Return of the a Achilles tendinitis

[The Fat Coyote]

Im with you PT guys. PT is where its at. I have stopped using the BPC 157 and TB500, I can't say if it helped or not. After using it i definitely did no have any pain in my Achilles-or i should say any discomfort was reduced by almost 90%. I got myself a stationary bike and started riding in the morning. going on two weeks now. No BPC injections and the pain is still gone, i feel like i am starting to heal albeit slowly. More updates to come

 

[flyfisher117]

Im with you PT guys. PT is where its at. I have stopped using the BPC 157 and TB500, I can't say if it helped or not. After using it i definitely did no have any pain in my Achilles-or i should say any discomfort was reduced by almost 90%. I got myself a stationary bike and started riding in the morning. going on two weeks now. No BPC injections and the pain is still gone, i feel like i am starting to heal albeit slowly. More updates to come

My doctor won't sign off on PT. He told me I am not doing the stretches well enough. Off to find another Doctor to see if he will sign off so I can go to PT.

I will be stopped by the Mtn Physio booth at Western Hunt expo and picking his brain. I see he has a new app launching so maybe that will be worth investing in.

 

[flyfisher117]

Update, Achilles has a small tear or 2. Get to wear Das Boot for a few weeks to see if it will heal up.

 

[The Fat Coyote]

*UPDATE* Hey Rokslide achilles homies. I am going on 5 months now with this. I have given up on BPC 157. I'm not saying it isnt effective, but finding a legit vendor is a gamble, and in the mean time who know what you will be injecting into your body. When you order BPC 157 peptide there will be a warning on it *not for human use* so you use whatever it is at your own risk. I did nasal spray, BPC 157 + TB500 for a month, and it dried out my sinuses to the point where i had to stop. I switched over to injecting subcutaneous at the site of injury. Did this for 4 weeks with no improvement.

I should explain, the pain did go away. Whether it was from the BPC or from 3 months of not running, I can't say. The rupture is still visible.

I spent two weeks (after giving up on BPC) massaging my Achilles before bed with a mix of Volteran and Arnica gel. I don't know if its the compound or the massage that helped, but it helped the rupture physically shrink. While does massage, i would have days where my achilles pain came back. so I stopped doing the massage.

I should preface that I did eccentric heel drops for 3 weeks before starting BPC with absolutely zero improvement, it actually hurt me more to walk around.

Here it is now nearly 5 months out- i took up cycling, I run maybe once a month for short 5 mile runs. But cycling every few days on a stationary bike, and ive seen the biggest improvement. The tendon rupture is much smaller (still there however) and pain is 2-3 out of ten maybe one or two days every 14 days.

Things I havent tried that I am curious of is standing calf contractions. There literature that says these are ineffective but I have found that whats prescribed to the masses doesnt always work which is why there are anecdotal support for alterantive treatments.
I started wearing 0 drop shoes (altras) which in the running community is an absolute no-no if you have achilles injuries. I tried all the high drop, rocker, non rocker, shoes prescribed by the doctors of running and they all hurt me more in the long run. walking around in Altras and barefoot I have found to really be beneficial at very least to the amount of pain I feel. I posted this on reddit on a few injury and shoe geek forums, and the reply i got is "everyones different" what doesnt work for the masses might work for you.

Ive read rest doesnt help the achilles injuries, but I have been relatively inactive this past month, working more and having less time to exercise, and my achilles is feeling better and better. The combination of the zero drop shoes, more time barefoot, and rest, with an occasional day of hard excercise seems to be working the best. I can physically see the rupture getting smaller.

I hope this helps some of you guys. This is a super shitty injury to have. I hope all of you guys find something or some path to help you get to where you want to be. I am still dealing with this injury but i have more hope than ever that it will heal.

 

[Marbles]

I had and achilles/soleus junction strain (so not really tendonitis), I continued to build running distance, but started doing isometric calf raise with load for 45-60 seconds, then added heavy calf raises (325 lbs) for 3 sets of 5 once a week. No more issues for me.

If the tendon injury is close to the heal, dropping the heal below the toes will cause compression of the injured area, making it worse.

 

[The Fat Coyote]

I had and achilles/soleus junction strain (so not really tendonitis), I continued to build running distance, but started doing isometric calf raise with load for 45-60 seconds, then added heavy calf raises (325 lbs) for 3 sets of 5 once a week. No more issues for me.

