Return of the a Achilles tendinitis

[Jtb.kfd]

My brother just went through 6 months of what you are describing. I had been telling him about the carnivore diet for over a year and he said it wasn’t for him. In September, after going through PT for months, seeing a foot specialist who made custom orthotics and trying every stretching regimen known to man he starting researching inflammation as that is what his doctor told him was the cause of the inflamed tendon. He kept finding articles on the carnivore diet, he then started watching Dr Ken Berry’s youtube videos on inflammation and gave in. He started carnivore the first week of September this year, by the 20th of the month he said the pain had almost completely subsided. By elk season in late October he said he felt 20 years younger and had zero pain. If you get to a point where you are done and nothing else works, I would highly recommend trying carnivore for at least 30 days, preferably 60. You would be amazed at how much different you felt.

 

[flyfisher117]

PT here. Yes, I believe seeing a good PT for an assessment is well worth your time. Treatment for Achilles tendonosis varies depending upon the individual's presentation. For example, stretching when your pain is primarily at the insertion (back of the heel) will often make the pain worse due to compression. Mid tendon problems may respond better.

Bottom line is your Achilles is currently unable to handle the stress/load it is undergoing on a daily basis. The key to success is finding a way to control the load at the same time as you work on increasing it's ability to handle stress (i.e. strengthening). Brief rest may help some in controlling the acute symptoms, but prolonged inactivity only leads to weakening of the tissue and decreasing it's ability to handle load.

Get some professional advice. A good PT can likely help you develop a plan to address the issue and get you back in the game.

Thanks. Side question. Should any decent PT be able to assist or are some PTs better than others at specific areas? Just curious if I should try and find a specific one or just use the PT office attached to my gym. Hoping to give them a call this week.

 

[Poser]

My brother just went through 6 months of what you are describing. I had been telling him about the carnivore diet for over a year and he said it wasn’t for him. In September, after going through PT for months, seeing a foot specialist who made custom orthotics and trying every stretching regimen known to man he starting researching inflammation as that is what his doctor told him was the cause of the inflamed tendon. He kept finding articles on the carnivore diet, he then started watching Dr Ken Berry’s youtube videos on inflammation and gave in. He started carnivore the first week of September this year, by the 20th of the month he said the pain had almost completely subsided. By elk season in late October he said he felt 20 years younger and had zero pain. If you get to a point where you are done and nothing else works, I would highly recommend trying carnivore for at least 30 days, preferably 60. You would be amazed at how much different you felt.

Yeah, I was going to ask about diet. A lot of folks do find inflammatory relief from cutting or eliminating sugars/carbs whether that is going full carnivore or Keto diet or similar.

Stretching won't do much of anything to help with inflammation. I'd cut those box step up/downs, even stepping down gently, for at least a while. Stepping down and loading the achilles can be quite deceptively stressful on the achilles -not a problem for people who don't have an inflamed achilles, but in your case, I'd chill on that for awhile while addressing the inflammation. What your describing about not perceiving pain/discomfort while performing exercises, movements/training is very common so if you finding correlation between doing X movement and increased inflammation 24-48 hours later, cut that catalyst out for a while. While I'm not suggesting you lay around for 3 weeks, you have to get over the inflammation "hump" to start making progress.

 

[PTArcher1]

Thanks. Side question. Should any decent PT be able to assist or are some PTs better than others at specific areas? Just curious if I should try and find a specific one or just use the PT office attached to my gym. Hoping to give them a call this week.

Just like any profession, some PT's are better than others. I would look for someone that deals primarily with an orthopedic/sports type clientele and promotes an active rehab process. Those pushing the ultrasounds, estim, laser type approaches are just not practicing in today's evidence based world. Sounds like the office attached to your gym could be a good starting point.
Good luck. Even with the best PT advising you, this process will likely take at least 3 months. And no, you should not be in active PT nearly that long, but will need to be willing to commit to a daily regiment of exercises.

 

[PTArcher1]

Yeah, I was going to ask about diet. A lot of folks do find inflammatory relief from cutting or eliminating sugars/carbs whether that is going full carnivore or Keto diet or similar.

Stretching won't do much of anything to help with inflammation. I'd cut those box step up/downs, even stepping down gently, for at least a while. Stepping down and loading the achilles can be quite deceptively stressful on the achilles -not a problem for people who don't have an inflamed achilles, but in your case, I'd chill on that for awhile while addressing the inflammation. What your describing about not perceiving pain/discomfort while performing exercises, movements/training is very common so if you finding correlation between doing X movement and increased inflammation 24-48 hours later, cut that catalyst out for a while. While I'm not suggesting you lay around for 3 weeks, you have to get over the inflammation "hump" to start making progress.

I agree with you that adhering to a better diet would likely offer some benefit to essentually all of us.

With regard to inflamation and an Achilles issue, that is just not the case. Long-term Achilles problems are not infammatory problems. That is why the term Achilles tendonitis is not accurate. These type of long-term issues are more degenerative in nature-thus the accurate term Achilles tendonosis. Trying to treat it as an inflammatory condition, using things like meds, injection, ice, rest, etc., typically leads to further degeneration and weakening of the structure.

