INJURY: Achilles tear

Got my verdict from the Carysfort Clinic this evening and the pain I have been experienced is a form of Achilles tear which means that I can finally add that type of ailment to my list of injuries (let me hear three cheers!).

Anyway, since this injury has interest to many, let me duplicate my extensive talk with the physio below. The aim of our discussion was to find a short-term solution to get me ready to race Saturday, accepting the inevitable small to medium setback of the healing, and then the long-term healing.

Can you rule out posterior tibialis and bursitis?

Bursitis would mainly manifest when you squeeze the area and it is a rare injury in runners to begin with. The fact you describe the main discomfort as being when during the stretches you showed me (red; when the calf/achilles is fully lengthened) suggests an achilles injury.

What would have caused it?

The low mileage and no previous warning signals leading up to the injury makes it hard to call but perhaps the weakened state of your body after the flu-enforced rest could have had you in a weakened enough state for the tendon to just overload there and then.

Is this Achilles tendinosis/tendinopathy?

No, luckily not, this is no degeneration of the tendon tissue. Firstly, the injury is not in an advanced stage and secondly the tendon is generally fine suggesting a micro-tear somewhere which is causing classical tendinitis.

Is the distinction important?

Yes, tendinopathy/tendinosis is not an inflammatory condition but degeneration of the tendon itself. Given your scan two months ago showed excellent tendon conditions and that the onset was not gradual, this condition is unlikely.

But for people suffering form tendinopathy/tendinosis a progressive strengthening program is the key and NSAIDs (Nurofen etc.) will not work.

What’s the prognosis?

Given that my treatment today improved the mobility of the joint and your performance on the “hop-test” (red: I hopped on one leg landing on the forefoot), I would estimate you would be fully healed within 2 weeks. Because of your race on Saturday this will likely be a bit longer.

Do I risk long-term injury?

That is not likely going by the current state of the injury.

Did I do any mistakes doing a few runs over the last three days and a few hill-walks over the last few weeks?

I would avoid any running until the race and walking/running uphill is known to aggravate Achilles injuries so avoid it as much as possible and also don’t do too much walking on stairs.

I had hoped it would strengthen it?

Once the inflammation settles more, which means you should be able to perform the jump-test with little or no symptoms, you will be ready to strengthen it.

Should I copy the massage you gave it and will it flare it up?

Leave it a day to settle and make sure you ice it afterwards and in general. A massage every two days is about right but don’t overdo it. It’ll be tender for a while after but should not flare up too badly.

Can I do any other cross-training?

Bikes can be alright as long as you avoid uphills and do not have to stand up in the pedals (such as in spinning). Cross-trainers should likewise be fine.

Why does it hurt less when I sprint/run fast than when I jog?

Because you land more on your forefoot so the stretch cycle of your Achilles is shorter.

For Saturday’s race should I risk wearing racing shoes with little support/low heel or go conservative?

If you can do the jump-test without any noticeable symptoms, you can risk the racers.

I’m worried about my orthotics as they look a bit worn out already?

It’s possible that they don’t offer the level of support you need any more especially since you were diagnosed with stress-induced arthritis in your left big toe. It’s unlikely they contribute to the condition.

I have been using the night splint I bought for my plantar fasciitis while sleeping to keep the foot dorsiflexed, should I continue this?

No, that’s likely to be too aggressive a stretch to keep your foot in for extended periods with an Achilles injury. Just ensure your duvet does not push your toes downward, a gentle dorsiflexion is ideal.

And what about heat treatment to supplement the cold?

As long as there is any throbbing or noticeable pain you are likely better off with cold treatment for a white tissue injury like this. Heat treatment is more effective for red tissue, e.g. muscle damage.

Anything else I can do?

Keep up the rehabilitation work you do and keep using the foam-rollers especially on your calves as there was noticeable tightness in your lower left calf.

Any other things to note?

The force generation in your left leg is currently reduced which is noticeable in the hop test, this can cause a slight imbalance in your running as your right leg has to work harder without the left being able to generate its normal force.

What now?

So, that was the conclusions. I won’t abandon our Wicklow Way Relay team this late as it is a race I really want to be part of this year, especially with Jason Kehoe and Tressan McCambridge having had to be substituted late in the game because of injuries. The European Trial race is definitely out in either case as running uphill for six kilometres will not be possible with a weakened Achilles.

The greater loss could be the Wexford Strawberry Half-Marathon, the race where I had aimed to beat my PB. Training was promising as the test at UCD showed I was on course for my target time after only seven of twenty-four weeks. Much has gone wrong since, however, so perhaps now it would be a blessing to either have to skip it, or treat it as a training run for the real PB attempt 3-4 weeks later.

Am I at fault at all?

Yes, I should not have rushed back so recklessly from the enforced rest, but having lost a good bit of time earlier to the shin splints made me panic. I made the session more difficult than what the program had scheduled because I had missed a few hard sessions. This again was a mistake and I would never allow one of my athletes to make such a choice (with my blessing anyway).

Here is an important rule: Never look back. Return to program without trying to catch up. If I could practice what I preach to others, this injury would very likely not have arisen and I would not be in a poor position going into the three weeks I had build my season planning around. I have no one to blame but myself.

Richie was right earlier in the season when he was saying “someone needs to watch out for coach.” Perhaps I should send any reckless decision on my mind past a committee of my senior athletes in the future…