This is one of those classic examples of where you go to bed healthy one night, and wake up injured.
Apr 14 was a day like most others. Nothing especially out of the ordinary in the way of training. After our nightly dog walk I noticed my right heel was a bit sore and tender. Being proactive and wary of things like Achilles tendonopathies I packed it with ice before bed.
The next morning I could barely walk because the pain was so bad. Fuck!!!
Quick… to the internet! I found a promising sports medicine doctor who actually had an opening that very afternoon. How fortuitous. Or… was it a red flag?
They took some x-rays. Then when I see the guy. What does he do? Well… he shakes my hand! Covid? We don’t care about no steenkin’ Covid. I am wearing high top chuck’s. He doesn’t even look at my foot. “Ice” he says! Have a nice day.
I say “what about NSAID’s?” “Sure!” he says. “What about e-stim” says I? “No evidence that it works for this application” he says. Then..”why not?” “What about topical applications?” “Yes” he says. “You could try that” “There is this new stuff Voltaren that you could try” New? Well maybe here. It’s been readily available in the rest of the civilized world for years bucko….
“Activity?” “Don’t ride up Craycroft. But you can ride an easy 5 miles. Kettlebell swings should be okay. Climbing will be fine as long as you only use your upper body” Seriously?
Shakes my hand again (twice). “You can tell everyone that you are okay”
Hmmmm? Wanker. About as useful as a screen door on a submarine…
The next day walking is even more painful than the day before. Back to the internet to look for a second opinion, and more self-help options. I am pretty sure I almost broke the internet over the next several days searching for everything that I could find on Achilles tendinopathies and the treatment thereof.
I started using KT tape. Still Icing multiple times daily. Still taking Ibuprofen. Resting as much as possible. Research indicates that alcohol and caffeine consumption might impede tendon healing. Sigh…as if things weren’t bad enough already…
Saw the second doc on the 19th. Much better experience. I was shown and had explained to me the x-rays. Some high mileage calcification was apparent. He actually looked at and felt my ankle. He explained how these things happen and some probable causes; but more importantly prescribed a variety of treatment options.
Keep up with the icing and KT tape. Prescribed a weeks long course of an oral steroid and twice weekly physiotherapy.
The first pill(s) were popped that very day… better living through chemistry my friends…
Physiotherapy appointment scheduled for the next day.
Second day of meds… Read the label a bit closer. Definitely no alcohol. Also one of the fun possible side effects is… wait for it… a ruptured Achilles… You can’t make this shit up. First day of physiotherapy. Nice place, but seriously who puts a physiotherapy clinic on the second floor? Nice young PT Dr. however she is not up to speed on some of the more current thinking and procedures. But she is open to being educated about them, so I have filled her inbox accordingly.
One thing that came up during the initial exam was a significant lack of ankle mobility and flexibility. On both feet! So that needs work at least. I have some simple band exercises that I can do at home, and two office appointments per week over the next six weeks. I will give these guys a few weeks and see how it all goes.
I have also started taking some collagen peptide supplementation as well…
The PT suggested that besides the assigned band and mobility exercises that I could also ‘try’ to resume Tai-Chi, TGU’s (to the seated position only), and easy cycling. Nothing that would register higher than a ‘3’ on the old 1-10 pain scale however. I was mightily surprised that the PT knew what a TGU was and the various components thereof…
So with that in mind…our erstwhile hero sets out…
Tai-Chi: Nope! Round One quickly goes to Achilles…
TGU: 16kg Round Two easily goes to offwidth…
Easy Cycling: I set up a bike on the wind trainer to do some easy spinning. 10min HR ZR Clipping in caused a slight twinge, but in pedaling there were no issues. Round Three… offwidth!
Home therapy consists thus far of 3 dead easy band exercises (dorsiflexion, inversion, eversion) and ankle circles. I am doing them on both legs. Icing continues throughout the day along with KT tape. Continuing the oral steroids. Started wearing a heel lift in my shoe.
Even though icing has become controversial in some circles; something the PT readily acknowledged and understood, she is of the opinion that it will not cause any undue harm, and if it provides some pain relief then that benefit outweighs the negatives.
After several days walking first thing in the morning has become tolerable again.
