The (Slow) Road to Achilles Injury Recovery

I couldn’t put weight on it.

I couldn’t hobble, shuffle, or even stand still. Not with my right foot on the ground. The swelling in my heel and lower calf had swallowed my ankle bone. It wasn’t a pretty sight.

I was looking at the injury that would dictate what I could and could not do for an entire year to come: a partially ruptured achilles tendon.

Many of us who use our bodies so regularly (and intensely, at times) have what I think of as our personal weak links: where we are most likely to succumb to the load, and get injured. As a long time runner, ITBS (iliotibial band syndrome), patellar tendonitis, and shin splints are all familiar to me, but achilles tendonitis and tendinosis has always been my weakest links.

Managing my tight calves and achilles tendons has been a part of my life as an athlete ever since my first run-in with tendonitis in 8th grade. My right achilles has never been fully healthy. I’ve always kept the flare-ups at bay with stretching, a constant regiment of my favorite exercise eccentric calf drops, heat, ice, sleeping in a boot to keep my foot flexed, and occasionally taking time off from running in favor of exercise that is gentler on my tender tendons.

IMG_20180309_153241445
March 2018. Tendon problems in my ankle AND my wrist

It might not surprise you that taking time off comes last on that list: it’s a last resort. I’m sure that many of you understand the desire to keep training above all else. With chronic tendonitis, it’s unlikely my achilles trouble will ever go away completely: I will always have to keep on top of it, and train through as much as my body will let me.

But as I sat on the ground last July, staring at my ankle in shock, I knew I was looking at more than tendonitis.

I had been dealing with a bad flare-up for about a month, but I wasn’t resting it like I should have been. In fact, I was pushing it harder than I’d ever done before. I was one month out from a nearly-impromptu move across the country from Vermont to Oregon to train with a ski team. I was less than one month out from my last dose of doxycycline to treat my Lyme disease from spring 2017. I was working hard to keep up with my new training partners, and to hopefully earn the respect of my new coach. In other words, I was feeling exactly as you might think I would under the circumstances: vulnerable, intimidated, and slightly desperate.

And determined. The competitor in me knows how to fight hard, and I knew why I had come to Oregon. I was here to train, to grow as an athlete, to push the boundaries of my comfort zone. Sure, I was lonely in a new place with no friends. Sure I was terrified at the prospect of all the unknowns in my upcoming race season, my first one racing the Super Tours (for my non-Nordie friends, that’s the domestic pro circuit). Sure I had some catch-up to do after missing most of spring training due to Lyme disease. But gosh darnit I was here to train, work hard, and get fast! I put on my tunnel vision goggles, and ignored everything that might have distracted me.

IMGP8376
Training in Washington last summer

Unfortunately, that included ignoring the warning signs my body was sending me. Understandably, my tendons just did not like jumping immediately from 2 months of inactivity to the hardest training of my life.

It was a hill-bounding workout that dealt the inevitable final blow. Hill-bounding is a ski-simulation exercise, done on foot up a hill, and feels something like classic striding when done correctly. I’d never been very good at it. Frustrated coaches would always tell me, “You’re just running!”. I could never figure out how to get that pop that I could see propelling my teammates up the hill. Years of training camps, dozens of coaches, and I just couldn’t get the hang of it.

Well, shout out to one of the coaches here in Bend, the legendary Ben Husaby, because in about 20 minutes he taught me how to hill bound. (For some tips, including an exercise he taught us, see the bottom of this post.)

The only problem is that in hill-bounding, like classic striding, a lot of the propulsion comes straight from the calves and achilles. As I was bounding on an already compromised tendon, one particularly powerful push-off did me in.

I was relatively lucky. My tiny little tear would heal itself. A larger or full tear would have required surgery.

Still, the fallout was significant. I couldn’t do anything at all for about a week. After the first couple days I could hobble a little, but I mostly hopped one-footed. The most dramatic improvement happened after that week, and by the end of the second I could walk (very stiff legged), pool jog, and mountain bike (also very stiff legged, and very carefully. A bump in the trail could send me into a world of hurt if it caused my ankle to bend.) Even the ski Erg hurt, as the simulated poling motion requires as much ankle flexion as actually skiing. 

