Running again: Coming back from Achilles tendinitis

I first noticed it nearing the end of a 30 km run back in March: my stride had become asymetrical. I didn’t like pushing off with my right foot, or landing on my right forefoot (as I deliberately been trying to do, to gradually convert to the barefoot style of running). I suddenly became aware that I had been running like this, asymetrically, for several weeks. But now, my heel hurt, and that pain brought my injury more into my consciousness.  It took a bit of googling for me to figure out it was Achilles tendinitis, and to try various treatments for it. And now, after most of four months off  running… I am back at it again!

Achilles tendinitis is an inflammation of the Achilles tendon. It seemed strange to me that I would suddenly develop it, when my heels have been fine for all the running miles I have put down these last two years. But, in retrospect, I think it was because I had been focussing on changing my stride, and especially my foot-strike, to the barefoot style of running (and also shifting to much thinner and harder-soled trail runners – I wasn’t using actual “barefoot shoes”). I think all that forefoot-striking, which causes more shock-absorbing and flexing in the heel is what set it off.

Free trail food!

The Achilles tendon is the tendon that runs down the bottom of your calf muscle, and connects to the back of the heelbone. Although I would feel some stiffness and tightening in my lower calf muscle when I was running (and during vigorous hikes during my recovery period), the actual pain that I felt was at the very back of my heel, over the heelbone. (Achilles tendinitis pain is not on the bottom of the heel – if you feel that, it is likely to be plantar fasciitis).

I’ll give a brief outline of what I did to recover from it:

First of all, I stopped running. Two days after that 30 km run where I clued in to what was going on, I tried a short little 40 minute jog. My heel felt OK starting out, but about 20 minutes in it started to hurt, and I could tell I was aggravating the injury. So I walked out, and laid off running until it was better – which turned out to be four months. I also took Ibuprofen (not every day – but from time to time when the pain was greater). Ibuprofen reduces inflammation, which can aid healing.

At first I thought that taking a two or three week break from running would be enough. Hiking uphill also aggravated it, so I limited my hikes to flatter terrain. To my surprise, even after weeks off running, it did not improve at all. I suspected that sitting sideways on the couch while doing my writing work (so my leg’s weight is on the back of my heel) was aggravating it, so I stopped sitting that way.

Dave and I were booked to run that 50 km ultra in late May, and I started to get worried about whether I would be ready for it. As the race approached, I could feel that my heel had improved, but it was not “better.” I decided to enter the race anyway (quite untrained!), fully prepared to drop out if it was hurting enough that I felt it was worsening the injury. To my surprise, it barely hurt for the first 25 km. In fact, it wasn’t bad for most of the race, other than the two big uphills in the second half. To my greater surprise, although my heel was very sore the day after the race, it improved to better-than-race-day the following week. Running that ultra seemed to have actually helped it.

Frequent stops to stretch my calf and Achilles tendon.

I laid off running again, happy knowing that Dave and I would be doing lots of biking in France in June and July, so I could start getting back in shape without aggravating the heel. But, even though I didn’t run at all in France, it went back downhill again. Some of our fast walks (either steep uphills in Nice and in Paris, or rushing for trains and planes with my backpack on) continued to aggravate it.

Around the end of the France trip, I started to tape it at night. I had done that before when I had plantar fasciitis, and I reasoned that the same logic would apply to this injury (which is a very similar injury above the heel to what plantar fasciitis is below and in front of the heel – both of them inflammations of a tendon that attaches to the heel bone). The theory is that when you sleep at night, with your foot extended, the tendon starts to heal in that position. Then, when you get up in the morning and stand on it, putting your foot at a right angle to your leg, all those fibres that healed break again (and that’s why both injuries are especially painful first thing in the morning, when you get out of bed). So, for about three weeks, I taped my foot at a right angle most nights while sleeping, so the tendon would heal in the right position. (Important note: I am not a doctor (well, I am, but I am a rock doctor, not a human doctor!) This experiment worked for me, but I actually think the best thing would be to see a doctor and ask the about the right way to tape. You definitely must be careful not to encircle any part of your leg or foot with tape or you risk cutting off circulation… and that is very very bad, you can end up having your foot amputated!)

Between the taping, and completely laying off any movement that made my heel hurt (fast walking, walking uphills, walking with a heavy pack), my heel finally started to heal! For the last two weeks, I have been starting to jog again. I started with short jog-walks, and have built up to 1.5 hour jogs with some walking (including steep hills!) and 45-50 minute runs.

Last week, a physiotherapist recommended to me an exercise to finish off the healing: eccentric heel raises. They hurt a bit to do (I am doing them with a heavy backpack). The idea is to work the heel hard, because tendons don’t have a lot of blood flow, and the increased circulation aids healing (I think this is why my heel improved after the ultra) – but it is important to remember that this is not an exercise to do with an early-stage Achilles injury; you will probably just worsen the injury. It is the final step, once you have done everything else, and the injury is 95% healed.

OK, like I said, I am not a medical doctor or physiotherapist. Nothing in this post is meant to be medical advice. I am just excited to be running again, so I am sharing what I did to recover from Achilles tendinitis. If your Achilles tendon inflammation is mild, you may be able to heal it on your own – but your best bet is to see your doctor, and figure out what combination of rest/exercises/taping/physio is best for you.

Hot day! Hot dogs! Hot me!

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