yes, I did that and also lowered the seat because I noticed that I was always on my toes, on the whole pedal stroke.
But even then I need to actively focus on lowering my heel to avoid having my calf locked up in a shortened position for the whole ride because that’s how I would naturally ride. Like tiptoing.
I’m wondering if years of minimalist running gave me stronger calves (relatives to my quads or glutes) that work too much during the ride and strain the tendons.
Hmmm…dunno. For me, moving to a low-drop show (but highly cushioned…i.e. Hoka) helped significantly. I also worked on shortening my stride, making sure my feet were landing below my hips, etc.
I tend to have a “toe-down” pedaling style as well…and I never tried to change it. My feeling is that your style is your style and if it is not causing any injuries, don’t mess with it. I wonder if your attempts to “ankle” more in your stroke is actually aggravating your Achilles?
Sure, if it’s not broken, don’t fix it !
In my case I do get relief by lengthening my calf (dropping my heel) during the ride.
I got rid of it completely.
Keep doing the eccentric calf raises. Also, stretch your calves after every run and every ride. If the calf muscles are tight, then the achilles is tight. So don’t wait for a “slight twitch” to remind you to stretch. Make the calf stretching a habit. I also roll mine w/a foam roller (rumble roller) or a stick (the stick).
Note, mine was never triggered w/cycling. I only felt it if I tried to run. I could cycle w/out issue. In your case, definitely make sure your bike fit is appropriate.
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FWIW my lessons learnt after nearly a year of suffering (and not exercising or cycling):
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It’s extremely important to identify if the tendonitis is insertional or not. I wasted a lot of time and money and physio exercises that actually aggravated the situation. If the pain upon touch is closer to the heel bone (calcaneus) then it’s most definitely an insertional one, which means “ECCENTRIC” heel drops will worsen it.
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Bike fit/saddle height: This is another issue that I was stupidly unaware of. I found that my saddle height was higher by 2inches (facepalm). This was causing additional pressure on the tendon and aggravating the condition. Once I corrected the saddle height, I now can cycle without pain (although haven’t done yet any long or intensive rides because I’m not fully healed).
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Foot condition: i.e. flat feet or overpronation; I was getting really puzzled because all my symptoms show that I’m nearly 90% recovered, but whenever I walk, I always get terrible pain. I went to a podiatrist and they basically told me my flat feet were causing overpronation that made my gait put pressure on the insertion point and basically undoing all the gains I got from exercises. He gave me special insoles and now there is no pain while walking.
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Finally, if you problem is closer to the foot (i.e. insertional) I highly recommend seeing a podiatrist not a physiotherapist. These guys know nothing about the rest of the body and their whole knowledge is focused on feet so they’ll be able to give proper advice and help.
For what its worth the heel drop provides tensile loading to the tendon which is what it is designed to do. Insertional tendonopathies are the same pathology but once you drop below 90 degrees (i.e., foot flat) you create a combined compressive/tensile loading at the front of the tendon which tendons typically do not like. A heel drop to flat for an insertional tendinopathy is usually 100% all good. Heel drops just aren’t particularly exciting and there is a lot of exercises that potentially load a tendon harder. It’s often just your physio’s imagination as much as anything.
Key points I try to get across to patients are:
We need to distinguish between a reactive tendon and a degenerative one (though it can be a mixed picture). They present differently in that reactive ones tend to get sorer the more we do, degenerative will tend to “warm up”, and then once they’re cool be stiff and annoying again until warmed up.
Reactive tendons need us to remove the abusive load (tight fitting heel counters, sudden passion for running etc.) and then recondition.
Degenerative tendons need load.
Timeframes for reactive tendons are short - see your doc or physio for how best to manage this (relative rest and load progression but there are medication options)
Degenerative; think 13 weeks of steady progression. They have a slow metabolic rate and a poor blood supply so things dont happen fast, and they need a lot of load to get changes. That is why you often get prescribed 3 sets of 15 heel drops twice a day. Think 90 a day. Basically, get the biomechanics right and load it. Don’t be afraid of the tendon hurting at a discomfort level (<5/10) but rather look at how it behaves 24 hours after load. If you are managing to increase loading and morning after pain is acceptable to you and not increasing, then you’re probably on the right track.
