I heard my Achilles with cycling I have rested for 3 weeks was at the physio 2 times I ride today but still the pain is there in the Achilles

Glad it was helpful!

Thanks for watching, and good luck with your recovery!

Hi Sujoy, If you need help with this, you are welcome to book a video consultation with one of our physiotherapists, who can do an assessment of your injury and provide you with a personalised rehab plan. More info: www.treatmyachilles.com/

Thanks for sharing, and good luck with your recovery!

Hello Tina I am telling you in all sincerity to completely cure your problem you need shockwave therapy it works 100% everytime everything else is fluf I feel when it comes to this problem 3 sessions once weekly from a physio that has the machine , google shockwave therapy and achilles tendonitis good luck

I hope you are better now? I love dancing, I'm 51 and a doctor mindlessly prescribed Levofloxacin which caused me tendonitis. It's one month ago and I'm still working through it (had before all this paid for a walking holiday so was worried how that will work) but ! I'm hopeful 🙏

Tendinopathy goes through stages - it sounds like you're in the reactive phase which (if you've never had tendon pain there before) means that your tendon is acutely irritated. If you allow it to properly settle down, it will usually recover relatively quickly and you have no real risk of rupture. However, if you continue to irritate it and it starts dragging on for several months, then it enters a disrepair and eventually degeneration phase where the tendon starts to lose strength - then you have an increased risk of rupture. In your case, you don't yet need rehab exercises - you need to let it rest first and then start with super gentle moves. If you want help with getting back to your normal activities, this is something that our team of physios can assess and help you with via video call. You can read more about how the online consultations work here: www.treatmyachilles.com/treatment-packages

You're welcome, and good luck with your recovery!

You're welcome!

The terms tendonosis, tendonitis and tendinopathy all refer to the same thing - it really is just a matter of scientists not agreeing about the finer details about the amount of inflammation involved - we discussed the different terms in detail in this article: www.treatmyachilles.com/post/what-s-the-difference-between-achilles-tendonitis-tendinosis-tendinopathy-and-tendinitis

Glad it was helpful!

Glad it was helpful!

Glad it was helpful!

So glad!

You're welcome, and good luck with your recovery!

Glad it was helpful!

Thank you! x

Glad it was helpful!

You are welcome!

So glad!

She did

kzfaq.info/get/bejne/o72FrdaCrrLeh3U.html

There isn't any microtears when you have tendonitis - that's nonsense people tell you on the internet - I've made a video where I explain this: kzfaq.info/get/bejne/rchxZKWl26i5nXU.html But if you're still worried about this, perhaps consulting one of our team can help - our team of physios can assess you and provide a rehab plan via video call. You can read more about how the online consultations work here: www.treatmyachilles.com

Very welcome!

You're welcome!

You're welcome!

Very welcome

Glad to hear that!

Don't know - it depends on your Achilles's stage of recovery and tolerance to load and what type of exercises you are doing or what the goal of the session is.

Glad you think so!

Welcome!

You're welcome 😊

I discuss all the types of exercises that one can do in this video, so I can't tell which ones can work for you because it will depend on how sensitive your tendon is, how strong it is and how it reacts to specific movements.

Glad it was helpful!

Thanks for sharing. Here's our article with some tips for people whose job makes it difficult for them to reduce the load on their tendon. www.treatmyachilles.com/post/achilles-tendonitis-rehab-what-if-you-can-t-rest-your-tendon

Wow cycling actually helps? I never would have guessed. Thanks for the tip.

It means that it likely: 1. Doesn't like being stretched and will feel worse if you walk around in flat shoes or barefoot 2. You may be at increased risk of tearing it further if you play sports that involve quick movements like paddle ball because it may not be strong enough to handle it. So, make sure you strengthen it properly before going back to paddle ball.

The rule with rehab and exercise is usually that it is OK to do as long as: 1. It only causes a slight discomfort while doing it, AND 2. It does not cause an increase in your pain and swelling that lasts for more than 24 hours So if your tendon pain is still increased above normal 24 hours after the session then perhaps you need to make it a bit easier. The other thing to keep in mind is that when you've had pain for more than 3 months, the body starts getting good at creating pain for no reason - it becomes oversensitive. So the random burning that only lasts for a few minutes likely falls into that category of pain that doesn't really mean anything but is just being caused because the system is oversensitive. How you react to it sounds fine.

That's why, when we set targets for our patients' rehab exercises we use % of bodyweight. So we will for instance get them to strengthen until they can do their exercises with a weight that is equal to 10% of their bodyweight (that would be 6kg for a person who weighs 60kg and 10kg for a person who weighs 100kg) but their targets are also influenced by the type of sport they want to get back to.

It's impossible for her to cover everyone's differences. She mentioned seated calf raises with possible addition of weights.