By the third week I could rollerski again, but I still couldn’t flex my ankle. For anyone who is not deeply immersed in Nordic ski technique, let me assure you that ankle flex is key. That’s how you load weight into one ski, getting ready to push off onto the other, in both classic and skate technique. I vividly remember the coach at my first ever training camp shouting, (probably good naturedly, but it sounded scary to my 12 year old self), “Ankle flexion, ankle flexion, ankle flexion!” when I rollerskied by. Poor ankle flexion goes with the tight calves and achilles. It’s always been a major weakness in my skiing. I didn’t really need something to set me back further in that regard.

But at least I could train. I lamented missing out on the running races I’d been planning on doing that summer, not realizing it would still be months before I would run again. I regretted not being able to practice my newly discovered hill-bounding technique. I was bummed that I was forced to rock climb one-footed because my swollen achilles wouldn’t fit in my climbing shoes. I’d just finished rehabbing a popped tendon pulley in my finger,and was finally back to climbing normally! I learned that one-footed climbing, like one-handed climbing, has its benefits. At least, I tried to look at it that way. It forced me to focus on body position, to use my core, and to rely on my balance. It forced me into new positions, to adapt to new movements. There were upsides. But I digress…

It was October by the time I was able to classic stride again. Let me reiterate that: I went almost the entire spring and summer, and half the fall, without striding. Not what you want when you’re training for your debut season racing with the best domestic skiers in the country. Not at all what you want. And even by October, I couldn’t put much force into my stride. I worked tirelessly to keep my other leg healthy, with endless exercises, stretches, and massage. I was relying on it to propel me forward, merely shuffling my injured leg as far as my range of motion would allow without pain. I couldn’t afford an injury to my other leg brought on by the strain.

I’m lucky to have escaped without injuring my other leg. Race season arrived and I could skate ski nearly pain-free if I didn’t bend my right leg too much. Classic skiing was still an issue, but I had no choice other than to do the best I could and rest for a few days after each classic race. I still wasn’t running.

Racing at U.S. Nationals in Alaska in January set me back a little, with back-to-back classic races, each of which became personal best results for me in their turn, with a 20th place in the classic sprints and 18th in the classic 20k mass start. But the intense strain on my tendon coupled with the lack of rest left me still limping two weeks later at my next race in Vermont.

IMG_6470
Classic Sprints at Nationals (I’m on the far left)

That was when things began to make a turn for the better.

Distraught at my regression, unsure of what was to come, and scared that I would never run again, I found myself sinking into what I like to call a mental hole. You know the sort: that unrelenting cycle of doom-laden thoughts that lead nowhere productive. The kind of hole that made me want to lay down on the ground and quit. The kind of hole that comes right before I discover a deeper strength I never knew I had.

Because of course giving up and quitting and crying and screaming why me at the top of my voice was not the course of action I wanted to take. And as often happens at rock bottom, I began to pull myself together. Surely there was something more I could be doing. I’d been managing my injury by resting as much as I could, minimizing ankle motion while training, and icing to keep the swelling at bay. I was doing very minimal strengthening, stretching, and range of motion exercises, fearing I would just damage the tendon further.

I think this cautious approach was the right course of action in the beginning. But after several months of healing, my tendon was ready to start getting strong again. I needed to start using it. But not in random bursts of maximal effort, like the classic races at Nationals. I needed regular, gentle, deliberate work. The new regimen began:

As my tendon issues have always been linked to tight calves, I can alleviate a lot of the problem through self-massage: myofascial release. By finding the knots (adhesion of muscle fibers where they shouldn’t be) and working to release them, I could remove some of the tightness in my calves and therefor some of the strain on my achilles. During the months of January and February I spent as many hours rolling out my calves as I did  training. This got me to the point where gentle stretching felt good. I slept in a boot to keep my foot flexed at night and prevent my calf and achilles from tightening up while I slept. I doubled down on my eccentric calf drops, building up to three sets of 15 reps of two different exercises twice a day, for 180 calf drops a day per leg. (For an explanation of the physiology of this exercise and how it corrects and prevents achilles tendonitis and tendinosis, see the footnote!) I used video to watch and correct my own stride as I walked, because 7 months of babying my right ankle had led me to stepping unnaturally. I wanted all these problems to be corrected before I started the next phase of my healing: run/walking.

