# Achilles Tendonitis cause?



## pjxndvm (May 30, 2004)

For the past two weeks I have noticed my left achilles tendon getting more sore. It does not hurt when I ride, walk or stand, only when I am stretching it. I first noticed it when I was doing some hindu pushups and I was in the up-dog position and the calf/tendon were stretched. I have not taken anything for it yet, but have an appt at the podiatrist tomorrow. I was wondering if someone might be able to tell me the potential causes. I ride about 5-7 hours per week on a computrainer, and do cyclocore workouts most of the time along with this....I have never had a problem before this and the only potential cause I can think of that I did different was a different pedal technique. I am sure many of you saw it Bicycling mag in the past issue where they had the complete pedal stroke, and suggested that as you come over from 12 oclock to 5 oclock, your heel should be angled down 10 degrees and the rest of the arc, it should be angled up 20 degrees. Well, I tried that for a short time on the bike, intermittently, and it just didn't feel right, so I didn't continue. That was about the time I started to notice the problem....

Questions...can I still ride while trying to heal the tendon? Or will I have to stop all togather? I read about the ice, meds and rest...but I don't want this to happen again, so I am looking for potential causes....any help would be appreciated..

Pete Jackson


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## acid_rider (Nov 23, 2004)

*in my case it was*



pjxndvm said:


> For the past two weeks I have noticed my left achilles tendon getting more sore. It does not hurt when I ride, walk or stand, only when I am stretching it. I first noticed it when I was doing some hindu pushups and I was in the up-dog position and the calf/tendon were stretched. I have not taken anything for it yet, but have an appt at the podiatrist tomorrow. I was wondering if someone might be able to tell me the potential causes. I ride about 5-7 hours per week on a computrainer, and do cyclocore workouts most of the time along with this....I have never had a problem before this and the only potential cause I can think of that I did different was a different pedal technique. I am sure many of you saw it Bicycling mag in the past issue where they had the complete pedal stroke, and suggested that as you come over from 12 oclock to 5 oclock, your heel should be angled down 10 degrees and the rest of the arc, it should be angled up 20 degrees. Well, I tried that for a short time on the bike, intermittently, and it just didn't feel right, so I didn't continue. That was about the time I started to notice the problem....
> 
> Questions...can I still ride while trying to heal the tendon? Or will I have to stop all togather? I read about the ice, meds and rest...but I don't want this to happen again, so I am looking for potential causes....any help would be appreciated..
> 
> Pete Jackson


I had this on my left leg too, in my case the cleat(s) were too a bit far forward (i.e. towards nose of shoe). I moved the cleat back about 4-5mm, so that centre of ball of foot is a little ahead of the centre of the pedal axle and problem went away after about 1-2 weeks. It seems to be a bit of a trend nowadays to move the cleats further back towards the heel of a shoe. I know at least 2 top class fitter who tend to slam the cleats far back for their customers and the customers have no complaints. I also read that this helps with "hot feet", and helps with stability, not just achilles. 

If you do this you might have to lower your saddle height to compensate for moving the cleats towards the heel of the shoe. In my case I lowered saddle by ~3-4mm when I moved cleats by ~4-5mm but your experience may vary.


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## pjxndvm (May 30, 2004)

*I will try that*

thank you for the info....I will try it as I doubt the doc will know anything about cleat position. Right now the cleats are set dead center, mainly because I didn't know where the preferred place is, so I went for the middle...


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## pjxndvm (May 30, 2004)

*Update*

FYI: to anyone else who may have achilles tendonitis...doc said cycling or the exercises I do had nothing to do with the problem, it was my walking. I am an overpronator, and the overpronation causes the lateral side of the achilles to stretch. He had previously made me a set of orthotics back in '98, and I had stopped wearing them because the plantar fascitis went away. Said all I had to do was wear the orthotics and pain would be gone in a few days. No meds, ice or rest, cycle all I want. Asked about moving the cleats back and he said that it might eleviate the pain because the moment arm is shortened and therefore putting less stretch on the tendon, however, flexibility of the achilles tendon would decrease. No special exercises or anything. Hope this helps someone else.


