Achilles tendon pain and swelling training for the Oxfam Trailwalker

Over-engineered shoes with high heel-counter
that digs into the Achilles tendon when
stepping downhill, or into depressions.  Fine
for flat running - terrible for running or walking
over rough terrain.

Hi Gary,
I am training for my first Oxfam challenge but am having a lot of trouble with my left archilles.  I have read previous posts where you have suggested it may be the smaller muscles around the tendon but am finding discomfort at touching the tendon and swelling after walking on it.

I am currently travelling around south east Asia and should probably be walking a little less but I took it very easy before my trip and it still didn't seem to heal.  It gets worse the more I walk and sometime goes so tight that I have to stop I pain and give it a few minutes. Is there something I can do to strap or support it as the oxfam teailwalker is only a few months away.

I have been to a physio but he was only massaging it and then strapping it which he advised me to leave on for 24 hours and it wasn't helping only while the strapping was on.

Thank you for any advice you can give.

________________________________________
Gary:
There has been an upsurge in Achilles tendon injuries in the last year.  In fact last year was a record for me.  There are a number of causes but there is one causation that stands out above all else: Footwear.  But why now?

I think the problem is in the shoe design which has high, hard heel counters (refer photo above).  Running shoes are designed in places like California where their idea of off-road is a manicured track - nothing like the rough stuff you find in New Zealand!  The real damage happens when walking or running down very steep slopes or stepping into depressions like pot holes where the foot is forced into extreme plantar flexion while the Achilles tendon has to snap taught.  This causes a guillotine chopping of the Achilles tendon.  This action can be repeated a thousand times during an hour or so of walking or running.

It is therefore hardly a surprise that Achilles tendon injuries are on the increase in New Zealand.

Check to see if your most tender spot on the Achilles fits with where your shoes bite into the tendon.  If this appears to be the case then it is best to biff your shoes and get a new pair that has a low-cut heel counter.  If you can't bear to do this, you could resort to partly cutting away the heel counter of your $220 pair of shoes!

Please take time to read the string of articles about Achilles tendon injuries here.

_______________________________________

About this website

The advice in these articles is given freely without promise or obligation.  Its all about giving you and your family the tools and information to take control of your health and fitness.

Does the Mirena contraceptive have anything to do with my degenerating Achilles tendons??

"Hi Gary, 

Former elite athlete with depressed copper levels
associated with Mirena (progesterone) contraceptive,
consequently suffering severe back and sacroiliac
pain, including lumbar spondylolisthesis.

I have a theory to put to you. I have had a Mirena for 5 years, started running 4 years ago and for the entire period have suffered achilles tendonopathy that just wouldn't respond to the normal treatment. 

Near the end of the 5 year term the tendonopathy disappeared completely and inexplicably. Recently I have had the Mirena replaced and guess what - the achilles pain is returning. 

If the plan is to remove the Mirena I'd have to find another treatment for menorrhagia.

What do you think?"

"K"

________________
Gary:

Example of a young woman with elevated copper
associated with oestrogen contraceptive use,
consequently suffering tendon, ligament damage
and stress fractures.

There is definitely a link between the use of contraceptives such as Mirena and tendon and ligament disorders.  


I have now completed hundreds of Hair Tissue Mineral Analyses and can now dig out examples of just about any health condition you can think of.  Menstrual and connective tissue disorders are among the most common.  Let me explain why:

Adequate amounts of zinc and copper are needed in the body for the normal production of elastin and collagen, which are the primary components of tendons and ligaments, including the spinal discs.  Copper, specifically, is necessary for the cross-linking of proteins that give strength and integrity to these structures.  Zinc is required for the body to synthesize protein, therefore, an imbalance between copper and zinc can lead to tendon, ligament and structural abnormalities.

Copper and zinc regulate the female hormones oestrogen and progesterone.  Oestrogen is closely associated with copper; when the level of one rises, so does the other.  Zinc is associated with progesterone; the levels of these two rise in tandem.  Hence the use of copper in intrauterine contraceptive devices.

An imbalance between the hormones Oestrogen and progesterone, as well as zinc, copper and other nutritional factors, is likely to be the chief culprit contributing to menstrual problems including painful, heavy bleeding (menorrhagia).

