Achilles Tendonitis

I've got achilles tendonitis at the moment, which was dismaying to hear until I learned that I could have achilles tendonosis, wherein the tendon begins to look "a lot like a long, thin piece of swiss cheese," says my PT guy (and 9:10 Ironman) Chris Ramsay, who's been helping me through this painful and frustrating process.

I'm not at the swiss cheese phase, and probably won't get there, Ramsay says, since I caught the tendonitis early. It manifested as a pain right where the line attached to "Achilles tendon" points, and seemed to get worse when I ran uphill. In addition to the pain the tendon swelled visibly. "Tendon inflammation tends to run its course in 10-14 days," Chris told me. "So if you take care of it you'll be fine in less than two weeks. If you get tendonosis, well, then you'll be dealing with it for months, or maybe forever." He ran some tests on me and discovered that I've got some weakness in my left ankle (and the hip muscles "of a 15 year old girl," but I'll write about that later) that's probably contributing to the injury. The other possible cause is a tale of three shoes, and it goes something like this: I was running in a year-old pair of Newton Distancia Racers which were getting pretty ratty. I began getting some knee pain, thought I probably had some IT Band issues, and promptly switched out of the Newtons to a pair of old, but lightly used, Nike Lunaracers. Soon my new Newtons showed up from Newton and I happily leapt into them. Chris thinks that I wore down the front lugs on my old Newtons so that they behaved more like normal shoes (Newtons have a very small heel to forefront "drop" due to those lugs under the frontfoot, but when you wear those lugs down the drop increases, turning your Newtons into a more traditional shoe where the foot slopes down from the heel). Having that larger heel—forefront drop takes some pressure off your Achilles tendon (although it's bad for a bunch of other reasons); point your toes—see how the Achilles loosens? Then I jumped into the Nikes, which, for all their close-to-the-road feel, still have about 7mm of heel-toe drop. My Achilles didn't notice a difference between the wore down Distancias and the Lunaracers. But when I started running in my new Newton Gravity Trainers (only 3mm of heel-toe drop) my Achilles had to lengthen by about 4 additional mm every time my left foot hit the ground. That began to stretch (and tear, slightly, the cause of any inflammation) the tendon. And here I am.

So now what do I do? Chris is working on my Soleus muscle (it's the less dominating part of your calf's musculature—look for the smaller inverted triangle that sits below and "behind" the gastroc, which is large and bulgy, like a biceps muscle) using active release therapy, which involves attacking adhesions (we call them "knots) in the muscles by applying specific pressure. You've probably heard of active release therapy. It is as painful (and effective) as you've heard, too. Adhesions are basically tiny cramps, little knots of muscles that can't stop contracting. To get them to loosen, Chris presses on them hard enough to cut off their direct blood supply. Cutting off the blood supply cuts off the muscle's oxygen supply (remember your high school A/P class?), and the adhesion needs oxygen to keep contracting/cramping. Eventually, the muscle gives up, kind of the way MMA fighters give up after dealing with choke/submission holds.

Remember, training stimulus damages your body. It's the only way we get faster and fitter: break down the body so it can build back up stronger. Only thing is that stuff (muscles, tendons) can get "crossed up" or "bound up" in the process. If you keep asking a muscle to contract, don't give it enough food or water or salt, and then don't cool it down properly (get in those ice baths, people) or stretch it back out, it's going to complain. What does complaint sound like?

Tendonitis.

Stay healthy. The only difference between those at the top and those just below the top is the ability to recovery.