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## tjanson (Nov 11, 2006)

*about tendionitis- not cycling related*

I had achilles tendionitis a few years ago going into my senior cross country season -totally interrupting my summer base training....
Anyways, I think it started from running the same direction on the track all the time in the spring, not properly stretching it, and wearing flip flops that made alot of pressure on my heels and not the balls of my feet.
I got better from stopping training and slowly starting it again, massage, acupunture, stretching. The massage/ acupunture therapist noticed I had a really tight muscle near my achilles. Her work on that help alot, and I took special care to stretch the muscles near the tendon alot once I got better. 
Ice...
Advil...


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## pjxndvm (May 30, 2004)

*Update*

FYI- I have done exactly what the podiatrist said about orthotics and wearing them all the time, and there is NO improvement, so I guess this isn't the cause... talked with my dentist who is triathlete and he has had achilles problems in one leg for over a year, tried everything, nothing has worked. I think I am going to break out the DMSO.


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## Spunout (Aug 12, 2002)

Move your cleats back, but at the same time lower your saddle by half of the distance your cleats moved. 

Spin, use lower gears, ice, NSAIDS, etc. Once pain goes away, stretch.

your dentist is giving you orthotic advice?


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## pitt83 (Apr 1, 2003)

*Orthopedist?*

You may want to get an X-ray. I went to my ortho for the same issue. He diagnosed "retro-calcanear bursitis". You have a bursa bewteen the attachment of the achilles and your heel (calcanea). From my symptoms, he's hoping that's my issue. He prescribed ice, stretching, heel lifts in my shoes and ibuprophen as necessary. In the X-ray, you can see some decay and fragments. He says they're below where I'm complaning and not recommending surgery now. Give the gentle approach a chance before he cuts and cleans.

In my exam, he noticed my flexion doesn't go past neutral. That is: I can't lift my toes past stratight. He told me my calves are WAY too tight because they're over developed and I don't stretch enough. This would be a cause of the bursitis.

I'm being diligen about the lifts, icing and strecthing. I feel a bit better after 3 weeks of it; we'll see how it goes.


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## [email protected] (Mar 25, 2007)

First, make sure it is Achilles tendonitis (vs posterior tibialis, bursitis, etc). As the pain is recent, it could be inflamed. Tendinitis is over-diagnosed in general. In most cases of true inflammation, rest will decrease the symptoms. Often, tendonosis is present which is a focal point of tissue breakdown at the cellular level. As for the "cause," overpronation could be one factor. I wouldn't expect this to instantly solve the problem. Orthotics can take several weeks for your body to accommodate. A slight heel lift may decrease the stress on your Achilles, as well. Cleat position is crucial. I work as a Physical Therapist who only sees cyclists and triathletes and this is the first thing I would check. The position must be correct. Then I would evaluate your spin technique. It's hard to read an article and change your spin. I'd recommend finding a local cycling resource that can evaluate your pedal stroke by having you pedal on a Computrainer with spin scan and doing a video analysis so you can watch yourself in side-view and use sEMG biofeedback as needed. Maybe a trial of Powercranks to "wake-up" any lagging musculature. The above advice is good. Ice, and NSAIDs are good if you are in the early inflamed stages. Spinning an easier gear is good advice IF you can control the cadence. Don't pedal any faster than you can maintain proper form. Rest is an important variable, as well. The bottom line is that you need to see a professional who has seen many cases of this. Anecdotal experience form folks who have seen one case (their own) may not provide the best solution, but it's a good way to generate a list of possibilities. Best of luck, feel free to contact me if you have any questions.

Russell Cree, DPT, CSCS
www.HerriottSportsPerformance.com


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## Doggity (Mar 10, 2006)

I dunno if you have Achilles tendonitis, but I got it from upping my miles too quickly when I was a runner. I was told at that time to totally rest it-ie crutches for 10 days to 2 wks, or it'd become chronic, and worsen. I listened, and it's never returned. Good luck.


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## reklar (Mar 15, 2003)

http://www.achillestendon.com/

Short summary ... achilles pain/tendonitis has been mis-diagnosed. It is not inflammation -- NSAIDS will just mask the pain. It is damage to the tissue of the tendon. You need to build your AT back up. Eccentric exercise (negatives) for your achilles will do this. Do assisted heel raises and non assisted heel lowers ... as many as you can, every day for 6-8 weeks. Stay off the bike if the bike is exacerbating the problem. Definitely no running. A heel lift is a good short term idea too as it can take some pressure off the AT from walking around.

