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Achilles Tendonitis, Self-Diagnosed
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edge


Nov 15, 2012, 7:34 AM
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Achilles Tendonitis, Self-Diagnosed
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About 5 months ago I began noticing a light pain in my right achilles tendon when I was walking, particularly on hills with a pack on. At the time I was climbing outdoors 2-3 times a week with a 20 minute moderately steep approach.

After a week or two the pain remained, and in looking at the rear of my foot I noticed a slight "bump" in the achilles tendon, protruding maybe 3/8" from normal and 1 1/2" long top to bottom. I google image searched and confirmed, certain enough for my needs, my initial thought of Achilles Tendonitis.

I began RICE, although cheated a bit on the rest part. I continued climbing 2 times/wk, but otherwise kept it rested, iced (2X/day), compressed (neoprene ankle sock folded over at the top to further compress the tendon), elevation (foot on the ottoman watching Sports Center), and treating topically with arnica gel and Iron Hand liniment 2X/day.

Bottom line is that the rock season was going so well, and I was able to remain climbing at a high level and put up a dozen or so FAs, that I have been trying to just "stabilize" the injury (my term, nothing medical about it.)

My hope is that I can add complete rest for a month or three once winter shuts down the rock season. For anyone with experience with this type of injury, will this be enough for complete recovery? How long did it take you to recover? Are PT type excersizes beneficial during or after healing? Any insight appreciated.

The images below were taken this morning. Presumably safe for work, assuming you have no foot fetish inclinations.










amarius


Nov 15, 2012, 1:23 PM
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Re: [edge] Achilles Tendonitis, Self-Diagnosed [In reply to]
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Keep in mind - it is all subjective

I had similar injury, self diagnosed, of course. Wasn't as bad as the one in pictures.

I took 3 months off running, switched to different exercising - elliptical, biking, and stepper. For PT used stretching and eccentric exercises - that is weighted heel lowering. NSAIDs did not appear to help. Instead I was kneading in (for lack of better words) some IcyHot - it stinks and burns, must be good?
I did not elevate nor did I ice - not a choice, just couldn't really imagine doing that at work.

At the end of 3 months, started running again adding a few minutes each week.
IIRC, at the end of year I was back to my running routine with acceptable levels of discomfort next morning - first steps down the stairs first thing in the morning are not that pleasant.

In my experience - forcing the correct stepping motion is the hardest when Achilles is hurting, but you've got to do it.
Best luck


dynobelay


Nov 15, 2012, 1:46 PM
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Re: [edge] Achilles Tendonitis, Self-Diagnosed [In reply to]
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Well, my bump was noticeably bigger than yours. But then I ignored it for a lot longer. The achilles tendon is rather difficult to heal, especially if you are past middle age. If you think it will just go away, it doesn't, and the bump (swelling) just gets bigger.
It commonly tightens up overnight, so your 1st steps in the morning are achey and stiff.
You can find out a lot about this common malady on the internet. Or see a Dr. or P.T. Rest, ant-inflamatories (ibuprophen). I also worn a theraputic boot to bed to keep the tendon from contracting. But then again I torn my tendon noticeably so my initial injury was probably worse.
Winter (the off season) is a very good time to get it to heal. My bump went away and I don't have any pain. But, if I have a hard day of hiking, etc. the next morning I still have those 1st few stiff steps. At my age it will probably always be so.


edge


Nov 16, 2012, 8:28 AM
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Re: [edge] Achilles Tendonitis, Self-Diagnosed [In reply to]
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Bump for further thoughts from other cankle Quasimodos.


smallclimber


Nov 16, 2012, 8:36 AM
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Re: [edge] Achilles Tendonitis, Self-Diagnosed [In reply to]
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Achillies Tendonitis is very hard to get rid of. I got this back in May, and have no idea how I did it as I was not doing any running, hiking, climbing etc. I just noticed a slight pain on back of left foot, assumed it would go away. Three months later it was much worse so went to Dr and then podiatrist. Had cortisone injection and they wrapped it up for a week. Slightly improved, but has worsened again since. I essentially don't do any exercise these days - certainly no running, climbing or hiking. Just walking around the house, at work etc. I also have pain in my big toe and ball of foot - which I think are compensatory based on changing my walk to try and help the heel.
So its been a real bummer for me, 6 months now of limping, some days really pronounced limping. I know treatment includes rest, but I can't exactly rest any more, I can't not "walk to the car" or around the house and thats all I'm doing.
Hopefully you will fare better than me!


maghold_messner


Mar 30, 2013, 8:30 AM
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Re: [smallclimber] Achilles Tendonitis, Self-Diagnosed [In reply to]
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I have been dealing with this since October of 2012.Achilles can be many different problems, but tendonitis is most common. It usually happens from overuse. However, it can also be caused by a weak or strained calf muscle; doing too much too fast, like when your body isn't ready for that much work, or just, again, simple overusage. I went to my physician and a podiatrist he reffered me to. He told me to do the whole R.I.C.E. thing, but to also work on a plethora of stretches, especially on the calf muscle. It looks like your problem is wors ethan mine, because you have calcification and scar tissue forming ( causing the bump). My suggestion is to se a doctor. If you must exercise, at least look at getting some good shoe insrts. I was prescribed shoe inserts, custom, but I used a pair of superfeet ( which I stole from my mountaineering boots) until the custom ones arrived. I found that wearing the insoles ( superfeet) made a huge difference.

