Thanks for the warning. I am of course hyper-aware and always try to react to how I feel. This Saturday I cut my planned 10 mile run short at mile 7 since I felt a minor twinge. I think the times were I can work out with abandon and no concern are a couple of decades gone already. 
Great news…keep adding weight as you do the eccentric calf drops, as needed.
I think I was putting a 25 lbs dumbbell in my backpack when I was at my height of those exercises. Adding more weight as needed is critical to building strength.
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I’m now at about 50lbs in a backback, and do the calf drops now as maintenance most days of the week.
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One more update: I am now 10 days out from my 70.3 tri (White Mountains Triathlon) and I have been able to maintain my run/bike volume and long efforts without any Achilles aggravation. On my hardest weeks I get up to 180 miles on the bike and 35 miles total runs, with a half marathon as the long run.
It is amazing how the heel drops combined with overall leg/ankle strength and mobility training have enabled me to train nearly as hard as I would like. If this holds up then I can actually start to pursue my goal of a full Ironman in 2022 (just in time when I turn 50). 
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Final update: Competed successfully in the White Mountains 70.3. I improved from my first Tri by 15 minutes even though the course was harder than last time around.
24 h post-race my left Achilles is a little irritated, but not too bad. I think a day or two of rest followed with a week of light training should get me back to normal.
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I’ve had it since February and didn’t know it was a problem until April.
Unfortunately I don’t think I’m improving that much. Yesterday I did Baxter and I’m in pain today 
My PT isn’t able to differentiate between insertional and non-insertional problems so he proscribed bad exercises in the beginning.
I’m gonna try icing + continue with heel rises. I’ll stop doing tempo and focus on endurance for now.
Does anyone know if weighted squats can help? I think my main problem is that over the past few years of cycling - as an intense hobby - I ignored strength training. I believe it would have made a difference if I had been stronger.
Do not do heel rises. Do eccentric heel drops. Pretty sure they are described above, but the gist is to raise up on your good leg, switch over to your injured leg and then lower your self past horizontal (do them on stairs). Then rise back up on your good leg and repeat. Don’t rise up on your injured leg.
Once you are doing 3x10 with these, grab a backpack and add some weight. A 5 lbs dumbell will work for starters, but you can use books, too. Keep doing the drops and adding weight over time.
I would avoid weighted squats and do single leg squats (but do both sides). keep your weight back by keeping you butt over your heel and you back straight. Weak glutes are a big problem with cyclists and can definitely lead to Achilles issues since the leg is one big, long kinetic chain.
Other glute exercises you could do:
- Monster walks (w/ bands)
- Hip bridges w/ leg extensions
- Running Man squats
Also look into getting a balance pad (or use a pillow) and do various exercises where you touch the ground or do some of the exercises above. The goal with the balance pad is to strengthen all the stabilizing muscles in your lower leg. Again, the leg is one big kinetic chain so you need to work the whole thing.
Also consider sleeping in a night splint…it will keep your ankle @ 90* during the night, which keeps the Achilles stretched. makes waking up much less painful (if you are having any issues in that regard).
Good luck…feel free to hit me up with any questions. I struggled for a couple of years with it, but once I got on a good rehab program (especially the heel drops), things started to turn around pretty quickly.
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Thanks for all the tips. Appreciated.
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If you don’t mind me asking for advice about indoor cycling. I think I back-slid because I moved from Endurance (Pettit…etc) to Tempo (Baxter, Maggie’s). Do you recommed continue endurance rides (it helps me mentally and keeps me sane) or just stop cycling altogether until I almost feel no pain in all reasonable positions (jumping from bed, walking…etc).
First and foremost, make sure you consult with your doctor and physical therapist.
That said, for me, cycling was therapeutic and my Achilles always felt better after a ride. But you have to avoid standing and likely any intensity. Also, move your cleats as far back as possible. This will help reduce the strain on the Achilles. I have never even moved my cleats back after I pushed them back. It is a better cleat position overall, IMO.
Let pain be your guide / limiter. If it hurts, don’t do it. And take it slow…ramp up slowly in both time and intensity over an extended period, and focus on time first. Zero need to do any intensity any time soon.
Feel free to ask anything else….it can be a frustrating injury, but once you start a regimen on the eccentric heel drops and some glute strengthening, you should hopefully start to see some improvement.
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I need to get back to doing more eccentric heel drops.
I’ll also add, in terms of cleat position… I’ve found I can get achilles pain if I move my cleats too far back. I have them 10mm behind the ball of my foot or so, and if I go back more my achilles starts bugging me. I’ve tried a true mid-foot cleat position and get the same effect. I think it almost puts compressive force on my achilles or it has to stabilize itself in a different way and it doesn’t like that.
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Eccentric heel drops are good (Alfredson). There is limited/no evidence that they are actually much more effective than both phases (Cook). A conservative treatment recommended often now is concentric heel lifts on both legs, and then slowly lower in the eccentric phase on one leg. Two up, one down.
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Heavy Slow Resistance doesn’t aggravate a tendon (Cook) and will improve structure when pushing really heavy weights (O’Neill). Anecdotally, some of my fastest improvement came after adding two+ days per week of slow heavy weights (seated and standing calf raises) in the gym. Evidence suggests that pushing more than 70% of 1-rep-max, even with shorter sets and more pauses within the sets, helps structural changes (Morrison).
