BIKEPGH MESSAGE BOARD ARCHIVE

Does the doctor know what you normally do?

I'm currently recovering from knee injuries incurred running last December, and I've been advised to cycle "moderately" on flat ground. When I explained I do 40 mile rides, I was told 'moderately' means 'to the point discomfort is minor and doesn't worsen the injury.'

A bit of both, myddrin. If your attitude is "no pain, no gain", that's not moderate. To me, moderate means: keep the pedal force light, don't mash the big gears, don't hammer up hills, and don't ride for more than an hour or so per day.

When I've had tendon problems, I got my best recovery from doing an activity a very little bit (like 3 to 7 minutes), then slapping ice on.

After weeks of inactivity with occasional icing not doing much, this just cleared it right up.

If it was the best strategy for everyone, though, I'd probably read about it in the literature. And I don't. So take it with a grain of salt.

Ice is your friend. Widespread agreement on that. Elevation is recommended as well.

Don't try to ride to Trees Hall to go swimming

And don't ride up Canton!

keep the gearing low, don't ride much beyond when the tendon starts to hurt, and obviously ice, elevate, and take some ibuprofen.

additionally, you might try a different foot position on the pedal that doesn't use your calf quite as much. you might have to lower your seat 1/4 inch or so, but you might find the pain to be lessened with the pedal closer to the center of your foot. this is not recommended for long hard rides, of course.

lately, I've decided on two things for myself, ymmv:

new pain is my body's way of saying "dummy, quit doing it like that."

old pain is my body's way of saying "HA you're still an idiot, and I'm not helping."

but I differentiate betwee "pain" and "soreness". The former is due to damaged but previously solid physical infrastructure. The latter is due to atrophied or neglected infrastructure. The line I cross from the latter to the former is most easily defined after crossing. One would think the discomfort would aid learning and remembering, but it never does.

I've been battling Achilles tendinitis for a year now. All the suggestions above are good. I still ride quite a bit - 2-mile commute and about 5 hours a week recreationally. I've found that what I do in between cycling has more of an effect than the cycling - lots of stretching, calf raises and wearing a ankle splint at night. And patience.

Thanks for all the advice. Based on this, and the pain levels today, I think I'm going to hold off for another day or two before I try commuting... but I may go for a short ride or perhaps some time on a stationary bike tomorrow evening.

I tried to get more info based on my typical cycling habits (2 hr commute 2-3 times a week, 1 long weekend ride) but was just told 'don't strain yourself'. *SIGH*

Telling that to someone like me is not helpful.

@ejwme that is good advice. I've been getting some hard lessons in the difference between soreness and pain over the last few days... right now, its just sore until I flex my foot about 3 degrees, then it suddenly becomes pain.

I'm still trying to figure out what happened. I'm in the last week of the couch to 5K program, and I'd been running on a treadmill at a constant speed for about 20 minutes. Suddenly there was sharp pain in my ankle that faded quickly... so I kept going but slowed down a little bit. Finished my workout, but with 10 minutes of ending it I was clearly limping... and was in some pretty bad pain.

If 1 is no pain and 10 is "that time I had a migraine so bad I thought about jumping into traffic"... this would probably be a 5 or 6. (Right now its in the 2-3 range... but back up to 5 or 6 when going up and down stairs.)

But for the life of me, I can't think of anything that I did that would cause this...which is bugging me because I want to make sure that I NEVER DO THAT AGAIN!!!

Hyperbole And A Half has the best pain scale.

Hahaha Stu. I love Hyperbole and a Half. Alot.

When I still thought physical therapy would help my ankle (mine's a peroneal tendon issue) my PT told me that as soon as my pain level hits a 4 on the 1-10 scale I should stop immediately and ice.

I'd stick with the stationary bike until you feel more confident - nothing worse than hitting that 4 or higher when you're a few miles away from ice/rest like I did on my last run.

And my experience is that I'll usually be trucking along as a 2 or so and then WHAM it's a 7 or higher. Tendons aren't shy about speaking up when they're unhappy.

I'll throw out the under-used yet well established fact: your ankle is not a discrete part of your body. It's attached to the rest of you (at least I hope it still is, I apologize if not).

If you can't think for the life of you what specific injury inducing action you've done to your ankle, and it's not a newly discovered structural anomaly (like some kind of genetic ankle deformity), perhaps your ankle is reacting to something ELSE you're habitually doing and has finally caught up to you. Habitually poor and weird posture causing my crappy hips is an excellent example. An easy and interesting read is Pete Egoscue's "Pain Free" book series. I'm not saying I agree with everything he's laying down, but it might be worth a look, it's a take not often heard on the PT table/doc's office.

Best of luck with your recovery and figuring out what happened.

I have a similar Achilles problem, once in 2009 and once this year on the other ankle. Riding 100+ mile weeks and centuries feels okay with some minor discomfort at the end of long rides when I have this issue but a 2 mile run today will put me in a painful limp for weeks which isn't worth the pain for me. A foot and ankle specialist in Bloomfield xrayed it in 2009 and I didn't think the xray would show anything which it didn't.

I spoke with a triathlete who mentioned seriously painful Achilles issues recently. He highly recommended treatments/injections into the Achilles area that are $250 each for 3 treatments. I think staying away from running and icing when necessary is a good alternative to spending that kind of money but if you want the details let me know.

flyS564, those injections sound like prolotherapy, which I had done to my hips/lower back to help me get my life back. Worked for me, but I'd literally exhausted all other possibilities (except fusing my entire lower back & SI joint, which was next if this hadn't worked).

I'd definitely give icing and carefully chosen movements an honest go first, see how things shake out.

I tried rest and ice, then I tried a brace for 6 weeks, then I tried PT, then I tried cortisone shots, and finally the doc (3rd for this issue) did surgery.

I'm just shy of 3 weeks post-op but he is fully confident that I'll run again once I heal up.

I definitely recommend doing what everyone is suggesting - starting conservative. You can always work your way up to more serious treatment, in conjunction with a good doc.

I love my foot and ankle doc if you want to PM me for his info.

Also, for what it's worth, my original injury came from running on a treadmill as well. My plan when I get back to it is to minimize treadmill running as I think it can cause repetitive strain more then outside running, with different surfaces and angles and footing.

@pinky, sent you a PM, thanks.

Treadmill running is also boring as heck...I didn't realize just how boring until the first time I took my dog for a run in Frick. (Of course, I'm running sweating up a blue streak and he is just trotting along side me, trying to figure out what the big deal is....)

Talking about it last night, I think we pieced together what is going on. I am slightly duck-footed, a condition I don't think about much unless I'm snowshoeing. Despite being in a brace until I was 2-3 years old for it, the condition is still there...and becomes exaggerated when I'm tired.

Well, the night this happened my legs were tired and the condition was exaggerated. So, I was trying to run with both feet more straight than they wanted to be. And the most duck-footed foot is the one where I pulled the tendon.

Today is much, much better. Just some soreness, so I think I may already be on the mend.

@hiddenVariable

I do stats for some pain studies - I've sent that comic to the physican investigators. The variation in "imagination" is a tremendous problem with the scale.

Moderate cycling? Not too far left or too far right. Sorta "middle-of-the-lane(road)".