Or ignore everything above and listen to this podcast. This lady is a genius The Physical Performance Show: 222: Ebonie Rio (PhD), NHMRC Senior Research Fellow, Sports Physiotherapist: 2020 Tendinopathy Rehabilitation Update on Apple Podcasts
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That’s really interesting, thank you. I’m a few years on from a complete rupture. No real problems with the tendon itself but I had a slow recovery for the first many months, and I still have very weak and visibly small calf muscles. My medial gastroc is almost non-existent compared with my other leg.
Any suggestions for bodyweight exercises to build it up?
Thanks!
I heard an initially depressing but worthwhile comment during a seminar for physio’s who prescribe 3 sets of 10 exercises as “you may be doing something to help your patients, at least initially…”
The theme of this was very much that to get changes in power (and to a certain extent hypertrophy), you need to be loading heavy e.g., three sets of five at 85% of 1RM. This is pretty hard to achieve with body weight (for a gastroc/soleus complex) and ideally prescription through a physio (or other suitably qualified professional) would ensure you’re not going to injure something in the process.
For years, Rehab protocols for ruptured Achilles were incredibly conservative given the huge fear of re-rupture, however these days are far more progressive. We know that offloading tendons for long periods of time has very little going for it beyond the initial stages of healing.
From a tendon healing state, a couple of years down the track things should be sound but they will still respond to loading, just make loading progressive and I’d suggest working toward heavy to get the changes. If you or your PT get imaginative enough, gym work doesn’t need to be a bore. Sessions also don’t need to be hours long and as Coach Chad points out, you can do it in a way as to not get massive (which you will then have to carry uphill with you)
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Has anyone had this flare up at the beginning of base? I’ve never experienced this, after I took about a month off after CX season, I started with a week of base (traditional), and my upper achilles is sore and swollen. I’m not sure what else ive done, other than skiing a lot more than normal in the weeks leading up to it, but even then, that was only six times.
I’m starting to do calf raises, single leg squats, and I’ll break out the bands for monster walks (used to do them for prior IT ban issues). I’ve been foam rollering, and yeah, the rest of my legs are tight, tighter than normal, but I dont imagine that is the entire cause?
My saddle could have been .5cm too high at most, its only in my left leg. I’ve switched to my MTB shoes now (cleats further back). Im hoping to continue with a month of traditional base since im working on weight loss and find the activity helps me a ton. Is this a bad idea?
I am using erg mode for the first time, any chance that contributes, or is exposing a weak part of my pedal stroke?
EDIT: a bit more info, definitely not insertional, seems to be the most common type.
So my question is, how long before I start doing the eccentric heel drops? Its currently sore to the touch with little to no activity. Its swollen a little. If I massage it, and loosen my calves with the foam roller, the pain will go away for a bit. Heel drops seem to hurt, almost directly after. I’m going to take this week off the bike, I have a trip to CA in February I really don’t want to mess up, and I want to get use out of my season ski passes.
I’ve suffered achiles problems too, but caused by running.
Like me, you do cyclo cross. Running in cycling shoes is the worst thing if you are prone to achilles tendon trouble, because the shoes have zero flexibility. This puts more stress on the calf and achilles, because the foot cannot work as it should (its flexibility works together with the calf ,and reduces the strain on the tendon).
Something I do is roll the arches of my feet on a rolling pin, or small ball, like a cricket or tennis ball.
I also do the one where you lay a towel on the floor (not carpeted) and scrunch it up with your toes.
Dont do the heel drops until you have no pain. Build up to it slowly and when you’re sitting in a chair you can do the eccentric heel drops but without your bodyweight to lift. You can do ankle rotations and stuff too. It is really worth taking the time to do the excersises, but don’t push into pain, and better to do fewer reps, several x daily, rather than all at once.
When its pain free and strong enough you can do wobble board work which will help .
Unfortunately, because the achilles area has just about the worst blood supply in the body, it takes ages to heal. Hope you can enjoy your ski-ing trip pain free. If you can ,see a sports physio.
I’ve been battling achilles problems since September. I was short on training as I had a strained quad early in the summer. Once I recovered from that I ramped up too quickly to get ready for an endurance Mtn Bike race (Marji Gesick) and began to experience some achilles soreness. During the race it become noticeable and I continued to push until I finished the event. The next day it was very painful… too much too soon. I’m now a little over three months of rehab and beginning to feel better. Can ride for 2.5-3hrs without pain, able to stretch my calf without feeling tension in the achilles and I don’t have any day after a ride lingering issues. But it is still not 100%. In addition to the eccentric calf exercises, strechting and foam rolling mentioned by others, I’ve had dry needle treatment twice in the past month. All seems to be helping. Going for a third dry needle session tomorrow.
