yaks_rule

I signed up for a bicycle tour in France this July (will beheld in conjunction with the Tour de France), which is a huge bucketlist dreamof mine since I started riding. Unfortunately, I developed quadriceps tendonitis earlier this year. Idid months of PT, rested for a couple of weeks, reduced the volume of my riding,etc.A couple of weeks I ago I finallyraised my seat a bit and the quad felt better, but then I started to develop amild case of plantar fasciitis and Achilles tendonitis.I lowered my seat a bit and the plantar fasciitiswent away, but the achillies tendonitis stayed.I put a heel wedged in my cycling shoe and that has helped, but sometimesI get a bit of pain in my Achilles. Ican’t push a big gear without getting pain in both my quad and my Achilles.Normally, I would take it easy with theriding until all my tendonitis werebetter, but that isn’t an option with the tour coming up in about 6weeks.

My question is how much should I train? I reduced the volume of my training a greatdeal. I use to ride 2-3 times a week with a 19 mile hilly ride after work duringthe week, 50-60 mile ride on theweekend, and a 8 mile mtn bike ride or 5-8 mile hike the other day of theweekend, and a 45 min hill repeat on astationary bike during the week.Rightnow, I am only riding 2/week.I did upmy after work ride to 24 miles and I am still doing 50-60 miles on the weekend,but that is it.No weekend mtn biking orhiking.I will do a 36 mile ride with 3mountains this weekend, but I had hope to increase that mileage.I feel like I am so behind the power curvefor this ride.I don’t’ feel like I havelost too much fitness and my endurance feels about the same.

Should I try to increase the volume or stick with the 2/week. Maybe I should stick with the 2/week andincrease the distances or intensities of those rides and then rest/stretchbetween rides.

I want to increase the volume so I will enjoy the rides, butI don’t want to risk further injury. Thetour guide did say that I could modify the rides based on my injury.I really want to make it up alp d’huez, but Iwant to also enjoy it as well.

jefnvk

Really a question best suited for your medical team, on here you're likely to get every opinion ranging from "your long term health is important, skip the ride completely" to "harden up and quit whining".

Did your PT folks give you any sort of guidance? They'd be the first ones I'd be talking to, as their specialty is exactly using exercise to repair injury. Also, do you know your bike is properly fit to you? If not, the money spent on that may go a long way to helping your situation, if you are already finding some changes from your base setup to help or hurt.

Viich

I dealt with Achilles tendonitis as a runner. Nothing really heals it but rest and corrective exercises, but I managed to keep running for a while by backing off on intensity - as you mentioned in 'pushing the big gear'. Just don't. Do the ride slower than you would if you were healthy. It might actually be more enjoyable than if you hammer it.

Ty0604

I had Achilles tendonitis in my left ankle during my cross country tour last year. It developed very early on. About 4 days into my 3+ month long tour. I still have it to this day. Some days it was really bad. When I flexed my ankle it sounded like a dry piston rubbing. It was nasty sound.

Anyway, my doctor gave me Meloxicam and I survived off of that the rest of my trip. Now when I bike I take any type of Naproxen. One in the morning and one at night. Even the generic store brand (50 for maybe $3) works well. And boy do I notice the days where I forget to take it. Remember that it takes 15-30 minutes for your body to absorb the medication so don't take it and get on the bike right away. It should be taken right away and by the time you're ready to break camp it'll be working.

yaks_rule

My PT told me to just keep stretching it. She told me to ease off if it starts hurting when riding and spin the gears. Right now, I really don't wont to tinker with my bike fit. When I initially rose the seat, my back also started to hurt so I had to raise the handle bars. Perhaps, when I come back off the tour I will go get a bike fit.

yaks_rule

Unfortunately, I have a really bad case of Gastroesphogeal Reflux Disease and can not take any type of NSAIDs. I talked with my GI doc and he said I will never be able to take NSAIDs and there is no anti-inflammatory drug that isn't an NSAID. The only thing I can take is Tylenol and it helps with the pain, but not the inflammation.

Ty0604

That's too bad. I don't know anything about that disease. Does this limit your ability to use an anti-inflammatory cream/gel like Voltaren since it's not ingested?

https://www.drugs.com/voltaren-gel.html

work4bike

It must be a really bad case of AT, because I'm currently battling this from all my running, but it doesn't even bother me on a bike. I've started doing a lot of sprinting runs and that really does add much stress to the body.

BTW, how old are you? I'm 52 and I've had to deal a lot with injuries over the years and I've found that weightlifting, followed by plyometric exercises are indispensable in maintaining a healthy musculoskeletal system. Unfortunately I mistakenly thought for a long time that since I hike and bike a lot that I didn't need to do lower-body exercises. Absolutely Wrong!!

79pmooney

I partially tore both Achilles several years ago, Went to a PT. the order was to stretch them and I was given a series of exercises. She also encouraged me to get some hard foam blocks like she had. Instead I made my own. Really easy. Nail or screw a 1 X 4 to a 2 X 4. Bevel the top edge about 1/2" across and 3/16" down (so with your heel on the floor and your ball is roughly flat on the bevel). Easy with a plane or table saw. Any grinder would also work. I have made both short (6") ones to do one leg at a time and long (14") ones to do both at the same time. (Make an extra long one, then just cut it into a bunch of blocks.)