If a woman has a high tissue copper level, her flow may be prolonged and heavy.  If a woman has dominant zinc levels, she may have a light and short menstrual flow, and her breasts may become extremely tender.  Too much copper, on the other hand, can also stop menstruating.  Women with eating disorders typically stop menstruating. High tissue copper levels are typically found in women suffering anorexia and bulemia.


Copper is an antagonist of iron.  Women with high tissue copper levels typically have low iron.  Iron supplementation may temporarily raise iron levels but the problem of low iron will persist for as long as copper remains elevated.


The liver regulates copper levels.  Men and women with elevated tissue copper levels often have a history of liver stress, typically a severe viral infection such as hepatitis, glandular fever or a severe case of influenza.   Women with heavy bleeding and other menstrual disorders may find relief with various combinations of contraceptives; but this is not remedying the underlying causes which could be a combination of factors, including poor liver function.


You might be wondering; "how come my medical specialists have never mentioned any of this to me?"  Well, they should have studied this in great detail as medical students.  Sadly, there is little interest in these matters in clinical situations with treatments well and truly entrenched in applying extremely expensive and often invasive patented treatments.  Basic elements and vitamins, such as zinc, magnesium and vitamin C, can not be patented.  They are ubiquitous and they are cheap.  There is no money to be made from prescribing them.


The health problems that you have described are very common, affecting countless thousands of women in New Zealand, let alone elsewhere.  These problems may be attributed to the near universal use of contraceptives, both uterine and oral, and from increasingly early ages when natural hormone levels are surging and attempting to find their natural, healthy levels.

Women are the unwitting subjects of an uncontrolled experiment 

on the grandest of scales

The next step in finding a healthy, life-long solution is to identify the underlying drivers of your tendon degeneration and heavy periods.  You can do this with a Hair Tissue Mineral Analysis which I can arrange for you and then run you through the options for correcting any imbalances that show up.


For further reading about the relationship between hormones, minerals, ligaments and contraceptives - and female athletes, please go here.

___________________________________

About this website

The advice in these articles is given freely without promise or obligation.  Its all about giving you and your family the tools and information to take control of your health and fitness.

Is your Achilles tendon injury really that: Or is it something else?

When people come to see me with their injuries and health problems, it is usually because they have exhausted every other option.  Achilles tendon injuries are near the top of the list of reasons for paying me a visit.  These injuries tend to be very poor healers.  The reason given most times is that this tendon has no direct blood supply to expedite healing.  There may be another reason why Achilles tendons fail to heal: The injury may not actually be to the Achilles tendon; but to one or more muscles immediately adjacent to it.  Of course, recovery will be poor if the wrong part is being treated.

If the first diagnosis is of, say “Achilles Tendonitis”, the tendency for all who may subsequently become involved in your treatment is to blindly continue down the Achilles pathway, even when the results are disappointing.  One reason why this may happen is the medical hierarchy and ACC claims setup makes it difficult for a therapist to

I am training for the 2010m Oxfam Trailwalker and feel like I have strained my Achilles Tendon

Hi Gary
I am training for the Oxfam Trailwalker and have experienced some discomfort and tightness in my left Achilles’ heel which is worrying me. This is my second year for the Trailwalker, and am relatively fit and active all year round (running and walking) – but never felt this time of thing before. Its more discomfort than pain, but came about quite suddenly on a short/hilly run on Tuesday night. I have good shoes and orthotics and stretch before and after every training session plus take a yoga class once a week. I am up to about 60kms training over about 4 days (Thursday – Sun) and have been going strong. But I actually had to stop my run on Tues because of the pain/discomfort. Wednesday it was still sore, and I couldn’t

I have Crohn's, Hallux Limitus and Achilles tendonitis

Hi Gary

I just saw your youtube demo on hallux rigidus. I'm 54 yrs. old from the USA. I enjoy fencing 2-3 times per week and for the most part I think I am fairly healthy. However, In my past, I've been diagonosed with Crohns and been warned that arthritis is not uncommonly associated with this, which I minorly suffer from in my hands and lower back. Very recently within the past 4 months I've been diagonosed with hallux rigidus in my left foot- big toe. I also have just completed physical therapy due to tendonitis of the left archilles heel, and tendonitis of the right elbow . Am I lacking a certain nutrient/s? If you have any advice and/or recomendations, I would certainly appreciate it.

Also, do you have a USA address for your products?