Yikes, thanks for all the responses. Pain and swelling starting to go down, going to give it a few days then start self PT on it. Massaging it seems to help quite a bit, as well as foam rolling the hamstring, glutes and calves.
Would it make sense to get some sort of brace for bike rides coming up in february? or skiing? I should be able to keep it around sweet spot on those rides but we’ll see.
I think this is highly individual…depends on the case, the location of the swelling, etc.
FWIW, I used these braces from CEP…have a silicone insert which keep compression on the tendon. Used it mostly for pain relief in daily activity, not during exercise. But it may be worth a try.
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Thanks again @AntC, I’ve just got around to listening to that podcast with Ebonie Rio, and that was really interesting.
My Achilles itself doesn’t give me any problems, (although I have slightly limited range of motion in dorsiflexion), and my management of the original rupture was intended to be pretty active and did involve some loading pretty early on. However I had other protracted issues that meant that by the time I could do a decent amount of exercise, my calf muscles had wasted away, and it’s hard to get them back!
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Related to the point that you mentioned, there’s an interesting preprint from Scott Morrison and Jill Cook (for others, those are two luminaries in the field) entitled “Putting the ‘Heavy’ in Heavy Slow Load”:
https://osf.io/preprints/sportrxiv/zju3h
They discuss the implications of very heavy loads for stimulating Achilles adaptations. Some other studies still suggest that both Eccentrics & HSR have similar outcomes in the long run (though with higher patient satisfaction in the HSR cohort, presumably because of lower time commitment), which could indicate that putting some form of load on the tendon >>>>>> putting no load on the tendon, with the precise question of “how” being slightly less important than is sometimes thought.
When I started having issues, I started with eccentric exercises and then progressed to heavy slow resistance, much in the way that Silbernagel recommends it. A little over a year out, and I’m almost entirely back to normal — though that was slowed down by a calf strain a few months back.
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An important point of the silbernagel articles is that both work, but heavy slow resistance only needs to be done three times a week. Hence improved adherence.
I liken to it to low versus high volume compared to eccentrics.
She also published a great randomized controlled trial where both groups had the same regimen of exercises but one continued training (whatever sport) and only stopped if pain went above a 5/10. That group had the same outcomes as the other and didn’t lose as much fitness compared to the control (therapy exercise alone). Food for thought.
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On the topic of continuing to train, I have fond a neoprene calf sleeve helps for reducing symptoms. It’s certainly not a complete fix or long term solution, but for me it keeps the area warmer/looser and even if I start a ride with a tight achilles I worry may become a problem, it never actually does.
I got into cycling due to a number of running injuries over the years. Initially, the bike was a means of cross training while injured. I had a not so good relationship with the bike. Fast forward 3 years and I consider myself a cycling who runs.
I dealt with achilles tendonitis for 1.5 years and addressed in the same manner as many of you had. Unfortunately, I “trained though” many of my chronic symptoms and I now have some irreversible damage to the tendon. Many of the treatments mentioned helped me, but never got me completely better.
My daughter, also a runner, was being treated by a foot specialist and I mentioned my ailment and lengthy journey with AT. The only thing that got me healthy was EPAT. I did 4 treatments and can run pain free for the first time in years. From the site, "EPAT stands for Extracorporeal Pulse Activation Technology. EPAT is a form of ESWT (Extracorporeal Shock Wave Therapy). It’s a new treatment developed and widely used in Europe. It treats severe or chronic bone, muscle, ligament, tendon, and nerve injuries.
EPAT uses sound waves to safely increase the metabolism and blood flow to injuries, which helps heal them. We recommend EPAT for patients with severe injuries as a way of speeding healing. It’s also great for chronic injuries that have failed to respond to other therapies. "
For those reading, it’s similar to ultrasound, but amped up and can be a bit uncomfortable. Worth the time to research and consider if it’s chronic.
Never heard of EPAT, but this is a key issue when dealing with Achilles issues……it is a low blood flow area, so the healing process can be lengthy. You need the healing properties of rich blood to stimulate healing.
This is why PRP was developed….it takes all the “healing” parts of your blood, separates them from the actual blood and is then injected directly into the injured area to stimulate healing.
Have no idea if EPAT does what it claims, but the idea behind it is certainly sound.
As a runner, I tended to have many overuse injuries. Upper hamstring tendinopathy was yet another. PRP got me through that. Essentially, if you tell me something might help me - I’ll try it. EPAT and PRP both worked for me. Good luck.
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