Achilles tendon pain - related to new shoes and/or cleat position?



noonievut

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Jul 5, 2004
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Well tfstrum, again it sounds like we're going to the same office.

When I met the PT today she had a totally different approach. After assessing my injury by having me do many tests, she believes it's not very bad, and that the cause was other alignment issues with my body (si1, or some other term, related to the big bone attaching to the spine).

She believes she's fixed that, and after some deep theraphy she gave, now I just have a series of stetching to do at home before the next visit in a week.

I can already feel the difference based on what she did, and it didn't involve any advanced therapy...though we may use ultrasound or something else in the future if it doesn't progress.

She also said cycling is fine, so long as there is no pain during or after, and if the intesity is moderate with little standing on the pedals (fine with me).
 

teetopkram

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Jan 27, 2006
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noonievut said:
Well tfstrum, again it sounds like we're going to the same office.

When I met the PT today she had a totally different approach. After assessing my injury by having me do many tests, she believes it's not very bad, and that the cause was other alignment issues with my body (si1, or some other term, related to the big bone attaching to the spine).

She believes she's fixed that, and after some deep theraphy she gave, now I just have a series of stetching to do at home before the next visit in a week.

I can already feel the difference based on what she did, and it didn't involve any advanced therapy...though we may use ultrasound or something else in the future if it doesn't progress.

She also said cycling is fine, so long as there is no pain during or after, and if the intesity is moderate with little standing on the pedals (fine with me).


When you start riding again, something that worked for me last summer (chronic achilles tendinitis due to running injury years ago), was learning to pedal with a toes down style. I came from the Lemond school where I pushed down through the pedal stroke, emphasizing almost full leg extension...resulting in my heel falling below the pedal axis...now when I feel any tightening I adjust the stroke to be more toes down, where the heel does not drop below the pedal. This reduces the total amount the AT is strectched. Seems to have worked, as I no longer have to worry about the tendinitis flaring up...

Now, if I could just do something about the patellar teniditis... :(
 

noonievut

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teetopkram said:
When you start riding again, something that worked for me last summer (chronic achilles tendinitis due to running injury years ago), was learning to pedal with a toes down style. I came from the Lemond school where I pushed down through the pedal stroke, emphasizing almost full leg extension...resulting in my heel falling below the pedal axis...now when I feel any tightening I adjust the stroke to be more toes down, where the heel does not drop below the pedal. This reduces the total amount the AT is strectched. Seems to have worked, as I no longer have to worry about the tendinitis flaring up...

Now, if I could just do something about the patellar teniditis... :(

Thanks.

I have been paying attention to pedal style as of late ensuring my toes stay below the pedal axis, however, I think when I hurt my achilles I was trying the oposite, having read somewhere it's a better style. Not sure it is but I know it's not for me, at least for now. I've had no pain with toes down since the injury.

I haven't been on a hill for a while (weather...) but when going uphill and standing to pedal (or seated), would the natural position mean maybe hurting the achilles, because I know running up a hill could cause pain for the achilles, not sure about biking though?
 

teetopkram

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noonievut said:
Thanks.

I have been paying attention to pedal style as of late ensuring my toes stay below the pedal axis, however, I think when I hurt my achilles I was trying the oposite, having read somewhere it's a better style. Not sure it is but I know it's not for me, at least for now. I've had no pain with toes down since the injury.

I haven't been on a hill for a while (weather...) but when going uphill and standing to pedal (or seated), would the natural position mean maybe hurting the achilles, because I know running up a hill could cause pain for the achilles, not sure about biking though?

I am certainly not a certified trainer, physical therapist, etc., but can only tell what worked for me. But my physical therapist told me to avoid running up hills for two reasons; one, it simply puts greater stress on the calf muscle and tendon, thus risking further tearing; second, the angle of the ankle bend is much greater (i.e., significantly more than 90 degrees) when the foot is on an uphill plane compared to a flat plane (i.e., 90 degrees) - this causes further stretching of the tendon and when combined with the extra exertion to run up hill, can further damage.

With climbing in cycling, as long as you are pedaling with toes down even when standing, I think the second factor mentioned above (i.e., greater ankle bend) can be more controlled. But I think the first factor dealing with greater exertion of the calf muscle and tendon would still be a concern...this is why my therapist recommended "easy" cycling as an exercise for achilles tendinitis...mashing hard gears and doing intervals, even with toes down, would still put maybe too much stress on the tendon. Even now I no longer have any pain, but the day or two after a hard race or weekend group ride it's definitely "tighter" (which is resolved with stretching).

And for what it's worth...my patellar tendinitis (in the knee) doesn't bother me that much after a 2 L2 endurance ride, but after doing a 20 minute L4/L5 interval or after climbing some of rolling hills around central florida, it will definitely be soorer the next day...those tendons just don't like to be stressed too much when they are damaged...I think the same logic applies to the achilles tendon.

