Achilles Tendon Soreness

[wileykt]

I was wondering if anyone had any information on how to treat a very sore achilles tendon. Before a race I competed in this past saturday my achilles tendon was a bit tendor, after the race the tendon was very sore and continues to be a couple of days later. I haven't ridden since Saturday but I'm getting very anxious to get back on the bike. Is this a good or bad idea?

[slowgoing]

Don't ride! Do a search for "achilles" on this forum and great advice will come up. Rest, ice and anti-inflamatories (subject to their new heart attack/stroke warnings) until it isn't inflamed and doesn't hurt anymore, which can take a while (weeks to months). Then ramp up slowly using the 10% increase a week rule, or some similar rule. You may have ramped up too quickly for your tendon, which doesn't strengthen as fast as your muscles, with resulting microtears (or worse) to your achilles. It won't get any better and may become chronic if you continue to ride. If you must ride, see the thread that includes advice on how to tape your ankle to relieve stress on the achilles - that really works!

I'm not a doctor but have seen one about this, and you may want to do so as well to rule out anything more serious than overuse tendonitis.

[Kirk Pacenti]

This is very common occurance when you run your saddle too high. When your saddle is too high, and you reach the bottom of your pedal stroke, the tendon is trying to expand and contract at the same time. This causes the inflamation you are experiencing. Try lowering your saddle 3mm or so and see if it helps.

Good luck,

[zap]

As far as treatment is concerned, slowgoing has it right. Don't push tendons. I found out the hard way last year.

Whats your cleat position?

You might want to adjust your cleats so that the ball of your feet is up to 10 mm (depending on the size of your feet) in front of the pedal axle. This will reduce the stress on your achilles tendon.

If you move the cleats back, you will need to lower the saddle some.

Check out cyclingnews.com for articles written by Steve Hogg.

[Keith A]

I suffered from tendonitis with my Achilles tendon several years ago and it was frustrating injury. I kept trying to ride with a sore tendon and guess what, it stayed sore! I finally just stopped riding until the soreness was completely gone and this solved my problem. Once it had healed, I was able to start riding again and have never had a problem since then.

[Ti Designs]

Don't ride!


Yeh, what he said!


The achilles tendon is a bit different than most in that it's probably not the attachment point at the bone which causes the problem (you would know for sure if it was blown, the back of your foot would feel flat and sore would be the least of your concerns). There are two muscle groups that fan across the lower leg and attach at the top of the tendon. A tear on either one of those muscles will cause pain when the ankle is flexed, but being a cycling related thing and knowing the dynamics of a cleated system, I'm guessing it's an irritation of the tendon itself above the attachment point. Clear signs there are pain when taking up force (walking down stairs is an example). A sign of an advanced case would be the feel or even the sound like a rubber band being dragged across a smooth surface. At this point you need to stop riding and find a good doctor and/or PT. As long as the movement is still there, the irritation remains, so expect some form of soft cast. There is a method of measuring the tendon width, they will probably use the other side for comparison. Ultrasound is often used by PTs to ease adheason, ibuprofen (and lots of water) does well to keep down the swelling. At home you can do a contrast bath by filling one small garbage basket with warm water and another with cold. Two minutes in each, going back and forth, ending on warm and some very light stretching, twice a day.

Don't think for a minute that this is going to go away by itself. You may get lucky, or you may find yourself off the bike for the whole season. A few weeks in a soft cast and a rehab program that gets you both strength and flexability will end the problem. Trust me, I've coached way too many riders who were too pig headed to stop riding for a few weeks...

Deal with the rider's problem first, then look at changes in position on the bike and/or cleats. I happen to agree with Kirk about the seat height, but that should have been explained to you by whoever fit your bike. I set up saddle height based on the heel being the same height as the ball of the foot at the bottom of the pedal stroke. The reason is simple, nothing in nature tuggs at the bottom of your foot, setting the saddle higher lets the pedal tug at the bottom of your foot every crank rotation. Something is going to give, it's either behind the knee or at the achilles...

[little.man]

I had an achilles problem a few years ago and resolved it by going to a
chiropractor who also practices ART, Adhesion Release Technique. This was
after staying off of it for a few weeks, seeing a regular doctor and getting
nowhere. I was back on the bike right after seeing the guy. Besides the
manipulation, he recommended stretching it aggresively, which I did. Here is
a link on ART.

http://www.activereleasetechnique.com/art.html

[Too Tall]

You guys are going to shoot me!!! But pls. "hear me" first.
Get it evaluated by a good Sports doc first.
If this is a simple strain / stress than I'd recommend you have your sports doc. teach you how to tape for cycling. The reason I advocate this is you will miss out on valuable training and exercise as an outlet AND taping achilles strains is compatible with cycling. Properly done the tape job will limit movement to a degree less than what may cause further or worsening of the injury. In very basic terms the tape itself becomes the achilles and uses the entire bottom of your foot and heel as as an articifial origin.....this limits flexion of your foot (twords your nose)....but only a little bit less than normal...thus the genius of a good tape job.

Increase in training volume and or intensity are both causes I've commonly seen in cyclists esp. at multi day events.

Use lots of ice. Consider using a natural compound inflammatory such as e-caps "Tissue Rejuvenator".

[bcm119]

I've had occasional achilles pain for a few years, and its usually related to my saddle being too high or my getting caught hammering through a cold rain w/o booties. Its never kept me off the bike for more than a few days, but I do have to take care of it by:

Keeping it warm at all times, except for 20 mins of ice before an evening shower.

Wearing neoprene booties if its below about 60, and in any temp if its raining. Booties keep it warm but also give a little ankle support- enough that you notice reduced achilles stress. In warm weather taping is probably the way to go.

Wearing a warm sock at night to keep it from getting cold if you kick the covers off your feet.

Trying a slightly lower saddle position.

[Peter B]

I was experiencing Achillies tendon pain and swelling earlier this season after riding lots of long fixed gear events (400k, double century, 12 hour time trial) as well as long gearlie rides. I tried rest, ice and anti-inflammatories with limited success. The pain and swelling would quickly return after 50 or so miles. I hadn't changed anything on my bike setup, so I finally went back to my massage therapist and found my IT bands were very tight, along with my quads. She worked me over good and I've not had any more trouble. Went on to ride a fast 600k the next weekend without any pain or swelling.

I strongly urge you to do as others have suggested and get checked out by a good sports medicine physician. That said, a good massage or two might do wonders if the achillies pain is the manifestation/result of other muscle tension.

Good luck with a speedy recovery!


Peter

[Dr. Doofus]

in 2001-2002 doof lost 6 months to an achilles injury that involved some casting and some removal of scar tissue from the tendon sheath...so...

1) the most problematic area is just above the calcaneus...the "watershed area" is the least vascularized point on the tendon, which does not have a strong blood supply to begin with. As a result, injuries to this area heal slowly.

2) Coupled with the low blood supply, the achilles is not a nerve-rich area...so...when you get pain, its already too late, and its time for conservative management. pushing it or using solutions (taping or symptomatic management with NSAIDs, or god help you and the fool doc who does it, steroid injection) to manage the pain and weakness while finishing out a season will often lead to more damage (tendonits, or what is more common, tendonosis, the degeneration of the collagen fibers in the tendon) and more time to heal.

3) the achilles is the one tendon you don't monkey with. see a good orthopedist, follow a conservative approach, and remember its better to give up six weeks than six months. trust the guy who looks like the doof.