______________________

Gary advises

In answer to your questions:

When there is a digestive disorder such as Crohn's, the possibility arises of secondary disorders, including arthritis and various connective tissue problems, including tendonits.

The nutritional contributors to these are deficiency of the fat soluble vitamins, essential fatty

 acids and mineral depletion.

This is partly due to the poor digestion associated with Crohn's and the restriction of the diet to foods that are less likely to stir up the ailment.

Here is what I recommend diet-wise, bearing in mind that each individual will need to cautiously experiment with the following:

Diet/Nutrition

• Take one lecithin oil capsule with each meal. Lecithin has many health benefits, including being a fat emulsifier and will assist the digestion and absorption of fat in the diet.
• Go back to entirely natural foods, avoiding anything that is fat reduced, has colourings, flavourings and preservatives. If you can not tolerate the natural form of the food then leave it out for the time-being.
• Avoid all refined sugars, flours, sports drinks, artificial sweeteners and fruit juices (Eat the whole fruit instead).
• Do not drink lots of water with your food which may reduce the effectiveness of the digestive juices.
• Ensure your diet is rich in pesticide free leafy greens, root crops, nuts, lentils, beans, fresh and dried fruit.
• One can assume that the fat soluble vitamins are seriously lacking due to Crohn's (a, d, e and k). Read my articles about vitamin K here and here. The best way to get vitamin D is from the midday sun, or else a supplement. Refer to my many articles about vitamin D here. Vitamin A is best gained from cod liver oil and vitamin E from a supplement. These are best taken with lecithin and a chicken broth.
• It may also be beneficial for health in general to take a natural vitamin B and vitamin C supplement.
• You might also like to try a course of MSM (methysulfonylmethane)
• Take a course of probiotics to help ensure the gut is populated with healthy bacteria.
• Prepare a chicken broth and have 2-4 cups over the day. Get some chicken frames and simmer in a pot for a few hours. Add lentils, herbs, etc. The minerals and the gelatine nourish and soothe the gut wall and are highly nutritious generally.
• Have a dessert spoon of cottage cheese (full fat) mixed with flax oil about 6 times daily. This supplies the essential fatty acids and easy to digest protein. Refer here about the Budwig Oil Diet.
• Complete the Active Elements Assessment and use this to supply your specific mineral salts needs.
• Without exception everyone with Crohn's that I have had dealings with are vitamin D deficient. Please ask your doctor for a blood test of your vitamin D. Report the results to me for interpretation.

Note:

Rather than just pile a whole lot of nutrition supplements on a person, I prefer to pick about four

 of the most likely ones to give benefits and do a three month course, all the while looking for subtle signs of response.  Depending on progress, one or two may be spelled and another one or two are added to the base mix.  The idea is to take one's time - not to be impatient, not to chop and change willy-nilly and not to go for the big hits.

Toe massage/manipulation.

Please read my other articles about this procedure here and proceed with caution. Give the

 nutrition a few weeks to kick in first so that the body has the capacity to heal properly.

You can also get the joints of the hands and fingers mobilised while you are at it.

It may be worthwhile to look at some alternatives to the fencing until well after the toes and tendonitis are fully healed. This is because the slamming of the toe from repeated lunging is just about the worst thing one can do for an impacted toe joint (Dancing in high heels, boxing fitness classes and toey distance running produce more than their fair share of this kind of injury). Try aqua-jogging for a while. Join a swimming squad and take swimming lessons. Get a bike and ride in the fresh air and sunshine.

Tendonitis

The tendonitis of the Achilles and other areas should settle once you get the nutrition going properly. In the meantime, the advice about exercise should be heeded to give the tendons time to settle and for the nutrition to work its magic.

Take a long Holiday

Now I do not mean a shopping expedition to Sydney or a week in Vegas.  I am talking about

 going to a part of the world where Crohn's does not exist and parking yourself there for a month or two.  

Stress is a controlable factor in these kinds of digestive tract disorders, as is diet.  My advice is to adopt the local lifestyle and diet and see what happens.

Having quite close connections myself with Samoa, I recommend that you get on a plane out there.  Not to American Samoa which has been ruined by fast food and handouts; but to the islands of Upollu and Savaii.  Go to a locally owned resort where you can live in a simple beachside Fale for about US$30 per day, including meals.  Eat only locally grown foods, float in the lagoon and generally chill out.  If there is a significant improvement in symptoms, stay longer and plan regular returns.