I've had AT tendonitis in both legs, and this has what has worked for me. .I'm back playing soccer now, riding, etc., and mostly pain free. An AT rupture is a bad, bad thing from what I've read, so you definitely need to take this seriously.


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## acid_rider (Nov 23, 2004)

*possibly consider wedges*



pjxndvm said:


> FYI: to anyone else who may have achilles tendonitis...doc said cycling or the exercises I do had nothing to do with the problem, it was my walking. I am an overpronator, and the overpronation causes the lateral side of the achilles to stretch. He had previously made me a set of orthotics back in '98, and I had stopped wearing them because the plantar fascitis went away. Said all I had to do was wear the orthotics and pain would be gone in a few days. No meds, ice or rest, cycle all I want. Asked about moving the cleats back and he said that it might eleviate the pain because the moment arm is shortened and therefore putting less stretch on the tendon, however, flexibility of the achilles tendon would decrease. No special exercises or anything. Hope this helps someone else.


if you are overpronating ask your doctor if you have a varus or vulgus forefoot and which one if not both (most likely it is varus as do 80+% of general population). If you do then you also might benefit from using either a LeMond LeWedge or a Specialized Body Geometry Footbed varus/vulgus wedge(s) to help straighten and stabilise your foot on the downstroke. This is in addition to moving your cleats back towards the heel and angling them correctly too - both critical for comfort and power. Varus/Vulgus wedge does not require a saddle height adjustment unlike sliding your cleats which most often does. I find Specialized BG wedges mush easier to handle since they go under your shoe insole unlike LeMond LeWedge which requires to remove the cleat and most often also requires you to get longer bolts too. Otherwise both will do the same job.


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## Dizzy812 (Feb 20, 2007)

Get a pro fit after you see a Sports Med Dr.

For me: Specialized shoes and/or LeMomd Wedges for pronation, and moving cleats back to solve achilles issue (mild tendonitis)


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## pjxndvm (May 30, 2004)

*Thanks for the response*

The achilles pain is still there, I just moved my cleats back and checked positioning (not by a certified fitter, unfortunately) moved my seat back and got a shorter stem. Thanks for the tips, I wil try the exercises also. I just want this to go away.


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## ahhchon (Apr 16, 2007)

[email protected] said:


> First, make sure it is Achilles tendonitis (vs posterior tibialis, bursitis, etc). As the pain is recent, it could be inflamed. Tendinitis is over-diagnosed in general. In most cases of true inflammation, rest will decrease the symptoms. Often, tendonosis is present which is a focal point of tissue breakdown at the cellular level. As for the "cause," overpronation could be one factor. I wouldn't expect this to instantly solve the problem. Orthotics can take several weeks for your body to accommodate. A slight heel lift may decrease the stress on your Achilles, as well. Cleat position is crucial. I work as a Physical Therapist who only sees cyclists and triathletes and this is the first thing I would check. The position must be correct. Then I would evaluate your spin technique. It's hard to read an article and change your spin. I'd recommend finding a local cycling resource that can evaluate your pedal stroke by having you pedal on a Computrainer with spin scan and doing a video analysis so you can watch yourself in side-view and use sEMG biofeedback as needed. Maybe a trial of Powercranks to "wake-up" any lagging musculature. The above advice is good. Ice, and NSAIDs are good if you are in the early inflamed stages. Spinning an easier gear is good advice IF you can control the cadence. Don't pedal any faster than you can maintain proper form. Rest is an important variable, as well. The bottom line is that you need to see a professional who has seen many cases of this. Anecdotal experience form folks who have seen one case (their own) may not provide the best solution, but it's a good way to generate a list of possibilities. Best of luck, feel free to contact me if you have any questions.
> 
> Russell Cree, DPT, CSCS
> www.HerriottSportsPerformance.com


One important thing to note when you are taking advice from people online is that they are just regular joes and may not know a single thing about your injury. 

It's great to see guys like russell read/post on these boards to make sure people don't "self diagnose" too often. It is best to consult your primary care and get a referral to a respectable physical therapist or orthopedic specialist.

john


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## reklar (Mar 15, 2003)

pjxndvm said:


> The achilles pain is still there, I just moved my cleats back and checked positioning (not by a certified fitter, unfortunately) moved my seat back and got a shorter stem. Thanks for the tips, I wil try the exercises also. I just want this to go away.


