Friday, November 28, 2014

Achilles Tendonitis in Cyclists, Runners and Triathletes

Whether your problem is ITB syndrome or Achilles Tendonitis ("AT"), quite often the source of your "running" pain is cycling-equipment related.

In nearly all of my high volume athletes that experience Achilles issues, the root cause can be traced back to their pedal system. What follows are excerpts from a common thread.

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With your AT -- check for lateral rock in your bike shoes. Nearly all my athletes' AT issues can be traced back to the bike -- specifically a worn cleat/shoe interface or Speedplay pedals. We need lateral stability. Any material pronation in the foot, eventually, fatigues the calf - in turn, causing your cycling load to move down to your AT.

Question: What is it about old shoes that makes them a problem? I currently use old Carnacs and Speedplay pedals. Plaatjes had suggested that I get a different pair of pedals.

Answer: That was the exact set-up that I had when I experienced a recurring AT irritation. Here's what happens...

  • The shoe is able to rock
  • The foot pronates through the bottom of the shoe stroke
  • Torque is pasted up the lower leg
  • Your calves take it until they are fatigued then the AT is overloaded

This problem cleared in 72 hours when I bought new shoes and went to Look pedals. When your irritated leg is clipped into the shoe have someone hold your heel/toe and see if they can rock the shoe (laterally, not swinging the heel). If you have a lot of rock then I would bet that this is the source of your AT pain.

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Question: Is it the float in Speedplays that contributes to the problem? Plaatjes recommended I get another pedal, and I was going to get the Coombes, which still have a little bit of float. I'm wondering if I should get pedals without any float.

Answer: In the Speedplays (for me) the source of the problem was that the cleat gives too narrow a base -- this enabled me to rock (laterally). With the wide base of the Looks, I was a lot more stable.

Initially, I used the cleats on the Looks which give some float -- float being the ability of the heel to swing (as opposed to the foot pronating). Over time, I moved to the mid-float cleat and now use the fixed clear.

So the issue for the AT, is pronation -- different from float.

A solid shoe/cleat set up won't do you any good if your foot is moving around inside the shoe. This is the reason that I use a three-strap cycling shoe combined with a lightweight orthotic.

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Question: I'm changing over my pedals to Coombe's and new shoes. I had old cleats on two pairs of shoes and with both of them they allow a significant amount of lateral movement between the pedal and the cleat/shoe. The Coombe's have a tiny bit of lateral movement between the pedal and the cleat, as I'm guessing that all pedal systems do, but I'm not sure. If you get a chance to look, could you tell me if the Time pedal/cleat combination also has a little bit of movement? I'm curious.

Answer: With new cleats and new shoes... zero movement at the start. As the plastic cleat wears, I get a little movement. If I get any AT issues, then I swap the plastic cleat out for a new one and I'm back to very little movement. The Look platform is quite wide and I think that this helps.

Even with a little movement, my form orthotic (soft) limits pronation.

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Eccentric rehab exercises will provide rapid relief and improvement. As well as the PP Online link, these are laid out in the Second Edition of my book, Going Long.

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From Dr Jeff Shilt...

I try to hit it with a full court press before it gets bad.

1. Eccentric Exercises for the calf muscles

2. Strassbourg sock

3. A slight heel lift if you are going to be in dress shoes at work for a few days...I don't recommend this for long periods, just until symptoms go away. In fact, after your symptoms and major event is over, then negative heel lift shoes (Earth brand is one) provide eccentric strengthening with normal walking.

4. Check and make sure the your work shoes, whatever they may be, have soles & heels that aren't worn unevenly

5. Deep tissue work in the calf and intrinsic muscles of the feet

6. Avoid fast running and running beyond the point you muscles are fatigued (if intrinsic or calf muscles are fatigued and stop working when you are running-increased pressure is placed upon the plantar fascia/joint capsules of the foot. This in turn increases work on the calf. Easy, light jogging until symptoms are gone

7. Make sure your cleats on your bike shoes are tight and new. Having participated in a few Epic Camp training weeks (training camp with 4-7 hours cycling/day for 7-10 days), I've seen both plantar fasciitis and achilles tendonitis flare up and be treated with cleat changes. Contrary to what many people suggest, I have found that increased float in your cleat and pedal system exacerbates this problem. Knee issues seem to respond favorably to the increased float, but if you don't have knee issues, I recommend switching to a system with less float (in the look pedal system, this corresponds to going to a grey or black cleat instead of the red cleat.)

8. Roll a tennis ball under your foot (many people like to put them in the freezer before using)

9. Stretching exercises for the plantar fascia and calf 1st thing in the morning and last thing you do before bed.

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