Sore achilles tendon

Just been off the bike for 4 weeks because of Achilles. Initially started by running, but bike aggravated it. A dodgy pedal seemed to be the culprit for me. It allowed my foot to rock from side to side. What pedals do you use and how old are they?

I strained my AT doing too much hill running and aggravated a torn calf injury from skiing. Rest at first helped then I found and did these exercises - without the dumb bell bit! I felt a twinge after some hill reps a couple of weeks ago - rested for a couple of days then did the exercises again. Now I do the exercises regularly (twice a week) as a precaution and I also do Yoga. I always stretch my calf muscles before and after running/cycling as a precaution. I shuffled my way round the Slateman Triathlon last weekend expecting problems but had none (with my AT, plenty with my overall fitness!). I think you should be OK with some rest and then stretching/exercise. I'm not an expert but am a bit paranoid about this recurring again. Got the exercises off the Web, btw, so if the photos don't come through, you can get them via Google.

Good luck,

Psyko

CONSERVATIVE TREATMENTS FOR ACHILLES TENDINOPATHY
ECCENTRIC TRAINING (lowering of the heel)

Research carried out in 1984 (1) stressed the importance of eccentric training as part of the rehabilitation of tendon injuries. It was demonstrated that a six-week programme of progressive eccentric loading of the tendon was successful in alleviating Achilles tendon pain. During an eccentric contraction, the muscle elongates while under tension (whether this be the result of body weight or through added resistance), as it does during the lowering portion of a heel raise, when the muscle acts to decelerate or control the movement.

The above programme was subsequently incorporated into a 12-week programme of eccentric calf muscle training for painful mid-portion Achilles tendinopathy and scientifically evaluated by Hakan Alfredson et al (2, 3). Alfredson is a professor of sports medicine and an orthopaedic surgeon. This training programme requires the patient to complete the programme despite pain in the tendon. If and when the patient experiences no pain while carrying out the programme, the load should be increased until the exercises do cause pain – this sequence is then repeated.

It is reported that Alfredson’s programme is effective when other non-invasive conservative methods have failed (see list above). It is successful in 90% of patients with mid-tendon pain and pathology. Patients with Achilles pain at the tendon insertion do not respond as well to this programme; however, good results are nonetheless achieved in around 30% of those with this type of problem who complete the programme.

THE BEST WAY IS DOWN

Other eccentric training programmes for the treatment of Achilles tendinopathy are reported to have been successful but they have not been subjected to the same rigorous evaluation as the Alfredson programme. Results of surveys have shown that heel-raise (concentric) training programmes have not proved nearly as effective as heel-drop (eccentric) programmes.

Picture 1
Alfredson’s painful heel-drop protocol
Number of exercises: 3 x 15 repetitions
Frequency: 2 x a day, 7 days per week
Technique: There are two versions of the exercise: one is performed with the knee straight – see picture 1 (activating the largest calf muscle, the gastrocnemius) and the other with a bent knee (activating the soleus) – see picture 2.

Important – remember, each time the active (affected heel) is lowered, you should use the unaffected leg to raise the injured foot back up onto its toes prior to the next repetition.
Use your hands/arms to stabilise your body prior to and during each repetition of the exercise.

Picture 2
** In the photographs the athlete performs the exercises in both the straight knee and bent knee version. Note: the heel is in the lowered position in both photos and, out of view, the athlete is holding onto a training partner for stability.
1. Straight knee gastrocnemius drop – The patient begins with the heel raised and the knee fully extended (the leg is straight). He or she then lowers their heel so that the foot is parallel to the ground.

2. Bent knee soleus drop – The patient again adopts a position on the edge of a step, with their heel raised, but this time the knee of the active leg should be flexed at 45 degrees so that the soleus muscle is engaged. The patient then lowers their heel so that the foot is parallel to the ground.

Progression: Do the exercises until they become pain free, using body weight. Then add load, via a barbell or dumbbells, until they are painful again. Progressively add load up to 60kg.

I've done the "Eccentric" exercises before, as described above. They work. I have an achillies problem atm but it is so painful when moving atm I am waiting a few days before starting the exercises

Thanks for the welcome - I hope the exercises help.

Cheers,

Psyko.