Thank you so much for your support.

The rule for rehab and any activity when recovering from this injury is usually that it is OK to do as long as: 1. It doesn't cause a significant increase in your symptoms during or in the 24 hours after the workout or activity 2. And any increased pain or discomfort should settle within about 24 hours

@@TreatMyAchilles Thank you.

"At low rates of loading, tendons are more viscous or ductile and, consequently, can absorb more energy compared to high loading rates. At high rates of loading, tendons become more brittle and absorb less energy, but they are more effective at transferring loads.Therefore, tendon load can be increased in 2 ways when prescribing exercise: by the external load or by the speed of movement" How do I make sure I'm not starting with way too much of a weight for it to be built viscous ductile?

Oh you are funny 🤣

Sorry you were saying something about beating SA in the RWC ……….!!😅

Hi there, Here are two videos of ours that may answer your questions: Compression socks: kzfaq.info/get/bejne/ebCdaNqq07_Ig2Q.html Blood flow: kzfaq.info/get/bejne/os5gfKWL0tebm58.html Hope it helps!

Sounds like you're likely overdoing your strength exercises - if they are not pitched at the correct level, they aren't useful. They should not cause pain while doing them. This video may have more appropriate advice: kzfaq.info/get/bejne/aNmkpZx32bi4e5c.html If you want more specific rehab advice and help with getting back to your normal activities, this is something that our team of physios can help you with via video call. You can read more about how the online consultations work here: www.treatmyachilles.com

This has actually been investigated and tight calf muscles is not something that has been found to contribute to this condition - it is more that they are a symptom warning that something else is going on and the calf and Achilles are not in good condition. However, research studies report on large cohorts and it is not to say that your case is different - it might well be that the levoquin caused a change in your muscle tissue because it seems to affect all tissues.

Thanks for your help!@@TreatMyAchilles

Hematomas can cause calcifications in muscles but I am not sure about tendons - it's not something that I've come across but I think it is just more rare to get a hematoma in a tendon. We generally knock or hit our muscles.

Thank you for your reply- the hematoma is in the medial head of the gastrocnemius, but it happened as I was dealing with the tendonosis, I wonder if I overdid my rehab for the tendon issue and caused the hematoma. Makes the rehab a little more tricky!

Glad it was helpful!

Not sure if you will see my other comment, so also leaving it here: It can really help to change to a shoe with a small heel on it or place heel lifting inserts into your shoes to take the strain off your Achilles while you walk. This video explains about it: kzfaq.info/get/bejne/mdiqpbFhsNnJh5s.html Maybe you can also benefit from this video where I summarize the best treatment options: kzfaq.info/get/bejne/fpeemcqGlsfRpps.html If you wanted help figuring it out, this is something that our team of physios can help you with via video call. You can read more about how the online consultations work here: www.treatmyachilles.com/

Yes, those are all signs of Achilles tendinopathy or tendonitis. It is typical for the tendon during the early stages to feel better with exercise but then often more uncomfortable later - I've discussed it in more detail in this video: kzfaq.info/get/bejne/mbR_q8dk3Jmbe2Q.html

It's not possible to know what is right for your case without assessing you. The exercises has to be tailored to your specific case and severity - otherwise they can make your pain worse. If you wanted tailored rehab advice and help with getting back to your normal activities, this is something that our team of physios can help you with via video call. You can read more about how the online consultations work here: www.treatmyachilles.com

It is difficult to advise without actually assessing you but here are 2 thoughts that spring to mind: 1. No, you should not wait for the tendon to be the same as the other before doing exercise because it is the exercises that will get it to be the same 2. However, to be helpful the exercises should be pitched at the right level for your tendon and it sounds as if yours may be a bit too much (either how often you do them, or how many, or with how much weight) so I do think you likely need to adjust your rehab programme to be less intense or perhaps follow a different patter. So I would suggest that you book a review with your physio to have it assessed and adjusted. Creating plans are not an exact science and they have to be adjusted according to how the tendon reacts. If you wanted more specific rehab advice and help with getting back to your normal activities, this is something that our team of physios can help you with via video call. You can read more about how the online consultations work here: www.treatmyachilles.com/

@@TreatMyAchilles thank you!

The thickness is caused by the change in the structure of the tendon - the evidence for whether you can turn the structural change around is contradictory with some studies showing you may be able to and others showing not really. As for how to turn it around - the treatments that can affect healing include relative rest, strength training, perhaps PRP (although evidence still not very strong), and all of this applied over a long enough period - several months rather than weeks. You can find a summary of the treatments supported by research here: kzfaq.info/get/bejne/fpeemcqGlsfRpps.html and a discussion about how the tendon is affected structurally here under the symptoms chapter: kzfaq.info/get/bejne/mbR_q8dk3Jmbe2Q.html

@@TreatMyAchilles Very helpful. Thank you!

