Wednesday, July 20, 2016

AT: What Works, and What Ain’t


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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