Courtenay Brown

I want to post a description of the micro-tear I sustained in my Achilles tendon last August, and of the steps I took to recover. I learned some good lessons and I hope they can be useful to other athletes (or, if nothing else, help others avoid the injury in the first place!).

Part 1: What made me susceptible?

Last summer I had a staph infection that forced me off the bike and out of the water for a few weeks. “No big deal, I’ll just run!” I thought. I was very enthusiastic because I love running and I was seeing steady improvement in my training. I started thinking of a late-season marathon and began following the training plan described in Road Racing for Serious Runners. I upped my mileage by 10% each week, and stuck to soft surfaces for over 75% of my miles.

All these things were fine and well. What wasn’t fine and well was that, once I was able to re-introduce cycling and swimming, my strength and flexibility training suffered. I tended to finish my runs and then really quick shower eat get the bus to work. This was a mistake. My second mistake was that I ignored the nagging pain in my calves even though I knew I probably shouldn’t. I also mentioned this on my blog back when the injury first happened: inflexibility, literal and figurative, is really bad for training.

Part 2: How did the injury happen?

The tightness in my calves would generally dissipate after the first couple of miles of each run. My shins were pretty sensitive, and I just figured that I’d get some mild shin splints due to the calf tightness but that it would eventually go away and sort itself out. This went on for probably two weeks, during which time I didn’t adjust my training plan at all. Then I headed out for my 17-mile long run. As usual, for the first two miles, my calves were tight, particularly the right one. Then I started to feel really good and began my tempo segments. Two miles from home on my out-and-back route, I was just finishing up my last tempo segment and I felt a sharp pain in my right Achilles. I had no phone and the shortest way home was the way I was going, so I just jogged it in and hoped for the best.

That day, I iced, massaged, and got a chiropractic adjustment on my foot. I had one week until the Danskin Seattle Triathlon, so I went into minimize-the-damage mode in hopes that I would feel good enough to race. I got two acupuncture treatments, aqua-jogged, and did three short runs on the track that week. Everything felt OK so I decided to race, and I am glad I did! Then I got a little greedy and decided to race in Portland the following weekend. Even though my Achilles didn’t hurt during Danskin, it started bothering me more and more throughout the week, particularly after extended periods of sitting down. I raced Portland anyway (I paid $100 to enter! You bet I was racing!), which was a mistake considering that my Achilles hurt the entire time, every step of the way.

In analyzing events with my doctor, it seems that I sustained a strain on my 17-mile run, and then because I didn’t allow it to heal, I sustained the tear at/around Portland (and for some dumbass reason I did a normal week of run training in the week between Danskin and Portland, including a 10 mile tempo run that Wednesday… I was definitely in denial).

Part 3: Treatment

After Portland I could barely walk because my right foot became so inflexible. I couldn’t point my toe at all, and I could barely move it upwards towards my shin. Here are the treatment steps I took:

-I stopped running all together

-I replaced my run workouts with aqua-jogging sessions because I was still (naively) hoping to race in some late-season triathlons and perhaps even the Seattle Marathon

-I got acupuncture 2x week for nearly a month, as well as a cortisone injection

-I did a lot of massage on my tight calves

-NO stretching because it aggravated the Achilles

After 10 days I tried to run and the pain forced me to stop. I gave it a full mile, just in case, but it didn’t get any better. I was continuing to swim and ride during this time, and I felt the tightness in both of those sports as well (especially kicking and pushing off the wall, and right when I got off the bike). After four weeks of treatment and continued swim-bike-aquajog training, my Achilles was still inflamed and painful. It was looking less and less likely that I’d be able to race again in 2009, so I pulled the plug altogether.

Rest became the name of the game.

Part 4: Recovery

Key therapies have been The Stick, Trigger Point, Foam Roller, and soaking my foot in an ice bath of ~53 degrees for 10 minutes

Ultimately I took two months off from running, from August 23 to October 25. I attempted a couple of runs during that time period but each time my body told me to go back to resting.

When I started up again, my plan was to begin at 1 mile of running at a time, on the track because it’s a soft surface. I would run three days in a row, take a day off, run three days in a row, take a day off, and after 2-3 successful runs I’d up the mileage by a quarter mile. I also did some running drills every other workout: skipping, grapevine, high knees, butt kicks. Then I started working in trail runs instead of the track, because my pool was in a national park that had some super fun, twisty, up-and-down trails.

This plan was BAD. Dumb dumb dumb idea. (Ben likes to say that he told me it was dumb, but really, who listens to their boyfriend?)

The drills strained my Achilles and the almost-daily pattern didn’t give me enough time to recover and adapt, even though the miles were really low. Plus my very incremental increases were mentally painful, and the steep ups and downs of the trails were putting too much stress on my injury so I continued to have nagging pain. It wasn’t like the sharp pain from August, but still. I realized that I needed to amend my plan if I wanted to make a successful return to racing, and I called Matt Russ for advice.

I got onto a more sensible plan of running every other day, increasing my long run by 1 mile each week, and factoring in rest weeks. After a month of successful training on this plan, I started running on consecutive days 1x per week so that I could get in 4 runs each week rather than 3, 4, 3, 4. Then the big test: the Christmas Biathlon on January 4th. Was my Achilles ready to race? Yes! I didn’t experience pain in the race or in the following week, at least, not anything beyond the standard race hurt-so-good pain .

Now, after two successful biathlons and several successful runs of 10 miles or more, I am pretty sure that I am healed. I’m up to 30 miles and 5 runs a week, and this week I am reintroducing track sessions. I still have some periodic tightness in my Achilles but everyone I have talked to and everything I have read has said that is normal for about a year after sustaining the injury. My primary plan to avoid re-injury is to stay vigilant with my strength and flexibility (thank god for netflix, I’m much better about stretching when I can do it in front of the TV), and to listen to my body!

So there you have it. My experience with an Achilles injury, and what worked/didn’t work to help fix it. Finally: a big thanks to Peter Schmidt at Inewmed for all the excellent treatment. This injury could have turned into 6 months off from running, instead it is not even 6 months since my injury and I consider myself recovered!