@@TreatMyAchilles Thank you! If the thickening remains, is there evidence that this impacts athletic performance adversely?

Hormonal yes - Menopause causes issues: kzfaq.info/get/bejne/pM6jeNWB2ae6qmQ.html I also recently found an article that showed that testosterone replacement therapy may increase risk of tendon injuries but I've not had time to review it properly.

That will depend on your tendon's tolerance and what activities you want to get back to and what type of rehab plan you are following. It is usually best to start with no weight and then slowly build it up. If you're a runner we usually build it up to at least 20% of your bodyweight e.g. 12kg in your case but it depends - if we've found that a more high load plan is better then you may be working at a 8 rep max (so a weight that fatigues your within 8 reps), but building to that over 12 weeks and starting only with 15 rep max during initial weeks - it really just depends on how your tendon is responding to different approaches.

It really depends on how your body reacts so go on what you observe but often in case of Cipro it is best to only train x2 a week with x2 days between sessions. However, it the exercises are still low load, then x3 a week with at least 1 full recovery day can sometimes be OK.

@@TreatMyAchilles Thank you Maryke, I'm so grateful. :)

There are plenty of different ways to get back to running and the 20% target doesn't work for everyone. It sounds like you already have a pretty strong Achilles but that it gets sensitive when you load it heavy. 1. It may be that yours does better from this point by simply easing slowly back into sport 2. or it may be that you need to simply spend a lot more time working on using 12.5kg 3. or that you should perhaps start with a lot fewer reps when going to 15kg. 4. Or another option is to switch to doing more plyometric exercises instead. 5. It may also be that you are simply trying too hard with the exercises and forcing it too low over the step etc. hence annoying it. Hope those options give you some ideas to try. If you want more specific rehab advice and help with getting back to your normal activities, this is something that our team of physios can assess and help you with via video call. You can read more about how the online consultations work here: www.treatmyachilles.com/treatment-packages

To give you an example - my colleague Steph also found the high load stuff just made hers worse - here's how she managed the final part of getting back to running www.treatmyachilles.com/post/i-treated-hundreds-of-patients-for-a-painful-achilles-and-then-it-happened-to-me

If you feel pain the next day it means that the total load (exercises + walking) was too much the previous day. It does not matter what time of day you do the exercises because the load is added together. So you have to reduce either your walking or the exercises or both a little until you find the correct balance.

Yes, for some patients we do that because it makes them feel more comfortable. But not everyone tolerates that protocol - some people do better just doing the high load twice a week and then doing other activities like walking or swimming or cycling on other days

Hi there, Here's our video on squats while having an Achilles tendon injury: kzfaq.info/get/bejne/nc9dp9mg2N6laJs.html

Thanks!

It sounds like you managed your insertional tendinopathy very well. It is absolutely fine to keep as active as possible as long as your symptoms are improving over time and you don't find the sport you do is aggravating it further. The rule with rehab and exercise is usually that it is OK to do as long as: 1. It only causes a slight discomfort while doing it, AND 2. It does not cause an increase in your pain and swelling that lasts for more than 24 hours It is only when you continue to aggravate it to a level that it hurts more for several days and just push through pain while training etc. that you end up increasing risk of tearing.

@@TreatMyAchilles thank you so much! What I find is more than a little but not a lot of pain when I play, but by 24 hours it is back to just discomfort. So I think I need to take some time off but probably can ease back in as you say. Thank you again!

It's in the video's Description, but here it is for you: kzfaq.info/get/bejne/o72FrdaCrrLeh3U.html

You need to check with your physio because it depends on what you've built up to with your rehab.

I would look first at what shoes you wear for work and if you can change them to be more like your shoes that you can walk in. Placing heel lifts in may help kzfaq.info/get/bejne/mdiqpbFhsNnJh5s.html

It really depends on how sensitive your tendon is - most people with mid-portion Achilles tendonitis are OK with cycling but some cases of inserional tendonitis can get more painful through it. So best is to test a gentle session and see. If it is an easy session and you don't feel that it works your calves much, then you can do it on the same day as your exercises. Although, I would recommend that when you do it the first time, do it on its own, otherwise you wont know if it is the cycling or the exercises that irritate your tendon if it increases pain.

Cases like yours usually does best with a individualized approach to rehab where the exercises are adapted to what suits you. It also sounds as if you can benefit from wearing shoes that have a raised heel + heel lift inserts - Alison discusses them here: kzfaq.info/get/bejne/mdiqpbFhsNnJh5s.html If you wanted help with figuring out your rehab and getting back to your normal activities, this is something that our team of physios can help you with via video call. You can read more about how the online consultations work here: www.treatmyachilles.com/

It is, but you need to avoid the positions that stretch or work the tendon - Ali has just made a video about how to adapt yoga poses that will be released early in March and the same concepts apply to Pilates as well.