It looks like:
__________________
/ . . . . . . . . . . . . . \
l . . . . . . . . . . . . . .l . . (2 X 4)
l . . . . . . . . . . . . . .l
---------------------
l . . . . . . . . . . . . . .l . . (1 X 4)
---------------------
except the bevels are much shallower (Ignore the ". . . .". The software doesn't acknowledge spaces.)

Now, every morning I grind my coffee by hand, 350 revolutions. While I do it I stretch one Achilles for 100 revs, then lean forward and move the stretch up to my hamstrings for 75, then repeat on the other leg. This works really well. Make or get yourself some blocks and start doing this. Stretching, slowly, gradually, regularly is the secret. I have those blocks kicking around on the floor by my bathroom sink and the kitchen sink as well as my coffee station.

I now almost never have issues with my Achilles, riding or otherwise. And when I do, it is always because I have not been stretching enough.

Ben

yaks_rule

[QUOTE=Ty0604;19639857]That's too bad. I don't know anything about that disease. Does this limit your ability to use an anti-inflammatory cream/gel like Voltaren since it's not ingested?



Yeah the GERDS sucks. I eventually will have a surgery to help it, but my GI doc says even after the surgery, I can't take NSAIDs. I can put creams on my skin. I just can't ingest it.

work4bike

I never take NSAIDs of any type, you're not missing much. Exercise is the best medicine.

yaks_rule

I'm about to turn 52 myself and I have had all sorts of injuries over the years. It took me years to get over a tight IT band and I had to have shoulder surgery for a kayaking injury. My PT knows me and my body well because I see him every few years. I do work out, but I am limited to what I can do with leg exercises because of the IT band injury and I don't have much cartiledge left in either knees. An Ortho Doc said eventually I will have to have knee replacement surgery...so yeah, I'm falling apart with age!

yaks_rule

Thanks, but what does the stretch look like? I've been doing lower calf stretches where you lean against the wall. I also have a boot I used for my plantar fascititis, which I have been thinking about wearing around the house.

Ty0604

[QUOTE=yaks_rule;19639955]Try the gel in the link I posted above. Either way good luck.

79pmooney

It's very simple. I just bend my ankle and lean my knee as far forward as I can until my Achilles feels tight. In other words, get my knee as low as I can keeping my heel on the floor. (But nothing crazy. I did partially tear them and have no intention of doing it again/furthering the existing tear.) For the hamstring one, I place my other foot well in front, weight on it, and straighten my back leg, still heel on the floor. I feel this in my upper calf and behind the lower part of my knee. I still have to do traditional hamstreing stretches but I do that at other times. (Can't grind coffee for those ones.)

Ben .

fietsbob

Travel Insurance gets you refunds when you have to cancel for medical reasons, Right?

79pmooney

It's very simple. I just bend my ankle and lean my knee as far forward as I can until my Achilles feels tight. In other words, get my knee as low as I can keeping my heel on the floor. (But nothing crazy. I did partially tear them and have no intention of doing it again/furthering the existing tear.) For the hamstring one, I place my other foot well in front, weight on it, and straighten my back leg, still heel on the floor. I feel this in my upper calf and behind the lower part of my knee. I still have to do traditional hamstring stretches but I do that at other times. (Can't grind coffee for those ones.)

Ben .

yaks_rule

Yep...I have travel insurance...so if it gets really bad, I can bail and get my money back, but I would rather not do that.

Retro Grouch 

Me too. I used to run marathons. When I discovered the Achilles pain went away after a few minutes of running, I decided to train through it. At the time I figured that if running a sub 3 marathon meant using a cane for the rest of my life, that was OK with me. Bad decision, it developed into a chronic condition that has never completely left. I can't run across a street now (30 years later) without feeling a pull at my ankle. Actually, I consulted with a surgeon who claimed he could fix it. The cure involved a hip length cast for 6 weeks followed by a knee length cast for 6 weeks followed by PT. THEN he'd do the other leg. I told him that was a fix for somebody who couldn't walk not for somebody who couldn't run. That's why I ride bikes.

welshTerrier2

Yup, someone here said you'll get all kinds of opinions from one end of the spectrum to another. Here's my two cents having experienced a bad achilles injury while distance running many years ago.

First, achilles injuries are often triggered by calf muscles that lack flexibility. Does that mean you should be aggressively stretching them? My feeling is that stretching while you're hurt is probably not a very good idea. My bike club had a free session from a local PT clinic a couple of years ago. Their number one recommendation: never, ever, never stretch cold muscles. If you're going to do calf stretches, toe raises and heel drops, make sure you've warmed up first. One stretch you can do is to hang your heels off a step or a curb. Do this as a static stretch (i.e. don't push your heel down quickly). Lower it into position and hold it there. My bottom line is don't stretch until you're completely pain free. Try some light calf muscle massage instead.

