Achilles Tendinopathy and life updates

In March, earlier this year I was noticing some discomfort in my right leg, near the soleus calf muscle. Most of the time it would be half way into a run, and it seemed more prominent when doing longer hill climbs. Soon after arriving back in Wales, I went for a tempo paced trail run on the coast path, and about half way in my leg gave way to a sudden sharp pain in the mid-achilles area. I slow jogged back home from there as it was now clear something was not right. Fast forward a week or so, and I had a local physiotherapist diagnose it as an achilles tendinopathy.

Rehabilitation program for my Achilles Tendinopathy

First off, if you’re reading this yourself as someone with an achilles injury, don’t take my findings or actions as the gold standard. There are so many nuances and differences when it comes to injuries and differences we all have.

Just to start, there are 3 x different types of achilles tendinopathy types. Low (heel) area, mid-portion (what I have), and the more rare higher-up achilles area.

Furthermore, where I started on my rehab program is very tailored to the results and performance my physio observed when I attended my first session.

The physio had a prod around my achilles, seeking to find any areas of discomfort, comparing both legs. Then he had me do a series of plyometric style jumping tests.

He found some discomfort in the mid portion of my achilles on my right side, however I didn’t appear to have any pain doing the jump and hop tests.

Initial achilles rehab program

I started my initial physio ‘Achilles rehab’ program as prescribed on April 9th.

The exercises were prescribed for me daily, so I did them every day, each session taking about 20 minutes to complete. I also needed to record down how easy each item was to complete, and how much pain or discomfort I noticed in each.

It’s worth noting that the item which seemed most relevant is the The ‘eccentric calf raise with support’ (at least to me). This is essentially an eccentric ‘heel drop’ style exercise, where I stand on a bit of a ledge, and raise up on both feet (to make it easier for the ‘raise’) and then:

• Hold at the top of the raise on one for for 3 seconds
• Lower down slowly to foot level for 3 seconds
• Hold at bottom ‘level’ position for 3 seconds
• Repeat

I did notice discomfort on the ‘heel drop’ exercises from time to time, and some days I could feel a bit of discomfort in the right achilles even just simply walking around at home.

The physio also cleared me to continue running, albeit starting off that week with very easy / low miles to begin with, and on a controlled surface and route. This would be to eliminate as many variables as possible if I felt any issues 24 hours following any runs. He asked me to try keep it as ‘flat’ as possible, though that is difficult here in Pembrokeshire.

I found the perfect trail loop close to home though – 2k loop on mixed ‘fell’ and stone trail, with about 45 meters of total elevation gain and drop on each loop. I started off this first week running most days but only doing 2 x 2km loops (4km total).

The following week I progress to 2.5 loops, so about 5km each day.

Physio follow up session

After two weeks or so, I had a follow up session. I hadn’t noticed any major pain, only feelings of what I would call 0-2 out of 10 on a pain scale. From what I’ve researched myself, with achilles issues, this sort of pain level is absolutely fine and means you’re staying within a safe range of load. The key being that tendons need some load, but not too much in order to better rebuild themselves.

This session at the physio went well, but we also discovered some interesting deficiencies in power output between my left and right leg.

The physio was happy for me to continue doing what I had been doing, and upgraded me to a new rehav program, progressed, and also added in some plyometric movements.

Performing various hops and jumps (both legs and single leg) on his floor pad equipment, the computer registered fairly significant weakness on my left leg in the Single Leg Hop Test.

My left was registering 5.3cm and right 6.8cm. On average, 1.5cm less on the left. The same happened on single leg jump tests, with a left score of 0.16 m/s and right of 0.18 m/s.

I think this is why he added the plyometric exercises in to the program.

Moving into week 3/4 of rehab

I continued with the progressed rehab program, but found the plyometric exercises to be quite taxing on load on top of running (slowly increasing my weekly miles). So I’ve stuck to a habit of alternating the days I do the plyometric movements.

The single leg wall squats also cause some discomfort in my left patella / or area just below the knee cap, so I’m also trying to find a way of improving that.