I think after this weekend's races I am going to take 3-4 weeks completely off the bike, go swimming to keep up aerobic health (much less stress knees), ice and stretch like crazy, then re-enter cycling doing nothing but easy miles for a long time. I won't win any races later in the season, but hopefully will keep the fat/weight off and not fall back into the trap of going too hard too soon (which is what caused this injury - Monday a second LBS confirmed my bike fit is spot on).

Again, good luck.

Mark
 

noonievut

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teetopkram said:
I am certainly not a certified trainer, physical therapist, etc., but can only tell what worked for me. But my physical therapist told me to avoid running up hills for two reasons; one, it simply puts greater stress on the calf muscle and tendon, thus risking further tearing; second, the angle of the ankle bend is much greater (i.e., significantly more than 90 degrees) when the foot is on an uphill plane compared to a flat plane (i.e., 90 degrees) - this causes further stretching of the tendon and when combined with the extra exertion to run up hill, can further damage.

With climbing in cycling, as long as you are pedaling with toes down even when standing, I think the second factor mentioned above (i.e., greater ankle bend) can be more controlled. But I think the first factor dealing with greater exertion of the calf muscle and tendon would still be a concern...this is why my therapist recommended "easy" cycling as an exercise for achilles tendinitis...mashing hard gears and doing intervals, even with toes down, would still put maybe too much stress on the tendon. Even now I no longer have any pain, but the day or two after a hard race or weekend group ride it's definitely "tighter" (which is resolved with stretching).

And for what it's worth...my patellar tendinitis (in the knee) doesn't bother me that much after a 2 L2 endurance ride, but after doing a 20 minute L4/L5 interval or after climbing some of rolling hills around central florida, it will definitely be soorer the next day...those tendons just don't like to be stressed too much when they are damaged...I think the same logic applies to the achilles tendon.

I think after this weekend's races I am going to take 3-4 weeks completely off the bike, go swimming to keep up aerobic health (much less stress knees), ice and stretch like crazy, then re-enter cycling doing nothing but easy miles for a long time. I won't win any races later in the season, but hopefully will keep the fat/weight off and not fall back into the trap of going too hard too soon (which is what caused this injury - Monday a second LBS confirmed my bike fit is spot on).

Again, good luck.

Mark

Thanks. And good luck to you on and off the bike.
 

noonievut

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I've heard when you initially injure the achilles tendon you shouldn't stretch right away. I've now had this for 3 weeks and have had one physio session (another on Monday). When the PT gave me the list of stretches as homework, one in particular (stand in front of wall, one leg straight and behind, other bent and in front) is where I really feel the tendon (not pain, just strange stiffness). I voiced my concern because this is where I feel it, she said that it's fine to feel the 'weird feeling' but there should be no pain while stretching.

So, during the stretch I get that feeling early while settling into the stretch so I don't go too far, but after holding it for a bit, I can slowly move forward more and get a deeper stretch. Is this fine to do? Will it help the tendon heel, or do more damage.

I'll clarify this on Monday but for now wanted to hear what you think.
 

teetopkram

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Jan 27, 2006
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When I was receiving PT for achilles tendinitis about 4 years ago, they had me stretching as well. I believe they don't want you doing stretching it when the injury first occurs or when there is swelling because it is at this point that the tendon is most damaged and further damage could be done.

Once the swelling has gone done and the tendon starts healing, the tendon will form scar tissue if its a relatively serious injury. Over time and unexercised, the tendon will become less flexible than it was before, and even more open to injury if flexed too much. So, the stretching you are doing, I believe, is to encourage some flexibility while it's healing. In fact, I remember my therapist actually rubbing the tendon a bit forcefully to break up old scar tissue, encourage more bloodflow, which would help healing and form new scar tissue...repeat process until the tendon is strong.

It's like stretching a sore muscle, doing it enough to feel the stretch is good, loosens up fibers, flushes the **** out, encourages blood flow, etc. But, stretch that muscle too much and you'll tear it slightly, causing damage. The same works for tendon I believe.
 

sportfactory

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Jul 8, 2005
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kaian said:
I've been having achilles tendon soreness as well as calf tightness on my left leg for the past week. Every morning when I get out of bed, my AT is sore and tight. After I shower and go on with my day, it seems to go back to normal. When I ride, I don't feel any pain or discomfort and it was only yesterday that it felt sore after a 75 minute "easy" ride (no big gears). In general each week I bike 3 times a week and run 2 times a week (2.5 miles each time I run).

