rides, I try to get a 50+ mile ride in once a week and did a really nice century ride a few weeks ago in the White Mts. of NH. Roads around here are rolly, with rides gaining about 1000' of altitude about every 20 miles.

At the beginning of the year, I got new shoes, pedals, and got them fit properly along with other small fit tweaks.

I'm planning on calling a doctor tomorrow to see what he's got to say.

Any ideas? Would stretching help?

Thanks,
Murph

[gone]

I'm sure you'll get lots of better replies than this one but I would hold off on the stretching for now. You've got the Achilles inflamed, do the usual rest/ice/anti-inflammatory routine until the inflammation is gone then start a program of gentle stretching. Be gentle and consistent. This is definitely not the time to apply the "no pain, no gain" mindset.

Good luck!

[93legendti]

Great advice in these 2 threads:

http://forums.thepaceline.net/showthread.php?t=3834&highlight=achilles
http://forums.thepaceline.net/showthread.php?t=27123&highlight=achilles

Too Tall has great advice...

I've been taping my left AT for a few months and it has gotten better, while still cycling as much as I did before I had pain.

[Tim]

I had something similar a few years ago. Use lots of ice after your ride, ride small gears- do not push big gears even when you feel good. Don't stretch for now. Check for a leg length difference- the shorter leg may be working differently and this may be putting pressure on the achilles tendon. These things heal but you have to be patient. Tendons do not have great blood circulation and so the healing process takes some time. Do see your doctor.

[John M]

Tough problem that I have had for 10+ years after a running injury. Mine is in pretty good shape now. The bump is likely an area of injury with some swelling and perhaps some evolving scar tissue. You have need to switch into rehab mode, but I think you can continue riding. I generally agree with the advice given thus far. My suggestions:

1. BE CAREFUL. Don't over do it and avoid the urge to "train through the pain". If it gets worse, back off on the mileage and take more days off. It is easy to convert a little achilles tendonitis into a chronic problem (i.e achilles tendonopathy). Ask me how I know......

2. If you go a doctor, try to find one that actually runs/rides/climbs or similar and that has specific experience with this problem. A running/riding doc will understand the importance of keeping you on the road safely.

3. Move the cleats rearward on the shoe a bit to put the ball of your foot 1-1.5 cm in front of the pedal spindle. This may require lowering the saddle a bit.

4. Be gentle on hills (lower gears, climb in the saddle, etc.....). Become a "spinner" if you are currently a "masher".

5. Gentle stretching can be done to keep the calf muscles lengthened but don't stretch to the point that it induces pain in the achilles. Gentle massage of the tendon at the site of the swelling can help break up the scar tissue and stimulate blood flow. The achilles is poorly vascularized which is one reason it doesn't heal fast.

6. Do a google for 'eccentric calf exercises'. A good physical therapist that works with runners/cyclists can help with this. The problem is usually tight calf muscles that put excess stress on the achilles. If you can strengthen and lengthen the calf muscles (gastrocnemius and especially the soleus), it can help a lot. Go slow with these, be gentle. As it improves, you can build up the resistance. This is/was very helpful for me since my injury originated with a soleus strain that led to the achilles tendon problem.

7. Night splinting or taping can be considered as well to help keep the calf muscles from shortening up overnight.

Good luck.

[merlinmurph]

Thanks for all the help, guys, lots of good info.

I'm making a doc appointment today, but that will just be the primary care doc who is just OK when dealing with sports injuries. We'll see how it goes.

Can 56-year-olds be mashers?? :) Nope, not this guy.

Enjoy your ride today,
Murph

[slowgoing]

Good advice above on how to recover. Then follow the 10% rule - increase mileage by no more than 10% a week. You will be tempted to do more, but your tendons, which strengthen much slower than muscles, will thank you. Moving the cleats back helps too.

[bigreen505]

Check for a leg length difference- the shorter leg may be working differently and this may be putting pressure on the achilles tendon.

+1 on that. Also try lowering your saddle a little. If I had to guess you have a leg length difference and set your saddle height based on the longer (probably more dominant) leg, causing your shorter leg to pedal more toe-down. This also could be a signal that you need cleat shims.

Find a shop that you trust that has good fitters, explain the problem and schedule and appointment for a pedal fit. They will adjust saddle height and position and cleat position. Probably about $75 including shims.

[mandasol]

6. Do a google for 'eccentric calf exercises'. A good physical therapist that works with runners/cyclists can help with this. The problem is usually tight calf muscles that put excess stress on the achilles. If you can strengthen and lengthen the calf muscles (gastrocnemius and especially the soleus), it can help a lot. Go slow with these, be gentle. As it improves, you can build up the resistance. This is/was very helpful for me since my injury originated with a soleus strain that led to the achilles tendon problem.


+1
I had bad Achilles pain a couple years ago. Eccentric calf exercises worked wonders for me.

[Kevan]

one at a time elevate your toes against something like a street curb and ssssssslllllllllooooowwwwwllllllyyyyy lean into the ankle bend stretching the tendon and slowly release the pressure. Alternate feet and stretching.

You might take some time off, letting things heal a bit before even starting the stretching routine.

[Alan]

Take a look at some of the articles on Cyclingnews.com from Steve Hogg re cleat positioning as he is very good about this. You can email him from the cyclingnews site and he will respond to you as I have corresponded with him in the past.

PM me if you can't locate his recommendations. In general move cleats back so your foot moves in front of the axle. Mine is about 10 mm in front and he gives recommendation by the size of your foot.

Alan

[merlinmurph]

Went to see my primary doctor, he referred me to an orthopedist.

Orthopedist was sympathetic because he's a cyclist, but was also apologetic because he said there wasn't much I could do. I could immobilize for 6 weeks, or try physical therapy. I figured I'd see what PT would say.

Went to PT this week, having no idea what their approach might be. I was pretty depressed going in because I simply thought I would have to stop cycling for awhile, and I've had a great year so far. Every ride in the last 2-3 weeks has hurt and I was bummed.

The woman at PT was very encouraging, said there's no reason to stop riding, and just to be careful. The basic strategy is s-t-r-e-t-c-h-i-n-g, like a lot of you have already suggested. Stretch the calf and the tendon. That and eccentric calf raises (right on, John M!).

Here's my routine:
- Before I even get out of bed, roll the calf muscle on styrofoam tube, then stretch by putting a belt around the toes and pulling back. Everything tightens up overnight and this will stretch things out before walking on it and re-injuring it.

- Eccentric calf raises 3-4 times a day

- calf and tendon stretches many times a day.

- Riding: Stretch lightly before riding. Ride 5-10 minutes, get off and stretch again now that the muscles are warmed up. Take it easy, small gears. I like to climb and get out of the saddle and crank - can't do that. :no: Enjoy the ride. Stretch after the ride, then ice.

- Taping or something equivalent is an option, I haven't tried it yet.

I've done two short rides (~25) since PT and have already felt better, i.e. no pain.

Thanks for all the help and encouragement. Good luck to all of you with similar issues.

Murph