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What doesn’t help: ice, immobility, “wait and see” (Low). Tendons need progressive load during recovery, and not giving it to them may remove symptoms but definitely doesn’t solve the problem. Additionally, adjunct therapies (dry needling, platelet-rich plasma) appear to not help. Stretching too much doesn’t either.
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There’s good reason to believe that once eccentric and HSR have reduced/removed symptoms, thay plyometrics can be introduced slowly, and help with both tendon stiffness (Young’s modulus) and potentially cross-sectional area. Once tendons can handle plyometrics, cycling should be no issues.
That’s my anecdotal bias on trying to encapsulate most of the research I’ve waded through in the last eight months.
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A few thoughts on these points…ice can help relieve discomfort short-term, but agreed it doesn’t help resolve the issue. I think the degree of relief is very personal…I mever got a whole bunch of relief, but know others that did.
As I noted above, a night splint at night can help reduce morning stiffness / pain. Again, it won’t resolve the core issue, but it make getting up in the morning a helluva lot easier.
Anecdotally, I had some success with PRP…I would say it got me back to about 75% functionality (from well below 50%). However, my recovery from the procedure was interrupted by a DVT / PE. Whether I would have continued to improve had I been able to complete the recovery protocol, or if I would have required anotehr round of PRP will forever remain unknown.
I’m glad you mentioned tendons needing progressive load. I forgot to mention this earlier…One of the things that helped me significantly was switching to very flat shoes. This is counterintuitive to what most docs / PT’s prescribe…they usually want you in a running shoe with a decent amount of heel-to-toe drop. Once I started wearing very flat shoes, I saw improvements almost immediately. My favorites were Sanuk sandal shoes. Similar to using a night splint, it seemed to keep a load on my Achilles during the day.
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Agreed on both points. What’s generally considered more productive is isometric holds, as those both help the tendon AND have an analgesic effect. Most with tendinopathy in the Achilles can’t do 3x45 seconds isometric holds, but that is the gold standard for it. Instead, start with 15-20 seconds and build from there.
Those static loads will reduce pain and do much more good than ice can. There’s not really inflammation in tendinopathy, so at most ice just numbs things a bit. I question (unscientifically) if that’s useful for the 24-48 hours worth of elevated collagen synthesis one has after inducing load.
As to Platelet Rich Plasma, my understanding is that it hasn’t been shown to be helpful beyond anecdotes. To quote the luminary on tendons, Professor Jill Cook, “Why are we even discussing PRP, the evidence is clear that is does not work for tendinopathy” Stronger words than I may use, but food for thought.
Is this basically holding your foot level with your heel off the edge of a stair?
That would be one, yep. Anything that involves inducing load then holding it still. Standing calf raise then just holding it in the flexed position, calf-raise machines (seated for targeting the soleus) — I’ve even see someone sit at a table, push it up with their knees while seated, and hold it.
Tendons display plasticity and love very slow loads. Isometric exercises are basically the ultimate /very/ slow load.
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Agreed…the data is unclear on it. But I do know that it did help me…n=1, and all that.
ETA - I would not recommend anyone do PRP unless they had exhausted all the other options and were essentially desperate. I had reached that point when I did it, but my PT guy pretty much sucked leading up to it and I just didn’t know any better. I may have resolved my issues with a proper regimen as outlined above. A lot of my eventual rehab also ended up being trial and error (the Sanuk shoes, for example).
But if you are all out of options, then PRP could be worth trying.
Could you share info on the papers (PubMed id)?
This thread has been useful for me as well.
I had to stop running for the last 3 months or so (except for the IM run last month, but that’s slow pace. IM training volume at the begining of 2021 was probably responsible for that in the first place).
I practice the eccentric calf raise (2x15 straight leg + 2x15 bent leg with 30%body weight added, with no pain), as well as the foam rolling (so painful at first, I am now looking for a harder foam roller).
I wake up now with no pain.
If I have to jump or run for any reason during the day, I feel no pain at all.
That is, on most days.
My problem is that I feel that I cannot get rid of it completely and start running again. Most day I feel I have nothing at all and the issue is fixed.
But after a long or hard ride, the next day I feel it is coming back.
Usually, if I feel a slight twitch before the long ride, I will make sure to stretch my calf during the ride. A lot. On every coasting. And then the next days I’m OK. So I forget about it. And then forget to stretch during the next ride because I fell good. But then I get a painful tendon the next day.
Did any of you can relate to this kind of never ending plateau ? Did you get rid of it completely ?
Have you moved your cleats all the way back on your shoes? If not, do this ASAP. It can amke a huge difference. For me (and every case is different), riding was very therapeutic for me and my Achilles always felt better after a ride.
Onset of my Achilles problems was 2009. Didn’t fully kick it until 2012. Spent most of 2010 playing golf. I had honestly gotten to the point where I thought I’d never be able to run around the back yard with my kids.
What changed for me…eccentric calf raises (which you are already doing) and glute strengthening. Monster Walks w/ bands, single leg squats, Running Man poses, and many others. I had a ~45 min glute routine that I did every other day.
Swimming was also wonderfully therapeutic…
I also did one round of PRP, which helped significantly, and got me back to ~75%. The jury is still out on the effectiveness of PRP, but if you are running out of options, there is little risk to the procedure. You are just injecting “you” into you. Biggest risk is infection from the needles during the procedure, which is very small.
Did my first 70.3 in 2012 and full IM on 2014, qualified for 70.3 Worlds in 2017. Also find a good physical therapist, one who understands active lifestyle.