Second, my podiatrist told me never to walk barefoot. I ignore that, of course, but it's a good idea while your achilles is hurting. Shoes or sneakers provide needed support. He recommended orthotics which actually made things worse. Also, achilles pain is usually worst in the morning. Take a little time to warm up gently when you first get out of bed. Nice, slow walking might be a good way to start the day.

Third, putting lifts in your shoes under your heels (both feet for symmetry) can take pressure off the achilles while you walk but also can shorten the muscle tendon unit if you do it for too long. It's probably fine for a week or two but maybe not a good longterm solution.

Fourth, consider heat and/or ice. This seems to have become increasingly controversial but give both a try to see if it helps. If you ice, stay off your feet until you warm up.

Fifth, the GERD business is really important. Stay away from all the NSAIDs. They'll make you suffer. Tylenol is moderately helpful. You can also try some rub on creams like Salonpas which I find very helpful for local pain relief. They also make patches which I haven't tried.

Sixth, while riding, uphills and speed are probably not great ideas for recovery. The problem is that your training prescription conflicts with your recovery prescription. Take a hint from that.

The bottom line here, upcoming travel notwithstanding, is that full achilles tears are serious business. It's really important to avoid making your injury worse. We can't know the full extent of your injury but, as a guiding principle, a sensible amount of rest and very light exercise is probably the best prescription. Best of luck with your recovery.

BlazingPedals

Achilles tendonitis: What you need to do is exercises to strengthen it, followed by stretches to keep it limber. I have used reverse heel drops to strengthen and full heel drops to stretch. A heel wedge may feel good at the time, but it is really counterproductive because it encourages the tendon to stay short. Also, remove excess stress from the tendon: move the pedals back and spin don't mash.

Plantar faciitis is similar - it's a tendon injury caused by keeping it too tight too often. Again, stretches to make it limber. Move your cleats back. Roll it over a frozen pop bottle to stretch it while preventing inflammation.

yaks_rule

Thanks for the great advice. I've been doing most of the things you've discussed. I have had plantars fascititis and have orthos in all my shoes and never walk bare footed. I have always stretched my calf muscles almost daily and a couple times when I ride as a part of my stretching routine and because of the plantars fascititis. NSAIDS are off limits. I have been dealing with GERDS for 4+ years and no better.

yaks_rule

I just wanted to give folks an update. I did a 40 mile, difficult ride in the mountains of N. GA called three gaps. I went over three mountain passes. One mountain climb is about 7 miles long. My Achilles hurt a bit early in the ride, but calmed down. Unfortunately, there was no spinning going up these inclines and I had to mash my way up two of the three climbs. The last time I did this ride I had a bike with a triple and I was able to spin at least up the 7 mile climb. I have a compact and a rear 11-32 cassette. My legs are just not as strong as just 6 months ago because I have been unable to work out or push a big gear.


The good news is my quad and Achilles seemed to handle the abuse. The next day my hamstrings were sore and today my calves are tight, but nothing really horrible. I think all the stretching and icing, etc. have helped my Achilles.


For various fit issues, I've had trouble getting my body adjusted back to my old bike with the triple, but I think I'm going to try to ride the triple so I can more easily spin up mountains. If the old bike with the triple doesn't work out, I'm going to see if I can put a larger cassette on my new bike.


I appreciate all the advice.

f4rrest

I have Achilles tendonitis and just completed training for the 13700ft climb up Mauna Kea.

I can't believe nobody has mentioned eccentric loaded heel drops! This is the only research-supported protocol to treat it. Do them straight legged and bent kneed.

Also, apply Penetrex cream morning and night. Check the reviews in Amazon, unbelievable but it works for Achilles and knees.

emalvick

A few more cents.

The calves are the key to healing Achilles and Plantar tendon injuries. I'm a runner and have instances of both (Plantar is more of an issue for me). Working the Calves to loosen them up is the best thing you can do, but it requires more than just stretches.

I have a really hard foam roller that I roll my calves over at least once a day. Youtube is great for videos and examples. I shift myself with short directed rolls to specific spots on my calves and then shift my left position until I roll the whole calf out. i.e. rather than rolling over the whole calf at once, I might do it over 3 to 5 increments. I even roll the achilles out with pressure over the leg as it also helps stretch the achilles out.

The boot probably won't work for that tendon as it is more designed to stretch the plantar tendon out (and as a result compress the Achilles a bit... possibly).

I have to admit, I've never heard of the injury with respect to bicycling, so I wouldn't know a longer term solution. For running, the solution is about getting the angle between the heals and toes just right (balances between whether you'll tend towards achilles vs. plantar injuries). For biking, I could see the position of the foot on the pedals having a factor. Of course, I'm not sure that one can really control that as I don't ride with clips or anything related. Otherwise, it would seem a change in the bike-frame geometry (e.g. new bike) would be a factor.

Last, once everything is cleared up strength exercises and stretches for the legs are helpful for preventative work against recurrence. In all honesty, that has been the toughest thing to be disciplined in, and it has led to minor recurrences here and there over the years.