My miles have been slowly increasing though, with no major discomfort appearing the days following my runs. I’m still doing on average 5 x runs a week.

Week 5 of rehab

I’m now around 5-6 weeks into the program after my initial physio consultation. The last two weeks I’ve averaged:

• 60-65km a week of running (90% on trail)
• 1000-1500m of weekly vert on runs
• 2-3 hours of rehab and strength + conditioning work

One run was a 25k run with 1000m of vert, which I was very pleased to have completed with minimal niggles and soreness the following day (just a bit of doms in my quads).

Watching those stats

I’ve learned in the past not to “stat watch” or rely too much on technology to tell me how I’m doing (thanks Jack!), so I do take these with a grain of salt, and tend to trust my own body more. However I found it interesting how “performance statistics” can decline when reducing volume and intensity:

• Since February (last 3 months), my Garmin ‘Endurance’ score has dropped by 1000 points. It tells me ‘you’ve lost endurance, however your score is still strong’.
• Similiar time frame, I’ve lost 1 or 2 points of VO2 Max.
• My hill score and hill endurance scores have slightly declined
• My legs are feeling stronger though, I think being consistent with physio and rehab has improved things there.

Running and Adventure plans to come, plus training methodology

I have a 100 mile event (the Rollin’ 100) in Shropshire at the beginning of July.

It would be nice to be able to complete the whole course, so my aim has been to build slowly up from this setback, and I’m trying to now incorporate one long run in each week. I did a 27km run two weekends ago, and the 25km, higher vert run last weekend. So far, so good.

I tried a faster VO2Max session about 1 week ago (a norwegian 4×4 session), and whilst I performed it well (on my class 2km trail loop), I could feel some aching in my achilles area the day after, so for now my thinking is I should just ‘play it safe’ and stick to base/endurance/aerobic running, with some tempo sprinkled in as well as a weekly long run.

I also have a time goal in mind for the Rollin’ 100 mile race, so that is a secondary goal of mine.

After the 100 mile event in Shropshire I am booked in with a few friends to fast pack / run the Tour du Mont Blanc (TMB) at the end of July. We’ll be covering about 35km a day.

If I can survive Shropshire’s 100 mile, then I plan to basically just rest and recover for the remainder of July with some simple, easy running if anything, maybe some time-on-feet hiking, and then just rely on residual fitness to get me by the TMB.

More achilles related notes and the psychological effects of injury

Achilles niggle notes

Something I was worried about each morning is the stiffness in my achilles / legs, and worrying about ‘microtearing’. One thing I’ve come across in my various research is that the gentle stretch in the morning is more of a way of clearing fluid build-up between the achilles tendon fibres, and its not necessarily microtearing happening. I’ve been binge watching the Treat My Achilles youtube channel, and they appear to emphasise that this is what is happening and its nothing majorly concerning to worry about.

Pain scale to determine activity – according to “Treat my achilles”, anything below a 3/10 on the pain scale is what would often be referred to as a ‘niggle’ and is generally OK on the road to recovery.

This aligns with what my physio told me, which was: “if you notice a a small amount of pain or a niggle the day after your rehab or running, this is fine, as long as it subsides quickly and doesn’t linger longer than 24 hours or so”.

Off Strava and the psychological effect

Although I’ve pretty much continued running soon after my initial achilles pain in early April, I’ve kept all my activity on Strava at my default setting of ‘Private’. I might move back to ‘public’ again soon, but I found while worrying about my injury, opening Strava was not good for my mental health. I would get frustrated seeing other friends’ running activities and longer runs, when I had to be very diligent about keeping to specific running loads.

Staying off Strava helped me focus on being diligent and just enjoying the process of being able to run, even if just for short periods of times. It’s certainly helped me build a renewed appreciation for being able to do what we enjoy doing.

Some photos out enjoying easy runs, hikes back in Wales

Shoutout to Keeponrunning

I’m also happy to say that Catrina’s findings on achilles recovery, titled “8 things that helped me with my achilles injury” seem to very closely align with what I am doing, and what my physio has recommended. Thanks for your article Catrina! I have already re-visited it a couple of times, once in February and again recently, comparing notes and differences.