Do I deliver to the USA?

Yes! With exchange rates and tax deductions, delivery to the USA is an affordable daily exercise.

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Ankle and tendon pain in a teenager

"Hi Gary I have a 17 year old daughter with a foot problem. Whenever she walks on hard surfaces( pavements) for a couple of hours she has a lot of pain in the back of her ankles,seems to be the ligament area.This usually happens during the night after walking around town.

At the moment she is in a lot of pain on the second day after walking around town for a school project. She does not wear proper walking or running shoes when she is in town,just flat school shoes with no support.

So I know this is not good but she still shouldn’t have such a problem. What can I do and who should I take her to see about this.I have taken her to our GP and to a physiotherapist and they can’t see any obvious problem. Would appreciate any help."
Anna
_________________________
Gary Moller replies:
Anna, the problem that you describe is probably the same condition I was troubled with as an active teenage boy. It is most likely that the pain is caused at the point where the Achilles tendon attaches to the heel bone (Calcaneus). The point of irritation on the back of the heel may be felt as a hard, tender bump as can be seen in the photo (My heels look like that; but not quite as pronounced!).

The following assumes that the pain your daughter is suffering is due to the Achilles tendon being under much more tension than before.

During the adolescent growth spurt, the long bones grow at a rate so rapid that the muscles and their tendons get left behind. The loss of flexibility can be dramatic as the muscles are drawn taught as bowstrings: A child that was able to fold oneself in half at 13yrs may be unable to touch his or her shins by 14yrs! This loss of flexibility is most pronounced in boys and it is only in their 20's that there is a restoration of reasonable flexibility.

With this growth spurt there is also an increase in weight which is a further stress on the Achilles and its Calcaneus attachment point. There is a huge increase in the need for nutrients during adolescence; especially for minerals, protein, fatty acids and fat soluble vitamins, including vitamin D from sunlight.

It is during adolescence; especially for girls, that nutrient intake takes a huge dive. The instant noodle, fat-free milk and an obsession with vegetarianism ensure that nutrient starvation sets in.

This lack of quality nutrients will show first of all in the collagen of the body: Skin, hair, nails, tendons and ligaments. Hence the common ailments of adolescence: Bad skin, dandruff, lifeless hair, cracked nails, sore tendons and their attachment points.

Please have a look at my updated Super Smoothie recipe. See if you can get this, or a variation of it, into her daily and you will see a huge difference in a few month's time.

The good news about this injury is there is very rarely any lasting damage and the pain gradually disappears as the growth spurt is completed.


Do you have a question?
Email Gary: gary at myotec.co.nz (Replace the "at" with @ and remove spaces). Please include any relevant background information to your question.

Achilles - lower calf pain in a distance runner

Hi Gary,
I am a 49yo off road runner who having come off a reasonably robust year culminating in the 31.5km Kauri Run, am experiencing pain in my right Achilles/lower calf area. It used to appear only when road running but is now a constant on most off road surfaces as well apart from technical single track. I have read with interest your response to Tendonitis and am trying many things incl new shoes, orthotics etc. What supplement do you recommend and is there a range of exercises that can help?

_________________________________


Gary Moller advises:
What you describe is an almost unversal injury among runners. It is also one of the most annoying and limiting injuries. It is also one of the the easiest to fix if it is what I suspect it may be.



It is possible that you have strained or even torn a few fibres where the muscle and the tendon merge - what is called the "musculotendinous junction". The illustration to the right is pretty good but does not show how the muscle and tendon gradually merge. This is a vulnerable region for injury in the older hyperactive runner.

Another possibility is that you have bunching and inflammation of part or all of a muscle belly. The most commonly affected in runners and cyclists is the lateral head of the gastrocnemius. If a person was to press firmly on the belly of the muscle and it felt tender and hard, rather than soft and supple, then that is part or the whole of the problem.

The solution is simple and I usually have close to 100% resolution in most cases within 3-6 sessions. In a recent case just a week ago, it took just two sessions to have a runner completely pain-free following several weeks of painful hobbling from a calf muscle tear. The solution is deep tissue massage of the affected muscles/tendons and all of the surrounding structures, including the unaffected leg. Each session takes an hour and there can be some pain involved as knots and infalmmation are broken up and dispersed. This should be done by an experienced therapist who has the time to do a good job.