It was a lousy, rainy, icy day in the northeast in February when I set out for my first run/walk. I had never done a run/walk before. It’s a valuable workout for anyone who is just beginning a running program, as a way to ease into running and avoid injury. But I can’t remember a time of my life when I was not a runner. Between my injury, Lyme Disease, and the winter of ski racing preceding Lyme Disease (2016/2017), I hadn’t run regularly since the fall of 2016, about 15 months previously. It was the longest I’d ever gone without running.

I found a patch of road that wasn’t covered in ice. Wearing my high-viz rollerski vest so cars would see me through the sleet, I set out: walk for five minutes to warm up, jog for one minute, walk for two. Oh boy, this is going to require some patience. 

I did that for half an hour. Walk for two minutes, jog for one, walk for two minutes, jog for one. On a flat road, in the sleet, in February. Yuck.

But I was quietly ecstatic. I knew I was on the road to rehabbing this injury once and for all, in a slow, safe, and smart way.

***

That’s the problem with injury recovery: the slow way is the best way. And quite frankly, who has time for that!? We all have places to go, mountains to climb, PR’s to set.

Completely resting my injury for the several months that it needed would have meant forfeiting my race season. And while it would be sound advice for me to tell you all to completely rest your injuries, I must also acknowledge that sometimes that isn’t the call we make.

I made two sacrifices in my decision: I delayed my healing by continuing to train, and I compromised my training as well. Had I healed the achilles with complete rest, I might have been able to fully classic stride by the first races in November. But I also would have had 7 months of inactivity as my fitness base. I settled for something in the middle: I would prolong my recovery while manipulate my training enough so that I could continue to heal.

For athletes with serious injuries, I recommend assessing how long the injury might take to heal, and what you could do in the meantime to keep training without hindering your recovery. In some cases, you can completely rest an injury while continuing to train in other ways. In some cases, the injury may heal quickly enough that it’s worth it to just take the time off. Maybe you’re injured in your off season and can afford the period of easy training. There are a variety of factors, but I think it’s important to consider all of them rather than simply accept that an injury means you’re on the couch.

***

My story continues on its happy trajectory after the end of race season. I was finally able to take some time off and rest. I continued my walk/runs, building up to a mile of running at a time. It wasn’t linear; I had days where my achilles randomly hurt after a minute of running, and days where I felt like my old self as I ran my mile. I’m still doing 180 calf drops a day (per foot!), and my stretching, icing, and rolling routine hasn’t changed. I’m still sleeping in my boot.

At the end of March I took a trip to Moab in which I did a handful of runs, all longer than five miles. It took about a week sans running afterward for the stiffness to go away, but it did, and I felt stronger afterward. Then in May I did something really stupid and accompanied two of my friends to the Grand Canyon for a rim-to-rim-to-rim run. To be clear, my intention was NOT to do the whole thing, but still, any amount of running in the Grand Canyon was probably a bad idea. I do not recommend a 31 mile run with two vertical miles of elevation as part of rehabbing a running injury. I was incredibly lucky that I didn’t reinjure myself.

I’m now able to rollerski normally again, and I’m unlearning my protective habit of not flexing my ankles when I ski. It’s critical that I unlearn this. I can run twice a week consistently, more if I plan on resting for a while afterward. I did my first set of running intervals in 20 months two weeks ago. And this week, I’ll do my first running race since October 2016.