If the tendon injury is close to the heal, dropping the heal below the toes will cause compression of the injured area, making it worse.

Thats incredible, the alfredson protocol is eccentric heel drops solely to strengthen this area and it made my injury so much worse. I believe youre on to something- i will try your PT method and see if it helps. contractions have seemed to help more than eccentric....so an isometric contraction only makes sense.

 

[Marbles]

A good starting point is a single leg isometric calf raise, you should be starting to shake by the end of 45 seconds. I rested each calf for 3 minutes in between and did 5 sets per calf total (switching legs, so about a 2 minute rest).

 

[The Fat Coyote]

A good starting point is a single leg isometric calf raise, you should be starting to shake by the end of 45 seconds. I rested each calf for 3 minutes in between and did 5 sets per calf total (switching legs, so about a 2 minute rest).

thanks man! Thats giving me more hope with a plan to rehab. ill give it a try

 

[TNRB]

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.

This was (one of) my root problems with Achilles and plantar issues. For me, finding things that provided relief gave me hope in the process. Really helped me mentally to not give up and keep trying after years of just being told to stop activity and take injections.
I second the importance of a good PT. I found a good one before my last knee surgery. He is my first stop after any injury.

 

[180ls1]

My doctor won't sign off on PT. He told me I am not doing the stretches well enough. Off to find another Doctor to see if he will sign off so I can go to PT.

I will be stopped by the Mtn Physio booth at Western Hunt expo and picking his brain. I see he has a new app launching so maybe that will be worth investing in.

F that clown. Seriously. Get a different Doc.

Keep trying different PTs as well. That app may be cool but you should be working with someone who can see you, your body and get hands on you.

My achilles issue was caused by hip misalignment FYI.

 

[ztc92]

My doctor won't sign off on PT. He told me I am not doing the stretches well enough. Off to find another Doctor to see if he will sign off so I can go to PT.

I will be stopped by the Mtn Physio booth at Western Hunt expo and picking his brain. I see he has a new app launching so maybe that will be worth investing in.

I am a family doc with a fellowship in sports medicine. Achilles tendinopathy (note - NOT tendinitis) is one of the bread and butter things we treat as sports docs. I have so many thoughts after reading this thread, here goes.

1) In my opinion (though most research supports this) and medical provider that doesn’t allow you to get care with a PT is someone you should never see again. Many years ago, doctors viewed PT as guided exercises and old-school docs (like yours it seems) often fail to realize that modern PT’s have a doctorate level education involving 4-years after college and thousands of hours with patients. In many states they can order imaging and in some states they can practice some aspects of medicine independently. A well-trained PT likely will be the most adept at diagnosing your issue using a physical exam (hands on evaluation) and you are greatly limited by not involving a skilled PT (even if this is due to your doctor putting up barriers).

2) In many states, PT’s can provide a screening evaluation without a physicians order and then based on that screening, the PT or the patient can request the doctor approve PT. Sometimes this helps justify PT to doctors who don’t understand it’s value or insurance companies that don’t want to pay.

3) The alfredson protocol linked earlier is what I give to patients who decline to see PT. It’s not perfect, but it’s the best evidence based home exercise program for Achilles tendon issues. As others have said, there is some nuance to the cause, location and severity of the tenoon injury that could make this more or less likely to work. Once again, this is where a good PT can help guide you through an appropriate rehab program.

4) If all of the above doesn’t help or you want to take the next step sooner, I would strongly advise seeing a sports medicine physician or potentially a sports medicine orthopedic surgeon. To name a few things we often do for Achilles tendon injuries that you haven’t yet done (based on the thread so far):

- Diagnostic ultrasound. We use an ultrasound machine to evaluate the health of the tendon and find the problem. Similar info to an MRI but far more affordable as it’s done in clinic and in some aspects, gives us more info than MRI since we can examine you and find sources of pain as we ultrasound. This would allow us to tell you where the tendon is thickened/disorganized/torn, identify any particularly painful areas within the tendon, and look for bursitis.

