Well this is embarrassing. My whole RMT career has been dedicated to figuring out running injuries. And by now I’ve probably had every running injury known to man, most recently the dreaded Insertional Achilles Tendinopathy. My bingo card is full. The lifetime prevalence of Achilles Tendinopathy is 52% in middle- and long-distance runners. It took 23 years to catch me.
It’s behaving exactly as expected, yet it’s still extremely tedious. After 12 weeks of no running I’m back to run/walk with minimal symptoms, and should probably be able to run continuously for 10 minutes by the end of next week.
What I wish I’d done differently:
The main takeaway is to progress in smaller increments than you think are safe. For example: I started with double leg isometric holds barefoot, then slow double leg calf raises, then attempted single leg a few times which caused 2 to 3 day flares each time. Then I tried single leg in runners with heel lifts which still caused flares, and then eccentric only (up with both legs and down with the injured leg) with the same result (now getting confused and exasperated).
What I should’ve done: continue the double leg calf raises but add dumbbells. I don’t know why I didn’t think of this. Even barefoot was fine. This was the bridge to tolerating single leg.
Footwear: I wore high heeled boots for the whole month of February, and planned to wean onto my 12 mm drop runners, but that was too aggressive and I needed 50 mm lifts. I’m still wearing these full time including while running. I’ll need to wean off the lifts before trail running or hiking, and expect this to take several weeks. Irritated tendons REALLY hate being compressed.
I’m often asked why I keep running when I’m so frequently injured. I don’t know what to say to that. It’s never occurred to me to stop. I could have just as much pain from other activities, and then I’d have to find a workaround. Shrinking the envelope of function is not the answer; learning to manage load and tolerate uncertainty is. The only certain thing is that injury is always a possibility, and that I’m a better clinician for it.
If you’ve read this far I hope it’s helpful for you and your patients/clients. It’s been frustrating as hell but it’s a textbook case. Go slower than you think you need to and you’ll get there.