14581301_10154588732194467_8479331177282363919_n

So why post about the achilles injury now? Well, for one thing, last Saturday was the one-year anniversary of that fateful bounding workout. For another, I’m nervously, though excitedly, anticipating my upcoming race. Though skiing is my primary sport, I consider myself a serious runner as well. My love of the sport began with the days of high school cross country running and has evolved to encompass long, self-supported mountains runs all over the country, which have given me one of the greatest senses of accomplishment and self-confidence of my life. When I’m done with high-level ski racing, I intend to beat my 5k cross country PR from ninth grade. I rely on running to ease my mind and get me away from the roads when I can’t tolerate any more rollerskiing. I have missed it more than I can say over the past several seasons. I simply love the sport. I cannot wait to feel like a runner again.

Of course, that’s a long way away. My achilles still won’t tolerate more than about 20 miles per week, and it will take a long time to build up my leg speed again, especially since I’m not exactly training for running. It will probably be at least another year before I’m able to run as fast as I could at my last race in October 2016. Nevertheless, I’m heading to Utah to race a Spartan Super at the end of July.

Spartan races are obstacle course races, not really running races. But there will be 8 miles of running involved. I can’t tell you why exactly I chose to do a Spartan race that I have to go to Utah for instead of a local 5k or something sensible like that, but I think there’s something about the total unfamiliarity of it that appeals to me. Or one of my friends talked me into it. Something like that. Anyway, I’m going to do it, and I’ll be sure to let you all know how it goes.

I have two questions for you today:

  1. Tell me your injury stories! I want to hear how you have recovered, or are recovering, and how that has impacted your training. Leave me a comment below.
  2. I spoke briefly about my love for running, and my identity as a runner. This topic runs a bit deeper than I let on. In fact, it took me a long time to fully commit to ski racing, and leave running behind. Even after I ski raced all through college, I considered ditching the sport to return to running. What about you? Have you chosen one sport but continue to long for another? How do you manage it? Leave me a comment, or contact me privately here. I’m really interested in this phenomenon, as it’s more common than I originally thought. I’d like to write a post about it, so please forward this to friends. I want to hear from as many athletes as possible!

As always, there’s lots of ways to stay in touch. You can join my email list to get all the updates, or follow me on Facebook or Instagram @Carly3ski.

***

*The bounding technique Ben taught me and the drills he gave us to practice the correct body position have become a central part of my training since that hill bounding workout. In light of that, I’ve added a new video to my Products and Freebies, demonstrating an “Impulse Drill.” Check it out for more details and an explanation of what exactly it is simulating.

***

A Brief Physiology of Achilles Tendonitis and Tendinosis and how Eccentric Calf Drops Help

First of all, there is a difference between tendinitis and tendinosis, although the two often go together. Tendonitis is tendon damage caused by overuse or a sudden acute strain, and involves the layering of scar tissue as the body’s “quick fix” for the compromised tendon. Tendinosis involves the death of cells in the tendon (and subsequent degeneration of the tendon) resulting from lack of blood flow to the area and the inability of the cells to uptake nutrients. This often happens when there is excessive scar tissue build-up.

Tendon fibers normally lie in the same direction, creating a strong and cohesive unit, but scar tissue can be a haphazard mess running any direction it likes. These misaligned fibers break more easily, and every time they do, it kicks off the body’s inflammation response again. Furthermore, although scar tissue may help prevent further injury to an already weakened tendon, it doesn’t make the tendon as strong as it was prior to injury. Eccentric calf drops do. This exercise stimulates the growth of tendon fibers, promotes lengthening of the tendon, and strengthens the muscles that allow the tendon to do so.

To do eccentric calf drops: Stand with the balls of your feet on the edge of a step, preferably with a railing to hold onto. Using your arms and both legs (or your uninjured leg if you are injured), push yourself onto your toes. On one foot, lower yourself until your heel is level with or below the step. If your pain is at the lower insertion of your achilles (on the back of your heel), stop when your heel is level with the step. If your pain is higher in the tendon or calf, lower to your full range of motion. You can find a video of this exercise and many more in my Products and Freebies. Click “Start Today!”

 

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s