AT pain is a long term issue! Maybe I had a particularly bad case, but I was off the bike for months before they calmed down enough to ride again. Stay off the bike if that is irritating it until it calms down. You should try to see a good (some are better than others) physical therapist. Deep tissue work and ultrasound helped me considerably and the work the PT did to loosen some tightness in my calves also helped. 

Still, the most important thing is the exercises. Take a look at the research on the site I posted ... In particular here are the two "important" ones according to the site:

Alfredson, H., Pietila, T., Jonsson, P., Lorentzon, R. (1998). Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. American Journal of Sports Medicine 26, 360–66. Key point: After a 12 week training period of eccentric calf exercises, 15 recreational athletes were back to their previous running activities. A control group underwent: rest, anti-inflammatory drugs, change of shoes orthoses, and physical therapy, but did not improve.

Khan, K.M., Cook, J.L., Bonar, F., Harcourt, P., Åstrom, M.(1999). Histopathology of common tendinopathies: Update and implications for clinical management. Sports Medicine 27, 393–408. Key points: a) The vast majority of localized Achilles tendon pain cases are not due to inflammation (Achilles tendonitis), they are due to Achilles tendinosis, b) eccentric strengthening of the calf muscles speeds up the recovery from Achilles tendinosis, and c) an Achilles tendinosis recovery program should include: relative rest, eccentric muscle strengthening, physical therapies, and ice therapy, but not anti-inflammatory medication or cortisone injections.

In addition here are a few articles you should read that I dug up on pub med. The first two are the more important ones, the third is more on the biology side of why it isn't inflamation causing your pain:

Alfredson, H. (2005). The chronic painful Achilles and patellar tendon: research on basic biology and treatment. Scand J Med Sci Sports 15: 252-259.

Roos, Engstrom, Lagerquist, Soderberg. (2004). Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy - a randomized trial with 1-year follow-up. Scand J Med Sci Sports. 2004: 14: 286-295.

Alfredson, Ohberg (2005). Chronic tendon pain: no tendinitis, but high levels of glutamate and a vasculoneural ingrowth - implications for a new treatment? Therapy (2005): 2(3), 387-392.

Much like the case of Pantani (CCKMP), here NSAIDs CKMP in the case of AT problems.  

Good luck! :thumbsup:


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## E. Tage Larsen (Dec 25, 2005)

I blew out my left achilles doing yoga a few years back. In my case it was Down-Dog. It cost me a season away from the bike. Three years later and a lot of different treatments and diagnosis and i'm back on the road. I can't say that any one thing improved my condition more than rest and stretching.

Good luck with the tendon. It's not a fun place to be in.


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## nepbug (Jun 6, 2006)

I've had Achilles Tendonitis in my right heel for a year now. It was a result of bad biomechanics (hips out of alignment and inflexibility). After some serious increases in calf flexibility and the strengthening exercises noted above (my PT has me do slow raises and lowerings though) I'm feeling pretty good.

I was able to cycle throughout, but I have moved my cleats back to help out with the problem. I've just got back to running.

This thread has reminded me that I've been slacking on my exercises lately and I better do them, thanks.


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## SlowButSteady (Jan 14, 2014)

*I agree with reklar: http://achillestendon.com/ has been a very helpful web site.*



reklar said:


> Everything About Achilles Tendons
> 
> Short summary ... achilles pain/tendonitis has been mis-diagnosed. It is not inflammation -- NSAIDS will just mask the pain. It is damage to the tissue of the tendon. You need to build your AT back up. Eccentric exercise (negatives) for your achilles will do this. Do assisted heel raises and non assisted heel lowers ... as many as you can, every day for 6-8 weeks. Stay off the bike if the bike is exacerbating the problem. Definitely no running. A heel lift is a good short term idea too as it can take some pressure off the AT from walking around.
> 
> I've had AT tendonitis in both legs, and this has what has worked for me. .I'm back playing soccer now, riding, etc., and mostly pain free. An AT rupture is a bad, bad thing from what I've read, so you definitely need to take this seriously.


_______________

The site is based on a ton of medical research, but is easy to understand and follow.


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