I hope this helps. Also, until my achilles was better, I stuck to elliptical machines and such, which allowed me to use resistance and jack the elevation up. It can be frustrating to be a climber and deal with doctors, as they are used to dealing with basketball and football players. If you do go to the doctor, make sure and be very specific about being a climber. I even wrote down my training regimen to show my doctor so they could work better with my needs. Also, consider working with a sports medicine doctor or trainer.


carolyntran29


Jun 28, 2013, 2:26 PM
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Re: [smallclimber] Achilles Tendonitis, Self-Diagnosed [In reply to]
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The reason why Achilles tendonitis is so hard to get rid of is because first, its one of those injuries that are simply prone to relapsing and secondly, because tendonitis-related inflammation is almost impossible to minimize.

In order for your ankle to heal, similarly to any other injury, you need to minimize your inflammation; however, with Achilles tendonitis, you'll be looking at an average of 6 weeks for the inflammation alone to go away- this is with proper precautions, rest and icing. Issue is, its hard to stay off your feet (unless you work at an office at home and you're okay with putting a full stop to your training) and accrue more inflammation by agitating your ankle on a daily basis.

Key steps to take in order to recover is to invest in a ColdCure Ankle Wrap http://www.kingbrand.com/Ankle-Ice-Packs-and-wraps.php?REF=33PV6

This will give you the proper support and cold therapy necessary while you're walking around at home, to get the inflammation down. Also invest in some great compression socks and tape to provide your foot/ankle with maximum support. Avoid ibuprofen and ice, ice , ice!
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jonapprill


Jun 28, 2013, 3:01 PM
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Re: [carolyntran29] Achilles Tendonitis, Self-Diagnosed [In reply to]
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carolyntran29 wrote:
The reason why Achilles tendonitis is so hard to get rid of is.........because tendonitis-related inflammation is almost impossible to minimize.

In order for your ankle to heal, similarly to any other injury, you need to minimize your inflammation

Hi Carolyn,

I find your above statement confusing because everything I have read in the last 5 years is that most tendonitis related injuries were found to have no inflammatory markers if studied histologically. Please understand, I'm not trying to challenge your statement, but rather expand my knowledge of the subject. Do you by chance know of any recent studies that have shown that reducing inflammation is the key to treating these injuries? To help you understand my point of view, here is a list of references that have influenced my current understanding of the subject matter.


Alfredson, H., Pietila, T., Jonsson, P., Lorentzon, R. Heavy load eccentric calf muscle training for the treatment of chronic achilles tendinosis. American Journal of Sports Medicine 1998; 26: 360-366.

Cook JL, Khan KM, Maffulli N, Purdam C. Overuse tendinosis not tendonitis: part 2: applying the new approach to patellar tendinopathy. The Physician and SportsMedicine 2000; 28(6).

Khan KM, Cook JL, Kannus P, Maffulli N, Bonar SF. Time to abandon the “tendonitis” myth. British Medical Journal 2002; 324: 626-627.

Khan KM, Cook JL, Taunton, J, Bonar F. Overuse tendinosis, not tendonitis: part 1: a new paradigm for a difficult clinical problem. The Physician and Sports Medicine 2000; 28 (5).

Kraushaar, B., Nirschl RP. Current concepts review – tendinosis of the elbow (tennis elbow) clinical features and findings of histological, immunohistochemical, and electron microscopy studies. The Journal of Bone and Joint Surgery 1999; 81: 259-278.

Maffulli, N., Ewen, S., Waterston SW., Reaper J., Barrass, V. Tenocytes from ruptured and tendinopathic achilles tendons produce greater quantities of type III collagen than tenocytes from normal achilles tendons: an in vitro model of human tendon healing. American Journal of Sports Medicine 2000; 28: 499-505.

Shalabi, A., Kristofferson-Wilberg, M, Svensson, L., Aspelin P., Movin T. Eccentric training of the gastrocnemius-soleus complex in chronic achilles tendinopathy results in decreased tendon volume and intratendinous signal as evaluated by MRI. American Journal of Sports Medicine 2004; 32: 1286-1296.


onceahardman


Jun 28, 2013, 3:29 PM
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Re: [jonapprill] Achilles Tendonitis, Self-Diagnosed [In reply to]
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Jon, I think Carolyn is a spammer selling cold packs.


jonapprill


Jun 28, 2013, 3:45 PM
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Re: [onceahardman] Achilles Tendonitis, Self-Diagnosed [In reply to]
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Thanks for the heads-up. Gotta love the interweb.


carolyntran29


Jun 28, 2013, 3:59 PM
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Re: [onceahardman] Achilles Tendonitis, Self-Diagnosed [In reply to]
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Dutifully noted- I'll stop promoting the products, but I genuinely still want to be part of the forum, so I will just focus on providing as many tips as possible without brand/product bias!