Hi Jole, Unfortunately it is not possible to tell when someone can return to playing their sport without having done an in-depth assessment of their injury and surrounding circumstances.

It actually sounds as if you're pitching everything at a very good level: 1. Your Achilles is strong if that is the rehab you have built up to = rupture risk is super low, especially since you are sensible with easing into basketball 2. The way your pain is reacting, it is showing us that your pain system is still getting sensitized for 24 hours but that you're actually doing it good because you then feel better. So pain is getting triggered but it is not causing injury. Bear in mind that I don't know you and your situation fully and my advice may thus not be correct, but I think if you continue at the same level for a couple of weeks and not increase training intensity or frequency too quickly (allow it to settle into it) then you will make a good recovery from here. Try to picture the training load in your rehab session vs. how much your body has to do in your training session - the jump is quite large = why the body will take a bit of time to adapt to it even at 70%. If you ever did want more tailored advice for your situation, you are welcome to consult one of the team via video call - you can read more about it here: www.treatmyachilles.com/

@@TreatMyAchilles hmmmmm, thanks for the reply and all the work that you guys have done. I will try to reach out. Thank you so much.

I'm sorry that you couldn't access our website. Could you please try again? www.treatmyachilles.com/

Icing is actually not something we recommend to do routinely. I find that using gentle movements work better first thing in the morning to get the tendon going and then during the day using the right shoes and load management. If a patient do have to ice for pain management, it is usually only twice a day but there is no best time - it depends on when then feel they need it. I've discussed ice and heat in this video: kzfaq.info/get/bejne/jb6Clc9ovcCrZWQ.html

@@TreatMyAchilles Once again thank you so much…such great information that I really appreciate😀

Unfortunately it's not possible to say without knowing which bursa is involved - there are quite a few of them in the ankle.

For Achilles the pain has to be on the Achilles tendon - it can also refer into the soleus but if the tendon is not painful when pressed or squeezed it is likely not going to be the Achilles. Remember to compare it to the other leg because squeezing the tendon is usually a bit tender - so check how it feels compared to the uninjured side. But the only way to know for sure is to have a scan - ultrasound is usually good

I would get it checked out - it does not sound like a tendinopathy but it may be a partial tear or referred pain from somewhere else.

​@@TreatMyAchilles Thank you for response :-) So for those who might be interested. Ultrasound scan showed small achilles tendonitis. So if it's caught early, it can probably show these symptoms. Recommendation from doctor is rest and 8x ultra sound treatment. I will apply relative rest and slowly start with proggresive loading with excercises from your videos.

Hi there, The treatment for insertional Achilles tendinitis is somewhat different. Here's our video about it: kzfaq.info/get/bejne/o72FrdaCrrLeh3U.html

This video contains lots of different exercises and some of them will be safe and others not. It is usually safe to start calf raises while your Achilles is still swollen but they have to be at the correct level for your current strength which can only be established through getting you do movement tests and also listening to how your tendon reacts to normal daily tasks. So it is always best to have your exercises prescribed by a physio or similar who has assessed you. If you wanted more specific rehab advice and help with getting back to your normal activities, this is something that our team of physios can help you with via video call. You can read more about how the online consultations work here: www.treatmyachilles.com/

I think you first need to get it properly diagnosed because what you are describing does not sound like typical Achilles tendonitis/tendinopathy symptoms. It sounds more like a nerve that is irritated.

How is your achilles? Was it nerve? I think that I have the same problem. Tendon is OK in the morning, pain while walking, which settles down. But my injury occured at the end of run (mild pain, which was worse the day after)

Not really - you can find more information about treatment for bursitis here: kzfaq.info/get/bejne/eJd8gK6oqsCZnaM.html

@@TreatMyAchilles That is an excellent vlog on the basics of retrocalcaneal bursa. So there is really no exercises to help it along, but I understand. What are your thought about PRP injections for the bursa? Seems like it would be much safer than cortisone.

As far as I know PRP is used for regenerating things that don't want to heal (kickstarts healing process) but with bursitis it is usually chronic inflammation that is the problem so I am not sure it will be of much use. However, I am not an expert on PRP so best to ask this question to a doctor who is.

The pain usually disappears but the lump may or may not disappear.

In my experience that extra sensitivity when you touch it remains for long after it has healed - it is not related to the injury but actually just a hangover from it - if you can play tennis for 10 hours your Achilles is strong and there is truly no reason to worry about it. I often have to tell patients to stop poking their tendons because it just makes you anxious and the more anxious your become the longer it will stay sensitive for - it's related to this video about how pain is created: kzfaq.info/get/bejne/fKd7dbqIvrvKoYk.html

Thank you for your support!