The end result is a pain-free, nimble-footed older runner.

There is a place for supplements during this process of restoring normal function because elimination of metabolic wastes and proper healing are all important and there are several supplements that can assist. These are available from my online store.

Vitamin C is at the top of the list along with the water soluble B vitamins. Vitamin E comes next for its healing and antioxidant qualities. There are several others that one can add, including minerals and fish oils; but these depend on individual need which I can assist with determining.

You could consider some of the assessments available here.

I am enthusiastic about Formthotics Active for running shoes. these are heat moulded to fit the contours of your feet, giving just that little bit of support needed as the feet tire and they reduce foot movement and consequent blistering. Formthotics Low Profile are designed for shoes like track shoes, golf shoes and cycling shoes. Although I have strong feet that never give trouble, all of my shoes, including work shoes are still kitted out with Formthotics.

Is a ruptured Achilles tendon the end of her sporting life?

Dear Gary,
I have a friend who is 35 yrs old, with young children, who has just ruptured her Achilles and is now in her third week of plaster. She was advised by a Specialist this week that her life will have to change now she has had this injury… his words “if you were a good tennis player before this injury then you will be a bad one for the rest of your life now”. I am enquiring on her behalf if her life will be as bad as this “expert” claimed as he has totally depressed my friend and she still has weeks left in plaster. He also informed her that she would be at great risk to snap in again if she is not very careful in the future. Can you offer any words of encouragement, advice?
Regards.
R.
_________________________________
Gary comments:
There is hope - a ton of it.
As somebody who has seriously injured both achilles, including one partial rupture requiring 12 weeks in plaster, I can understand partially the distress your friend is going through right now. The good news is recovery can be complete and there are more successes than failures. I am a good example of that and so is my sister, Lorraine, who underwent at least one achilles operation and still managed to win a bronze Olympic medal. There is hope. That's for sure.

An achilles tendon rupture is a nasty, catastrophic injury and the best resources and expertise need to be mustered to ensure the fullest recovery. If it was a complete rupture, as you appear to imply, then the general consensus is that the tendon be surgically sewn back together and then immobilised for several weeks. If that has not been done for your friend, it is probably too late. This method of repair generally gives a faster and fuller recovery than placing the leg in plaster and hoping that ends meet and join back up again.

It is when the plaster comes off that the hard work really begins. Especially if the tendon was not sewn then extreme care must be taken when gradually mobilising the ankle because reinjury can happen without warning. Many years ago when I was working in the physio department of Dunedin Hospital, a young physio was giving a patient with a post achilles rupture some heel raise exercises. There was an audible snapping as the tendon snapped again. It was hard to tell who was the most upset - the patient or the physio. The lesson here is not to push things - to take one's time for a good 12 weeks or so after the plaster comes off while the tendon completes its recovery. Seek the services of a physiotherapist who has been working for several years, rather than an inexperienced Young Gun.

Recovery is probably well on the way about 12 weeks after getting out of plaster, but it is that final 10% that might take a good one-two years to be completed. The initial stages should be guided by an experienced physiotherapist who can guide your friend.

In the meantime, she is in plaster, and there are several extremely positive things she can do to aid her recovery:

Get into a gym and work out vigorously:

• It is only the bottom part of one leg that is immobilised - the rest of the body is in perfect order, so here is an opportunity to get super fit, including working on all those lose and soft bits. Being super fit will improve circulation to the injured area and ensure that she does not put on excess weight which could be a burden on her leg when the plaster comes off.

Improve nutrition and healing:

• Take some glucosamine and chondroitin which aids tendon as well as joint healing
• Take up to 4,000mg of MSM per day. Perfect for tendons and fantastic for skin, hair and nails and a natural anti-inflammatory
• Take up to 2,000mg of vitamin C per day for the same reasons as the MSM
• The same advice applies for vitamin E which is traditionally used for softening scar and for promoting healing.

All of these are available through http://www.myotec.co.nz/

The good news is that a properly treated and rehabilitated achiiles tendon is very strong. Some argue that it can be stronger. I tend to agree. My experience is that if an achilles is going to rupture again 1-2 years following the first time, it is usually the other one! (Not sure if that is good or bad news??).