Old 09-07-10, 08:49 PM
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I had what I think was a bursitis where the achilles tendon inserts into the heel bone for about 3 years, so not the same as you but maybe this advice could apply. I was taking NSAIDS pretty much every day. I never had significant bike pain in that area, but running and even walking was painful. I went to a physical therapist and he thought it was a combination of poor biomechanics and lack of strength to support the abnormality. I think I had sprained my ankle a few too many times, which led to my foot/leg adapting in a way that was causing me pain. I also had pain in the large tendon behind and laterally to the knee after my first century. It lasted about 6 months and really hurt to ride. More on this later...

Anyways, the treatment plan for both issues was essentially to strengthen up the muscles involved. In my case, doing calf raises and strengthening the gastrocnemius (calf muscle) helped significantly. With a backpack filled with about 25 pounds of stuff, I stand with more than half of one foot hanging over the edge of a step (other foot is off the ground), and while supporting myself by holding a wall or something, I raise up as high as I can go, then dip my heel below the plane of the step, and repeat. I started with using two legs to rise up, then drop with one leg, but now my calves are strong enough to do it all on one leg. I do this every day, usually while waiting for the train. People sometimes look at me weird, but it's a great time to do it.

At first I thought it was counterintuitive to stress the muscle/tendons where the pain was, because my achilles tendon was what was hurting me, but after a little while, the exercises started to feel good. I also started using Superfeet insoles because the insole helped to immobilize the foot into a better position. These insoles also make riding with my clipless shoes much more comfortable than the stock insoles. The calf raises not only lessened the bursitis pain during running and walking, but also ended the tendon pain behind my knee. My point (and the therapist) is that biomechanically, pain in one area could be entirely due to a weakness somewhere else. Unfortunately, the other idea the therapist often stressed was that the human body is ridiculously complicated and it's very difficult to determine why the problem you're having arises.

The very best option is to see a physical therapist if you can. You might need a referral from a physician, but in my experience, their advice is usually useless; "You should rest it, do some stretching, and take NSAIDS" (no ****). It sounds like you spoke to someone in the know about active release techniques, but consider seeing someone else that can address the inflammation and give you exercises that would be safe for your condition.

If seeing a trainer is not an option, I would consider doing some leg strengthening exercises if you can somehow bring down the inflammation. I didn't have significant inflammation, which I think is more common for chronic injuries. It just hurt. How do you know your paratenon is actually full-on inflamed? Consider squats, lunges, stair climbing (with or without weights), calf raises, standing hamstring curls (stand on one leg, bring heel to butt), etc.. But I'm not a trained professional so don't go crazy with it. If the pain feels wrong, then please stop. I had pain when I started with the calf raises, but it felt like a good pain as in I was working the muscles and tendons, if that makes any sense. It also served the function of stretching the tendon. A doctor also said to consider supplements like fish oil and multivitamins. Maybe even glucosamine and chondroitin. Worst case scenario, they don't work at all, but I don't think these would hurt anything.

Hope you get better soon. I know how much it sucks not being able to ride due to pain (stupid behind the knee tendon).

Last edited by vega2614; 09-08-10 at 12:15 AM.
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