That title (a Joe Cocker song) is a pun, by the way.
I’m writing this exactly a month since the last episode. Back then, things were going quite well with “Project Rehab”, as I’m beginning to call the long term process to mend my shoulder and start racing again. How things change. Well, partly so. Work on rehabbing my left shoulder is still going well. I’ll come back to that later. However, I have other fish to fry.
I made a passing, and possibly prophetic, reference to my achilles tendons in my last blog. I was concerned about doing more running over longer distances, given that, being a sprinter all these years, my legs are simply not those of a distance runner. They work differently, to achieve different results. Thus, building in a weekly 5km Parkrun to my regime, to try to help compensate for some of the other aerobic training my damaged shoulder won’t let me do, was always going to be a little bit of a risk.
My left achilles lasted just three parkruns. I was just getting used to losing myself in the crowd every Saturday morning, when a niggle in my heel walking back to the car alerted me to trouble I’d not really anticipated even five minutes earlier when I’d had my barcode scanned. Home, twenty minutes later, and I was in pain! I’ve had achilles tendon problems occasionally in the past. This time it was strange. The main body of the achilles tendon leading up to my calf seemed fine. No inflammation or pain in it. However, on and around my heelbone there were areas I could hardly bear to touch. The worst was on the outside edge of the heelbone. My self-diagnosis was of some kind of calcaneal bursitis. Dr Google appeared to agree, and recommended elevation and ice.
By the late afternoon, it was becoming apparent that the ice wasn’t doing very much. I’d been trying to avoid frostbite, of course, and conceded I needed to give it more time. Walking was agony. Almost any exploration and movement to try to define the precise area of damage was futile. The whole heel area hurt, though it wasn’t even that much inflamed.
Now, one important aspect of “Project Rehab” is patience. I’m not rushing my shoulder to mend, so why rush my achilles? A few days of reading about the causes of achilles tendinitis – or, as we’re told we should call it now, achilles tendinopathy – taught me a lot about its causes. I learned enough to know that, with my recent history, I was a sure-fire target. What I didn’t really mug up on that much were the different types of achilles problem. A bad omission. I’d never heard of “insertion-point” tendinopathy/tendinitis, and it was three weeks before I discovered it. It had, of course, discovered me three weeks earlier.
As you can read in that rather good article, it’s damage to the point of attachment of the achilles tendon to the heelbone, leading to persistent pain, but notoriously little inflammation. Like most of the achilles, the blood supply is poor, and the micro-tears of the damage don’t show bruising. Despite tending to my heel in the time-honoured text book ways of dealing with achilles problems (lots of calf stretching, eccentric heel drop exercises etc), I’d not made any headway. The only activities I could reliably do without pain during or after were spinning sessions on a static bike at the gym. This had become my sole aerobic activity. That it was pain free was a mystery to me. I was reaching the point where I thought I might have picked up a stress fracture of the heelbone itself. I held on for another week, until my next scheduled appointment with my chiro to check on my shoulder, and threw the achilles issue into the overall fitness equation.
Yes, it was an insertion point problem. Rehab based on longitudinal stretching of the calf or the heel was not recommended at all. The name of the game was to build stress tolerance slowly, mostly by a variety of different isometric challenges. I did some recommended reading, and found that for three whole weeks, I’d been treating my achilles all wrong! What was needed was a complete absence of dorsiflection-type stretching (as in toes up, heel down), including traditional calf stretches. The achilles needed compressing, not stretching. Heel lowers were fine provided they were onto a flat surface, not over a drop. Spinning had worked precisely because my foot position while pedalling compressed the tendon, rather than stretching it. I wasn’t surprised to learn that cyclists also have notoriously tight calf muscles!
I’m chastened, but back on the case!
My shoulder now has pretty much complete pain-free movement in all directions, including under the moderate tension of an elastic dynaband. Maintaining that while aiming to add stability is a next target. I picked up a few tips for some additional exercises from shot-putter friends recently. They suffer badly with shoulder problems, as you’d expect. However, I soon found that to do the exercises described to me needed a bigger physique and a far stronger shoulder structure than mine. They’ll make for some good challenges later on in Project Rehab, when my targets turn to rebuilding strength.
So, I’m behind schedule in one sense, but glad I’ve chosen to give this thing the luxury of time. And time, as, as we’re always being told, the great healer.