I purchased new cycling shoes a month ago - Sidi Genius women's. I have extremely narrow feet so have been wearing thicker socks to compensate because my heel tends to slip in most shoes. I don't feel any major slipping at the moment. With the new shoes came having to reposition my cleats. My knees feel fine, so I figured the cleats were probably positioned correctly. I am also wearing my orthodics in the cycling shoes for arch support.

One thing I notice when I am spinning is that my left foot feels different than my right foot. My right foot feels relaxed and comfortable while my left foot feels tensed up and uncomfortable. Does anyone have any suggestions as to what could be going on? I know there are a lot of factors involved, but are there certain cleat positions or foot positions that would cause strain to the achilles? I thought about trying a different insole - maybe Superfeet - instead of using the orthodics. The orthodics are on the new side and they may not be right for my feet.

Any insight would be appreciated. Thanks.
I would have an coach look at your fit and video your mechanics. If you have a leg length discrepancy or condition such as scoliosis you may be putting more pressure on one side and "ankling." This coud very well be a biomechanical problem.
 

kaian

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Aug 22, 2004
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Well...I am still having my AT issues. I had my chiropractor doing ART (active release technique) and that seemed to help for a while, but now it's feeling really sore. I had a week when I was sick (flu or bad cold) and I didn't do much stretching of my calves. My AT felt fine. Yesterday, I did some stretching and it started hurting pretty bad. It's still sore today. So it's been roughly a couple of months or so since I've had this. I guess I should go to PT, but I've already been to PT 3 times in the past 3 years for 3 different body parts. I'm only 33 and already I feel like I'm falling apart! My calves don't seem weak - they've actually gotten stronger with the cycling and running I was doing. I haven't run in over 2 months because of this problem, but I have continued to do some biking on the trainer 2-3 times a week. I don't know how to find out if this is a biomechanical thing or not. I had a sports med doc check me over and look at my orthodics. ????? Frustrating!
 

sportfactory

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Jul 8, 2005
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kaian said:
Well...I am still having my AT issues. I had my chiropractor doing ART (active release technique) and that seemed to help for a while, but now it's feeling really sore. I had a week when I was sick (flu or bad cold) and I didn't do much stretching of my calves. My AT felt fine. Yesterday, I did some stretching and it started hurting pretty bad. It's still sore today. So it's been roughly a couple of months or so since I've had this. I guess I should go to PT, but I've already been to PT 3 times in the past 3 years for 3 different body parts. I'm only 33 and already I feel like I'm falling apart! My calves don't seem weak - they've actually gotten stronger with the cycling and running I was doing. I haven't run in over 2 months because of this problem, but I have continued to do some biking on the trainer 2-3 times a week. I don't know how to find out if this is a biomechanical thing or not. I had a sports med doc check me over and look at my orthodics. ????? Frustrating!
It could be how you are fitted on the bike or how you are pedaling the bike, both, or unrelated (sorry that is a big spread). Note that stretching may make it worse. Do not stretch it until it has had a chance to heal properly. Basically what you are doing is reinjuring it. I have dealt with athletes that have had to be "booted" in order to allow a AT injury to heal because they would not give it the rest it needed. The AT has a poor blood supply and is slow to heal. As it is mending the stretching you are doing may be reinjuring it lengthening your healing time. It is going to take time and patience. The injury was not caused by any weakness in your calves, you can injure the AT doing almost anything. Usually it starts with a small level I strain that is made worse by training stress compiled on it. This is the case for a lot of injuries. If you are in the Atlanta area I would be happy to look at your bike fit and video your form. Please visit www.thesportfactory.com for details.
 

kaian

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Aug 22, 2004
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sportfactory said:
It could be how you are fitted on the bike or how you are pedaling the bike, both, or unrelated (sorry that is a big spread). Note that stretching may make it worse. Do not stretch it until it has had a chance to heal properly. Basically what you are doing is reinjuring it. I have dealt with athletes that have had to be "booted" in order to allow a AT injury to heal because they would not give it the rest it needed. The AT has a poor blood supply and is slow to heal. As it is mending the stretching you are doing may be reinjuring it lengthening your healing time. It is going to take time and patience. The injury was not caused by any weakness in your calves, you can injure the AT doing almost anything. Usually it starts with a small level I strain that is made worse by training stress compiled on it. This is the case for a lot of injuries. If you are in the Atlanta area I would be happy to look at your bike fit and video your form. Please visit www.thesportfactory.com for details.
Thanks for the advice. I am in Michigan. Know anyone in MI? I got fitted professionally when I bought my bike, but since then have changed saddles and shoes. Some things could've gotten moved around in a bad way. I am thinking of going back to the shop and having the fitter take a look at me - including my pedal stroke. I wouldn't be shocked if my stroke is off. I used to pedal toes down and I had no problems then, but I thought that was incorrect, so I focused on changing that and I have, so I wonder if that contributed. So...how long should I rest and does that include not getting on the bike at all? Thanks again!
 

noonievut

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kaian said:
I used to pedal toes down and I had no problems then, but I thought that was incorrect, so I focused on changing that and I have, so I wonder if that contributed. So...how long should I rest and does that include not getting on the bike at all? Thanks again!

