It’s been over three years now. I initially thought it might
be plantar fasciitis, since that was another malady that I’d done battle with
in past years. Then two years ago I received the diagnosis of Achilles
Tendinosis. There are subtle differences between tendinosis and tendonitis, but
tendinosis is generally considered to be the chronic form of the injury.
Chronic is right: Thirty-six months of pain. Of course it
isn’t always the same. It’s subsided at times, only to come roaring back other
times. But it’s never gone away completely. This post is my attempt to list and
describe my experience regarding the “for better or worse” influencing factors.
Running, Part 1
Running hurts. The AT pain is significantly greater during
the days that I do my morning run than for the ones that I don’t. Since I only
take one or two days off each week, that’s a lot of pain. Naturally some types
of running seem to influence the pain more than others. I’ll get more specific
about this later on in this post.
Nitroglycerine
When I received my diagnosis in 2014, the doctor prescribed nitroglycerine
patches and Physical Therapy (PT). I used the nitro for about six months. There
was no change to my condition.
PT
The Novacare Physical Therapy did help, but only up to a
point. Six months after seeing the doctor, I began this treatment. I went twice
a week for several weeks. There was significant progress at first, but after a
couple weeks there were diminishing returns. About four weeks and eight
sessions in, my cost/benefit brain informed me that since the condition was no
longer improving, there was no point in continuing to pay for the service.
Eccentric Exercise
Eccentric exercise in this case refers to simple heel drops
done on a raised surface. Several articles, including this
very good one, consider eccentric exercise the “gold standard” for
strengthening and repairing the Achilles tendon. And my experience has been
quite positive; I’ve been doing the lifts after runs for some time, and they
always seem to provide some relief. Now, after re-reading the article for the
umpteenth time, I’ve started doing even more heel-drops: 3 sets of 15, twice a
day. I am instructed to continue this therapy for 12 weeks. It’s been three,
and again, there’s been some improvement. The thing is to not re-injure it. Which,
of course, I do regularly.
Driving
Ouch. No, that’s not quite right; OUCH! Yes, driving hurts.
The AT is in my right heel, of
course, and I don’t believe that’s a coincidence; I spend over two hours in the
car each day, and that’s a lot of pedal pushing. The absolutely most painful
thing I can do is to get in the car and drive somewhere soon after a run. BIG
OUCH!! Unfortunately, a good percentage of my runs do involve getting into the
car and driving afterwards.
Walking
Walking hurts, but only when I’m hurting more anyway. I am
pretty sure that walking does not create any further injury.
The Boot
Wearing my night splint does seem to help. At least I have
felt better the morning after wearing the clumsy thing. In fact, stretching the
tendon such that my foot is more than 90 degrees flexed helps even when I’m
seated at my desk and such. Some articles, however, warn against excessive
stretching, and they note that night splints aren’t too helpful because they
only flex one of the two main muscle groups involved. I don’t use the boot anymore.
Insoles
These orthotics, as they’re also known, are sold over the
counter. I like Superfeet brand. I wear them in some of my running shoes, and
even some of my casual work shoes. They seem to help, but only a little. Very
little.
Surgery and Other More Aggressive Treatment
I haven’t tried anything more aggressive than the other
treatments noted here. Everything I read says that there is no proven aggressive
technique. But new technology is being applied all the time. Maybe in the
future..
Running Part 2
And now for some factors more specific to running:
Speedwork
Speed Kills. I hit the track about a month ago, the first
time in half a year. I am still paying the price for that little workout. My usual
slow plodding doesn’t appear to do as much damage as when I pick up the pace. I
can’t even think about a shorter race such as a 5K or marathon.
Hills
Hills hurt horrendously. They’re almost as bad as speedwork.
Soft or Hard Surface
Soft seems better. I’ve done some long runs on the limestone
and dirt surfaced Lester Rail Trail, and the slightly softer landings didn’t
hurt, at least not any more than concrete or asphalt. Having said that, I’ve
been careful about any other trail running. I’m afraid of uneven surfaces, even
when they’re soft. Not to mention rocks or roots causing a sudden hard
footfall, a twisted ankle or a partial or complete trip.
Soft or Hard Shoes
Minimalist shoes with low heel drops are definitely out. They
may possibly be the primary cause, or at least a contributing factor of this
whole thing; I’d been experimenting with them when I first noticed the
condition. Having said that, I’m currently running in some Hokas and Sauconys
that have somewhat lower than average drops. But the shoes not what you’d call
minimal, and of course they have plenty
of cushioning. That cush does appear to help. A little. Very little.
Distance
By a quick count, I believe that since my diagnosis I’ve
done about six ultras and three marathons. I think it was that last 50-miler (Rock
the Ridge) that really got me. The others had me limping a little afterwards as
well, but not nearly as much as I am now. Before that April 30 run, I would
have said that my Achilles can handle distance; it was only the speed that I needed
to watch. Now I’m not so sure.
Running, Part 3
Here’s something I am
sure about. Running hurts. I should probably quit until this thing gets all the
way better…. Maybe after MP6. And NC24. And BW50K.
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