 

[Winnie]

I have had it twice. My underlying cause was my hips were rotated and causing issues. I remember the day I casually mentioned it to my chiropractor and he said that one cause can be your hips....lets check. I walked out of his office with noticeable improvement. Probably not your cause, but thought I would mention it.

 

[Poser]

I agree with you that adhering to a better diet would likely offer some benefit to essentually all of us.

With regard to inflamation and an Achilles issue, that is just not the case. Long-term Achilles problems are not infammatory problems. That is why the term Achilles tendonitis is not accurate. These type of long-term issues are more degenerative in nature-thus the accurate term Achilles tendonosis. Trying to treat it as an inflammatory condition, using things like meds, injection, ice, rest, etc., typically leads to further degeneration and weakening of the structure.

Would you consider this to be truly "long term" though? I know he said its been a problem for a year, but achilles tendons often take quite a long time, often some amount of of months, to heal and its unclear whether he's reinjured/intensified/or prolonged the injury.

My experience with these types of injuries on people who are extremely active is that the trajectory often involves them making the initial injury much worse within 1-3 months due to improperly addressing it and then, after experiencing more severe consequences, they'll back off allowing some healing. From there, some/many folks are prone to pushing it too hard as soon as they experience some level recovery and enter a more prolonged state of injury. While I'm no expert, I've also known people to experience bursa inflammation that results in what they perceive as pain in the achilles tendon.

I've never experienced anything more than minor tweaks in the achilles myself, though I have been the same room on 2 occasions where people managed to blow an achilles tendon and both times, the culprit was box jumps. Its a shockingly loud sound.

 

[PTArcher1]

Would you consider this to be truly "long term" though? I know he said its been a problem for a year, but achilles tendons often take quite a long time, often some amount of of months, to heal and its unclear whether he's reinjured/intensified/or prolonged the injury.

My experience with these types of injuries on people who are extremely active is that the trajectory often involves them making the initial injury much worse within 1-3 months due to improperly addressing it and then, after experiencing more severe consequences, they'll back off allowing some healing. From there, some/many folks are prone to pushing it too hard as soon as they experience some level recovery and enter a more prolonged state of injury. While I'm no expert, I've also known people to experience bursa inflammation that results in what they perceive as pain in the achilles tendon.

I've never experienced anything more than minor tweaks in the achilles myself, though I have been the same room on 2 occasions where people managed to blow an achilles tendon and both times, the culprit was box jumps. Its a shockingly loud sound.

Yes, I do believe it to be long term. What I believe you are describing is an acute flare up of a chronic condition.

An example would be someone has an injury, it hasn't adequately resolved prior doing something to further stress it again. So now their chronic problem has been acutely exacerbated. This stress and a period of relative inactivity due to the pain, etc. then leads to further degeneration and weakening of the tendon matrix. There is often a continued pattern of rinse and repeat.

If the problem persists and is within the tendon itself, you will often see a significant thickening of the tendon, with this area being quite tender. If it is at the insertion on the heel, it can manifest itself in bone spur development ( Haglund's deformity) and/or a retrocalcaneal bursitis. Once you reach this stage, it can be very difficult to overcome with non-surgical means.

So, the key to halting this progression is to develop a plan of strengthening the tendon via exercise while at the same time controlling the forces thru the area to avoid an acute flare up. Exercising thru some level of pain is fine as long as that doesnt worsen the pain the following day and prevent continued exercise. It truely is a balancing act and is why seeing a professional, at least initially, to develop a good plan is key.

 

[ETtikka]

This is the only thing that would help me, the first exercise in this link. Actual calf raises will aggravate any level of tendinitis but reverse calf raises seem to help

 

[Sioux33]

The eccentric calf raises were what healed my Achilles tendinitis. Lasted over six months, but once I started these, it was a game changer. Really focus on controlling the drop of your heel slowly and stretching the Achilles on the bottom.

 

[flyfisher117]

Yeah, I was going to ask about diet. A lot of folks do find inflammatory relief from cutting or eliminating sugars/carbs whether that is going full carnivore or Keto diet or similar.

I won't pretend to eat the healthiest but my diet is already fairly clean. Not interested in Carnivore and I've looked into Keto just never explored it too far. Focusing on high protein, good macros, everything in moderation etc.

I have had it twice. My underlying cause was my hips were rotated and causing issues. I remember the day I casually mentioned it to my chiropractor and he said that one cause can be your hips....lets check. I walked out of his office with noticeable improvement. Probably not your cause, but thought I would mention it.

The wife wants me to see a chiropractor for other things so I have considered it. I may run it by the PT when I get in there. The doctor had me put a lift in the shoe of the hurt ankle. That little bit of a misalignment was not friendly on the back.

This is the only thing that would help me, the first exercise in this link. Actual calf raises will aggravate any level of tendinitis but reverse calf raises seem to help

So the normal calf raises I have no issue
Eccentric calf raise or any activity that causes the heel to drop below the foot stretches the Achilles and aggravates it like none other. Pain is right at the top of the heel bone.