This is where I believe my AT began. I pedalled hard one day trying a 'toes up' stroke and noticed the pain afterwards. You should be able to pedal this way without problems, unless there is something else wrong and this happens.

On Saturday I got outside on my road bike for the 1st time in months and I noticed that right away I needed to lower my seat a bit to be able to pedal toes down easily. I have to for now until the AT is better, but it makes me concerned about fit because I've now messed with it and I hope other things don't go wrong.

Good luck.
 

sportfactory

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Jul 8, 2005
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kaian said:
Thanks for the advice. I am in Michigan. Know anyone in MI? I got fitted professionally when I bought my bike, but since then have changed saddles and shoes. Some things could've gotten moved around in a bad way. I am thinking of going back to the shop and having the fitter take a look at me - including my pedal stroke. I wouldn't be shocked if my stroke is off. I used to pedal toes down and I had no problems then, but I thought that was incorrect, so I focused on changing that and I have, so I wonder if that contributed. So...how long should I rest and does that include not getting on the bike at all? Thanks again!
Although I coach an athlete in Michigan I don't have a referal source, sorry. The change in pedal stroke could definately be a factor, especially if you are "ankling" more. This is going to put more stress on the achilles and involve more ankle movement. I would give it a week then ease back in with some recovery level riding and see how it reacts. Good luck!
 

kaian

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Aug 22, 2004
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Thanks! Right now the pain is the worst it has been the whole time, so something is definitely wrong. I'm thinking PT again. My insurance should cover it. Maybe I need some ultrasound to get it calmed down. I don't think my seat is too high - it feels fine. Good luck to you too Noonievut!
 

noonievut

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kaian said:
Thanks! Right now the pain is the worst it has been the whole time, so something is definitely wrong. I'm thinking PT again. My insurance should cover it. Maybe I need some ultrasound to get it calmed down. I don't think my seat is too high - it feels fine. Good luck to you too Noonievut!

I haven't read all of your posts in detail, so I apologize if you've covered this, but my PT first looked at the potential cause of my AT, based on the fact I mentioned the left side always feels weaker, and she found that my SI1 was off (I don't know the technical jargon). She fixed this and has me doing exercises to strengthen the 'big muscles', to try and prevent this in the future.

Maybe you have another physical issue which is impacting your AT? May not be bike related...
 

kaian

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Aug 22, 2004
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Actually, I've come to the realization (along with my sports med doc) that I have hypermobile joints - especially in my ankles! I don't know if anyone knows about hypermobility, but basically I have loose joints in certain areas of my body. Because they aren't as stable, exercise puts more strain on my muscles and makes me more likely to suffer from overuse injuries. I think running is what initially aggravated my achilles and the cycling just kind of fed into it. My feet, for instance, can be moved forward and back (while my leg is being held stationary) and can almost be bent upwards almost completely sideways. :eek: So...once the inflammation goes down, I'll be focusing on stabilizing/balance exercises and also going slow with the cycling at first. I also plan on wearing some elastic ankle supports to help my ankles from flopping around so much while pedaling.
 

noonievut

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Well it's been over a month since I've had achilles tendonotis and I've had about 5 appointments with the physiotherapist and have been doing stretches and exercises 3 times a day. I still have the tightness from time to time but it has improved significantly, I think primarily due to the stretches, exercises, and physio work I've been receiving.

It's funny that after all the work though the tightness is still there, though a not as bad. Cycling causes no problems, in fact according to the PH it's good for it (in my case anyway).

I never thought I would get injured considering I don't often go hard, nor do I race or even ride that much...but it does make you open your eyes :eek:
 

sportfactory

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Jul 8, 2005
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noonievut said:
Well it's been over a month since I've had achilles tendonotis and I've had about 5 appointments with the physiotherapist and have been doing stretches and exercises 3 times a day. I still have the tightness from time to time but it has improved significantly, I think primarily due to the stretches, exercises, and physio work I've been receiving.

It's funny that after all the work though the tightness is still there, though a not as bad. Cycling causes no problems, in fact according to the PH it's good for it (in my case anyway).

I never thought I would get injured considering I don't often go hard, nor do I race or even ride that much...but it does make you open your eyes :eek:
Glad you are recovering. Injuries are not reserved for elite athletes. Anyone can get an injury but there a lot of ways to prevent them. I would go to sportfactory.com and put "injury prevention" in the search engine. There are a lot of good articles. You may want to note that you might always have a weak spot in the achilles now and will need to take some extra precaution, especially with proper warm up.