I need some insight, feedback, advice regarding Achilles tendon pain.
I’m working through some Achilles tendonitis (self-diagnosed) that was brought on after a hard ride back on April 20th. I think high-force low-cadence repeats caused it.
I’ve been on and off the bike since doing very easy rides and was able to do a 2 hour Z2 ride on Sunday with no ill effects. However, today (17 days post-injury) I pushed it too far and did some high sweet spot/threshold efforts in the 5-8 min variety and felt quite a bit of soreness after the ride. I have Almanzo on May 18th so this was more or less a test ride to see how things felt. Soreness confirmed.
For the last 3 days I’ve been following this protocol, and I felt improvement—but have since screwed that up with my hard ride today.
For those of you who have experienced similar issues, was there anything you found helped your recovery? How did you deal with the mental side of being sidelined?
I’m afraid that a long stint of zero cycling is in my future so I’m processing the inevitable decline in fitness that was fought for over the last 12 weeks of training as well as having to withdraw from 3 planned gravel races and fight to salvage what’s left of the year.
You might want to get the following checked/adjusted:
cleats
saddle height
Everyone I know including myself who has dealt w/achilles tendonitis in the last couple years were able to ride pain free, but unable to run. Riding was our fitness saviour. Ride easy, but only if it is pain free. Until then, eccentric calf-raises!
I’ve just come out the back of this, caused by going too hard too soon with running but guess it’s pretty similar. Went to see a physio and it was successful, so thought I’d share what he said/prescribed:
firstly assess how bad it is - is it stiff in the morning, does it hurt to walk etc. if it hurts in a “normal day”, I was advised to rest it/ice it until that stopped. mine wasn’t too bad thankfully so was able to go straight into rehab
one legged eccentric calf raises, aka heel drops. prescribed to do 3 sets of 12 reps of both straight leg (targets gastrocnemius) and bent leg (targets the soleus). will likely require building up to this from a strength perspective, but then once you can do that and have no pain afterward, look to add weight (I used a dumbbell in one hand). did this 3 times a week, and aiming for “controlled” descents - say 2-3seconds per rep.
stretching - again straight leg and bent leg stretch to target both calf muscles, hold for at least 1min, and also foam rollering the calf - apparently a tight calf puts alot of stress through the tendon as the calf transfers the loads directly through to it rather than soaking them up itself)
unfortunately it’s one of those that I found you need to continue to hit until way after the symptoms have stopped, otherwise they come back pretty quickly! in addition, I’ve tried to incorporate it into the weekly regime to prevent it coming back going forward. my experience was any sudden increase in training volume causes it to flare up, so need to keep consistent
hope this is useful - obviously not medical advice just my experience here.
I gave up running 10 years ago due to Achilles tendonitis that had calcified around my heel. I picked up a bike and never looked back. I’ve never had any pain from cycling so am a bit surprised to hear that you are unless you are also a runner.
When I was in physical therapy, main goal was to rid of the inflammation. I think some anti-inflammatories, massage (if you have a partner). After the inflammation goes down, some light stretching for a bit and then later some exercises as these folks are describing.
You may want to check your bike fit as I can’t see how you tweaked it on a bike.
Here is a great link which matches up with what my orthopedic said as well as my own personal experience w/the eccentric calf raises being the solution.
I’ve never had an achilles issue due to cycling, always got them from playing sports in high school, but never have I had a cycling related issue. Some of the literature I’ve read states that cycling doesn’t put a lot of force on the tendon so it does seem odd. Regarding bike fit, I’m confident bike fit is not to blame due to the fact that I’ve logged good mileage (as well as 3 years of training) with no issues. I have since adjusted cleat positioning by moving them toward the heel of the shoes as well as dropped the seat a few cm.
I did some high force seated hill repeats during the ride that triggered this and I’m guessing those were to blame.
Now I’m just trying to determine if ANY cycling is going to further damage or if I can ride at low wattages so long as I’m not sore after the ride.
“The most common type of Achilles injury is paratenonitis. This injury represents an inflammatory reaction in the outer sheath of cells surrounding the tendon. The inflammation results in a visible lump that forms about two inches above the Achilles attachment. This mass represents localized thickening of the paratenon in response to microtrauma.”
This is exactly what I’m experiencing. Slight lump and puffiness about 1.5-2" above the heel and visibly thicker.
I wore it all the time during waking hours and continued to ride and race (with the brace). Admittedly, the training rides were a bit painful, but not the racing (maybe the adrenalin rush?). Post ride, I would soak my achilles in a bucket of ice water to bring down the inflammation.
By the end of summer, it was healed enough that I was able to stop wearing the brace.
It seems like the only thing that will make it better is time and reducing any activity that will aggravate the inflammation, which is any walking and riding. I really didn’t want to abort my road season if I could help it, so I powered through training with the brace. I was prepared to abort the subsequent CX season if my plan didn’t work and it wasn’t healed. Admittedly, from a healing perspective, continuing to train and race was probably counterproductive, but it didn’t seem to get worse and eventually healed in time.