I used to take kinesiology (which still doesn't make me a professional) and did a lot of competitive/recreational running before I focused on climbing, hiking and trail running, so I have a bit of knowledge from experience; however, I may be wrong. From what I've learned, you do experience inflammation due to the overuse and strain associated with tendonitis. Now, you can also take preventative measures like using a foam roller to break up muscle scar tissue and loosen up the muscles, but definitely focusing on getting inflammation down will help with the pain- this can also include cold/ice soaks (my SO used to do ice baths - which are crazy btw, to deal with his issues).

An ice water bottle can be used as a substitute but definitely make sure to have a piece of clothing or fabric between your skin and the actual frozen bottle itself because you want to avoid freezer burns, while rolling it from the end of your calf towards the actual ankle itself.

In terms of preventative measure, playing close to attention how you strike your feet, stretching the calves etc. will be a great help.

Here are a few examples of what you can find online, but again, you can definitely refute it with other studies, I'm just trying to help:

http://www.ncbi.nlm.nih.gov/pubmed/23640524

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Achilles_tendonitis

http://www.eatmoveimprove.com/2009/08/on-tendonitis/

http://www.nlm.nih.gov/medlineplus/ency/imagepages/19632.htm

http://www.nativeremedies.com/ailment/natural-treatments-for-tendonitis.html


onceahardman


Jun 28, 2013, 4:18 PM
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Re: [carolyntran29] Achilles Tendonitis, Self-Diagnosed [In reply to]
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carolyntran29 wrote:
Dutifully noted- I'll stop promoting the products, but I genuinely still want to be part of the forum, so I will just focus on providing as many tips as possible without brand/product bias!

I used to take kinesiology (which still doesn't make me a professional) and did a lot of competitive/recreational running before I focused on climbing, hiking and trail running, so I have a bit of knowledge from experience; however, I may be wrong. From what I've learned, you do experience inflammation due to the overuse and strain associated with tendonitis. Now, you can also take preventative measures like using a foam roller to break up muscle scar tissue and loosen up the muscles, but definitely focusing on getting inflammation down will help with the pain- this can also include cold/ice soaks (my SO used to do ice baths - which are crazy btw, to deal with his issues).

An ice water bottle can be used as a substitute but definitely make sure to have a piece of clothing or fabric between your skin and the actual frozen bottle itself because you want to avoid freezer burns, while rolling it from the end of your calf towards the actual ankle itself.

In terms of preventative measure, playing close to attention how you strike your feet, stretching the calves etc. will be a great help.

Here are a few examples of what you can find online, but again, you can definitely refute it with other studies, I'm just trying to help:

http://www.ncbi.nlm.nih.gov/pubmed/23640524

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Achilles_tendonitis

http://www.eatmoveimprove.com/2009/08/on-tendonitis/

http://www.nlm.nih.gov/medlineplus/ency/imagepages/19632.htm

http://www.nativeremedies.com/ailment/natural-treatments-for-tendonitis.html

Carolyn, I'm sure your background in kinesiology can be helpful here...I don't mean to be too negative. There are several MDs, PTs (like me), ATCs, etc who post on this forum. I may be a little jaded, but historically, several of us have had to "beat back" various alternative treatments over several years.

The first link you posted really regards heel strike forces in runners. It was not really treatment-based, but cause-based. Most of the others are from companies selling things, not really scientific articles. They smell like alternative medicine.

I'm not saying alternative medicine never works, or that "mainstream" medicine is always best. Most mainstream medicine, though, is improving. Hopefully, that is the result of the rigorous application of the scientific method (not always the case, of course).

Right now, there has been seen a difference between the "old" definition of "tendinitis", vs the newer-school "tendinosis", which is not inflammatory, but chronic. For Achilles tendinitis, heavy eccentrics have a good body of objective evidence supporting their efficacy. There is no compelling reason why this should not be effective in other tendons, but there is so far little evidence.

There is scant evidence for cold packs curing tendinitis or tendinosis, but they can provide temporary pain relief.


carolyntran29


Jun 28, 2013, 5:08 PM
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Re: [onceahardman] Achilles Tendonitis, Self-Diagnosed [In reply to]
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Hi onceahardman, thanks for the response- nono, you're not negative, I try to help but also look forward to learning more about injuries and recovery.

I don't believe cold packs or even cold baths can cure tendonitis but it will definitely get rid of inflammation which will provide relief. Assuming there is inflammation, the body cannot effectively begin to heal itself once the inflammation has subsided.

In regards to the heel striking, I mentioned that as a preventative measure, not a resolution- just realized how I organized my response was confusing, so totally my fault!

Again, the main reason why I'm here to basically share information but also update my basic knowledge on injury to help myself and my SO during training (esp. because I want to get back to increasing my mileage and doing more climbing/ mountain hiking). :)

Feel free to share any tips or links you have on achilles tendonitis because my SO is still dealing with his - although his is more due to long distance running (110km weekly with a low of 80km weeks). Thanks again for the response!


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