Clinic sessions include: Calf massage / Side Stepping / Double Heel Raises / Single leg step downs / Reformer leg presses & calf presses / Single leg ball throw and catch. The worst of all though was the morning soft rock FM radio station they were playing…oh the humanity…
No one at the clinic had heard of GTN patches, or FMS. They did know about BFRT but no one is trained, and they don’t have the equipment. And apparently not only are my ankles highly inflexible, but my hips are wonky too…
I forgot to mention that I started introducing some healing visualization techniques I have employed in the past. Impossible to tell their efficacy if any, but why not use every tool in the toolbox even if it’s mostly voodoo
Therapist said to keep increasing the cycling duration. (Which is about the only good thing that they have said…
Since my second Moderna vaccination the pain in my Achilles has been markedly less. Coincidence no doubt, as there have been some other variables changed as well. One other interesting (at least to me) symptom is there is this small but very audible click in that ankle at times when walk. Not always, but if anything it is becoming more prevalent as the pain is beginning to subside. The doc didn’t seem too concerned, nor did the physiotherapists. But still weird eh…?
I have been reading various studies on the effect of alcohol on tendonopathies. I guess that it should come as no surprise that alcohol interferes with healing of any sorts, but there has been specific research into the Achilles and ethanol’s effect on collagen production. Lots of fun experiments with rats, and some human studies as well. Not only does it appear to impede healing, but (gasp!) alcohol consumption may actually contribute to Achilles issues. What’s that now? Now I don’t want y’all thinking that ol’ offwidth is some hard drinking boozehound here, but I do like a wee dram now and again, or a tasty IPA from time to time…I am sure as with most things the poison is in the dose, but it’s a bit unclear as to the dose.
So the weeks pass. I am doing therapy daily: 2 days a week at the clinic, and 5 days a week at home. Eventually things are starting to improve. Finally after about a month I go for a short real ride. I had worked up to 45 minutes on the trainer, but as we all know, the road is much different. 15k, 30k, 40k, I slowly started building distance. No doubt not slowly enough. Renee was visiting and my first real ride was about 100k with 900m elevation. I was unfit, slow, and sucking wind, but the Achilles was seemingly not bothered.
Three days after that we went big; 104k up Mt. Lemmon with over 2,300m elevation gain. We road right to the observatory gates. That last 3km was tough! Again, slow and sucking wind, but no apparent issues. The very next day we did a nice 40k recovery ride.
The following day however is when the wheels came off the cart a bit. We went climbing at the gym. I knew this would be the test. I took it easy. Only doing auto-belay climbs of a pretty easy grade. Again, I felt no pain. Later that evening however, I knew that I had worked it. In the middle of the night I woke up and I could feel my whole ankle throbbing with pain. Fuck! By morning I was an incapacitated mess. As bad or worse than my first go-around with this. All day was agony. There went almost six weeks of hard work. Wasted because of some stupid gym climbs. You reap what you sow. I felt really bad because Renee was here for some fun. Riding and climbing. I was being a real damper on that. Sure she was still getting out on her bike, solo and with the club, but I should have been there.
But… the very next day… as I was dreading getting out of bed, I could somehow sense that it wasn’t going to be all that bad. And it wasn’t. Back to normal? Hardly. But at least 100% better than the day before. There was still pain, and a hitch in my giddy up, but I could walk without agony. Back in the game baby…!
Okay, I suppose that I shouldn’t get too excited and that I should proceed with a certain amount of caution. Slow and steady… no set backs…
I had my last day of PT and will now figure out which exercises I can and should carry on with. Right now I am thinking of something along the lines of:
- Foam Rolling
- Goblet Squats
- Calf Raises
- Soleus Calf Raises
- Inversions / Eversions / Plantar Flexion / Dorsal Flexion
- SLDL
- Soleus Stretches
- Banded Side Stepping
- Box Step Downs
So here it is the 16th of Jul as I write this. Almost three months. Am I all better? No. But I am feeling pretty good. I’ve been riding a decent amount considering; and doing some moderate climbs at the gym, along with kettlebell training, and going on some longer walks. I keep up my physiotherapy on an almost daily basis. I can tell it’s still somewhat weak, but I’m willing to close out this story for the time being. We’ll see what the future brings…