- Needle tenotomy, prolotherapy, and/or PRP injection. This could be its own thread but here’s the simple explanation. When you have chronic tendon pain, it’s usually due to the tendon being injured from overuse and being unable to heal faster than the rate of repeat injury. As others have mentioned, tendons have poor blood flow. In a needle tenotomy, we numb the tissue around the tendon and then stab it multiple times to make it bleed on purpose. The goal is to both re-injure the tendon in a new acute way that leads the body to mount a more robust response to heal it and also cause the tendon to bleed, potentially improving blood flow. Adding prolotherapy to this means we inject something irritating (such as sugar water) to get a more robust inflammatory response. With PRP we are injecting your own plasma that has been selected to have a high amount of platelets, which signal inflammatory markers that promote healing.

- Nitrous oxide patches: This is fairly new in the USA but has been used in other countries for decades. The nitrous oxide is a potent vasodilator so when a small patch is applied to the injured tendon, it can diffuse through the skin and improve blood flow to the tendon.

Feel free to PM if there’s anything I can help with that you don’t want to discuss publicly. Achilles tendon pain is a real bear to get over but it can be done with time and proper treatment!

Edit - Spelling

 

[ztc92]

The tendon rupture is much smaller (still there however) and pain is 2-3 out of ten maybe one or two days every 14 days.

Just want to call this out for you and others on this thread. The language we use really matters in medicine. I’m not correcting you to be picky or “right” but rather because it may impact the care you get if you describe your injury wrong.

Here’s a basic list of Achilles injuries:

- Tendinitis: Acutely inflamed from a recent stress or injury. Often a new or difficult exercise, poorly fitting shoes or other general issues that can cause inflammation. Tendon is usually swollen, red and warm as a result.

- Tebdinopathy: Term for poor tendon health. This is what most people with Achilles tendon pain actually have. Basically a chronic injury that has failed to heal. Usually tender in a specific area but not red or warm as there is minimal inflammation.

- Partisl tear: Some but not all tendon fibers are torn. Think of it like a fraying rope. As long as we prevent further damage, we can usually heal these with time and rehab.

- Compete tear (rupture): No fibers are left intact, the tendon is split in half. In the rope analogy, the rope has broken completely. This has to be fixed surgically as the tendon retracts towards the calf muscle and will never heal naturally in a way that is functional.

As you can see based on this, I think your use of the word rupture is incorrect and you likely have tendinopathy or a partial tear with thickening/swelling as the site of tendon injury.

 

[The Fat Coyote]

Just want to call this out for you and others on this thread. The language we use really matters in medicine. I’m not correcting you to be picky or “right” but rather because it may impact the care you get if you describe your injury wrong.

Here’s a basic list of Achilles injuries:

- Tendinitis: Acutely inflamed from a recent stress or injury. Often a new or difficult exercise, poorly fitting shoes or other general issues that can cause inflammation. Tendon is usually swollen, red and warm as a result.

- Tebdinopathy: Term for poor tendon health. This is what most people with Achilles tendon pain actually have. Basically a chronic injury that has failed to heal. Usually tender in a specific area but not red or warm as there is minimal inflammation.

- Partisl tear: Some but not all tendon fibers are torn. Think of it like a fraying rope. As long as we prevent further damage, we can usually heal these with time and rehab.

- Compete tear (rupture): No fibers are left intact, the tendon is split in half. In the rope analogy, the rope has broken completely. This has to be fixed surgically as the tendon retracts towards the calf muscle and will never heal naturally in a way that is functional.

As you can see based on this, I think your use of the word rupture is incorrect and you likely have tendinopathy or a partial tear with thickening/swelling as the site of tendon injury.

You know what man, I think youre right. I had read a few articles that bundled the terms "rupture" tendinitis, and partial tears all together. What i have is definitely not a complete tear so I will stop saying "rupture." i believe what i have is a partial tear.

Technically i probably should even say that without a proper doctors diagnosis.

Where I live, with the healthcare I have, I would have to schedule a doctors appointment about a month out, who would then refer me to a specialist which would be a few more months out, the healthcare in my area is pretty crappy so I try to figure it out on my own.

I appreciate being called out man, nothing gets me more than hearing exaggerations or things being portrayed inaccurately.

At this moment all i can say for sure is I have a bump on my achilles tendon about the size of a quarter, that points backwards, it use to point to 5 o clock, but rest and massage has it pointing back to 6 o clock. It hurts anytime i have to wear certain shoes/boots or anything touches it and i have to run (usually after my kids). BPC 157 didnt fix me and neither did alfredsons protocol, but riding a bike and being barefoot alot seems to be making it a little better.