Snakes and Ladders

 

Too many snakes

I was nearly there. After patiently doing the rehab, I had built up gently running 1 mile, then 2 miles, then 3 miles. Saturday I ran/walked 9 leisurely miles and didnt feel any worse.

Monday evening after work I set out to do 5 miles. The first 2 miles felt great, no pain at all. This was the best my achilles had felt and I was enjoying just jogging round feeling injury free. Then for no obvious reason the achilles started to feel a little sore. By mile 4 it was feeling stiff and by mile 5 it was very stiff and a big bit sore.

Major fail and major ensuing depression.  Decided to cancel the accommodation booked for the Moray marathon as there was now no way I would be fit for it.

On reflection I probably changed too many things at once on that Monday evening run. I wore my Brooks Pure Cadence which have a slightly lower heel drop than the big sturdy shoes I had been rehabbing in; I ran entirely on the pavement rather than the softer grass or trail and despite not intending to I was running much faster than I had been up to this stage in my rehab. I would probably have got away with any one of those things but to do all three was a bit careless. I was too impatient. I suppose it just reinforces the old adage about when you think you are ready, wait another day…..

So I am back at the bottom of the board again. Back to the physio and with instructions to use a weighted jacket while exercising to build up strength in my achilles.  After 4 days of being really sore and stiff and not being able to do anything at all, I am on the move again.  At the moment I am only rolling 1’s and 2’s but at least I have managed to move forward a couple of squares by doing some bouncing and some heel drops.  I am hoping that if I can be dilligent in doing the right things I will hit a ladder sometime soon which will shortcut me back up the board. Unfortunately there aren’t too many ladders in recovering from an achilles injury and an awful lot of snakes.

The only good thing is that there is a tried and tested formula for coming back from an achilles problem. Here is my  recipe:

General Principles – DO NOT move on to the next stage unless you have completed what you did yesterday again and have NO reaction.  If you have a reaction have a day’s rest or go back a stage. Shoes with a heel help. Minimalist shoes aggravate the injury in the early days of rehab.

Ice –  especially in the early days. I use disposable ice cube bags as a wrap and also a polystyrene cup of ice for massaging the achilles

Ibuprofen – these are bad things but at least initially the anti-inflammatory does help a little

Compression –  I find that compression helps. I wear compression socks and alternate with a compression bandage round my ankle.

Massage –  physio and self massage help. Gently rubbing a heat rub into the achilles helps reduce the inflammation and get the tendon moving in the sheath.  Foam roller and general stretching also helps.

Calf raises –  these are the first exercise I can manage. Repeat every 30 minutes or whenever I get the chance throughout the day. Start off with using both legs and work up to single leg as the achilles repairs/strengthens. Sets of 10 reps at a time

Heel drops –  these are the exercises which do the job of repairing and strengthening the achilles. Dropping of a step, starting off with two legs and working up to doing it one legged. Build up to sets of 3 x 15 with no pain before proceeding to running. I do it on the stair so I can hold on to the bannister.

Bouncing –  on a mini trampoline, run on the spot. Start with a couple of minutes 3 times a day and build up to 20 minutes or more. When the achilles is nearly ready pushing vigorously with each leg will feel fine..

Running – start by jogging really slowly and walking on short grass no more than 20 metres at a time. Build up to 20 minutes of this.

Progress to the football pitch. Jog the short side, walk the long side for 20-30 minutes.  Do this for 2 sessions with no reaction afterwards. Then move on to jog the long side, walk the short side. Again 2 sessions with no reaction afterwards.

Jog/walk – run 2 mins walk 1, then run 3 mins walk 1, 4/1, then 5/1. Build up time on feet from 30 mins to 1 hour.  Repeat each level at least once  before moving on if there is no reaction.

Run continuously – 2 miles, then 3, then 4/5. Only move on if no reaction.

Run on harder surfaces –  repeat 2, 4, 5 mile runs on pavement.

Finally, start introducing speed but only at 30-60 seconds / mile at a time. No jumping from 12 minute miles to 8 minute miles.

This whole process takes a long time. There is a minimum of 3 weeks in this programme and more likely 4-6 weeks depending on how disciplined I am.

Patience is most definitely the key.

Once running again, it is then time to work on the stability and strength exercises which will correct the biomechanical imbalances which tend to be at the root of achilles problems. I find that if I am going to the gym regularly my achilles is fine. I also suspect from experience that my achilles problems are caused by my computer. I am right handed and slouch when using my computer. This compresses my right hip and gives me tightness in my Glutes, Hip Flexor and SI joint on my right side. This in turn causes tightness and restricted movement when running which I suspect results in compensating movements in the opposite corner from my right hip which is of course my dodgy left achilles.

One thing is certain, an achilles niggle is the most frustrating of injuries.

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