I think I would follow the same protocol again (brace + ice bucket)
Often the true cause is the calf muscles. They tend to tighten causing the achilles to be strained. Avoid low ramp shoes, try to not walk barefoot until it clears up. I used a rolling pin to find and dig out adhesions in the calf muscle which helped. Once I actually targeted the culprit, which was a very deep muscle in the calf, I had an acupuncture session of over an hour on that muscle and it has disappeared for 2 + years now. Ease the strain by ramping up the shoe choice and aggressively treat the muscle to loosen it to reduce pressure on the tendons.
I’m happy to report that the eccentric calf raises have been helping and the puffiness and inflammation has been greatly reduced. However, I’m still very eager to return to cycling, but realize I need to take it very slow.
At what point did you feel like you could start integrating rides back into your rehab protocol? I would hate to go too hard again and re-aggravate a healing tendon only to find myself back at square one.
Keep doing the eccentric calf raises. Build up the number of reps you can do, which should come naturally and quickly as you get used to doing the exercise. Per the link I provided above:
In a recent study evaluating tendon resiliency with different strengthening protocols, researchers from Taiwan discovered that high-level athletes have no change in tendon resiliency unless they perform 4 sets of 80 repetitions.
It took a few weeks before I could do 4x80. Slow and controlled. I I would count 1 up and 5 down. Keep icing as well.
As for riding, until you are able to walk pain free, I would not ride. When you can ride, it needs to be pain free as well and thus most likely very easy for a while yet. In the meantime, try to figure out what caused this? bike fit? shoes? cleat position? sudden change in intensity or volume? etc…
Again, this is based on my own personal experience. Best of luck. Be patient.
p.s… I did not do 4x80 all at once. I would break it up into 4 different sessions over the course of the day. After each session, I would also ice for 10-15min.
I had achilles tendenosis/tendinitis issues when I was a runner. After I quit running and started cycling my heel pain went away.
It does not seem that Cycling loads up the Achilles tendon’s very much.
I am surprised that it irritates your achilles that much.
I am sorry to read you have this injury.
Amazing how much fatigue resistance and strength I’ve built up in just 3 days of 3x15 2x/day.
I don’t know if I’d call myself a high-level athlete, but I will work up to 4x80. Would like to know if in that study the subjects were knocking out 80 continuous reps…that would be impossible right now. I can get to 20-25 before form degrades.
Right now I can walk, and even job without any immediate onset pain. Pain is really only produced when I do sustained sweet spot or harder efforts on the bike and shows up AFTER the ride is over. There has to be some sort of load or stretch being put on the tendon at the bottom of the pedal stroke that is causing this. I’ve lowered my saddle 1/2" and have moved cleats back toward heal in hopes that when it comes time to ride hard again it won’t flare up. In terms of training load, here’s a peak at my TR calendar:
The injury occured on April 20th which was my first long outdoor ride of the year. Otherwise I have carried a decent workload into the spring with no issues. Raced cross last season with the same bike and cleat setup and had no issues there either.
Exactly. I’m surprised this has happened. I played sports in high school and would get sore Achilles tendon(s) from time to time, which I was accustomed to with all the running. They would heal much quicker than this one is. I’ve read a couple of research papers on the biomechanics of cycling and loads put on the tendon and it sounds like it’s not that much. Running is where the tendon sees tremendous loads so it makes sense that runners have issues.
Perhaps the high-force hill repeats I was doing was just too much…I don’t do a lot of that work outdoors.
Thanks. Rehab has been ok thus far. I’ve been following increasing weight and reps on my eccentric heel drops and am now doing 3x30 with 35lb of added weight. However, I’m no where near 100%, but I was able to complete a 3hr endurance ride last weekend with minimal soreness after. I still cannot ride at an intensity above low tempo though. Feels weird to toot around at endurance watts day after day…one upside is that I’m building a decent base. Nothing else though.
It seems as though getting back to full strength is going to be a season-long effort.
I do not have achilles tendonitis but do have peroneal tendinitis. I was pretty worried bout it as it came out of the blue. I did two sessions of physical therapy and while not ground breaking, the massage they did along with dry needling helped a lot. I am back on my bike doing all out sprints and long rides with no issues. I’m doing my exercises as well and that really does seem to help.
I also have weak ass hips.
Is that in the opinion of a medical professional?
I actually agree with your advice. Unfortunately, I’m one of those people that have had terrible experiences with PT’s over the years. I actually doubt that many of the PT’s I’ve been to could be classified as medical professionals.
A PT is not the be all and end all. You’re better off consulting an actual specialist and educating yourself before expecting a PT to fix your problems.
Too many PT’s like to pretend they can perform an MRI based diagnosis without the MRI and specialist involvement.
I like the advice and links provided in this thread. They are on target for my situation. They also follow the same theme as the advice from my PT in regards to this ailment.