Ask Pete: Achilles Injuries and Stress Fractures

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QUESTION #1

I’ve had nagging Achilles/heel pain for more than a year. I wore a boot for six weeks and did radiation therapy. It didn’t help. I wondered if it might be an insertion injury or heel bursitis? – Craig

ANSWER

I feel your pain, Craig. Or, at least, I did. For six long years. That’s how long I suffered from severe pain at the Achilles insertion point on my heel, coupled with more pain from the associated inflammation of my bursa. But it wasn’t bursitis. And it wasn’t an offshoot of Haglund’s Deformity (a bony protuberance on the back of the heel). It was, in fact, an Achilles insertion-point injury. And the only way to treat that injury—and yours, I suspect—was to trigger healing and strengthening in the Achilles.

But here’s the thing about the Achilles: It doesn’t heal well on its own. A 2013 study from Denmark that measured levels of carbon-14 (a radioactive isotope) in the Achilles tendons of people who’d lived during the nuclear bomb testing of the 1950s found those levels to be identical to what would’ve been expected at the time of the testing—in other words, the Achilles tendons had undergone zero tissue regeneration during the intervening decades.

But there’s hope. Here’s what I did for my insertion injury. I stopped all running—because running aggravated the injury and prevented healing. And I embarked on a program of lower-body resistance training that included exercises such as squats, step-ups, and, most importantly, heel dips (also called heel drops).

The resistance training strengthened my muscles through an increased range of motion, the better to relieve the every-stride tug on my Achilles, and the heel dips directly stimulated healing in my Achilles tendons. Nine months later, I was good as new. So be aggressive (no sitting around waiting to heal), but also be patient.

QUESTION #2

I had a tibial (shin bone) stress fracture that healed 1.5 years ago. The location still hurts sometimes. Is this normal? Am I at risk of another fracture in the same location? – Jon

ANSWER

Pain following tibial stress fractures is common. Could be a calcium deposit (part of the healing process) pressing on adjacent tissue. Could be lingering nerve damage, scar tissue, or some other offshoot of the original injury. Could be phantom pains as your brain focuses (i.e., obsesses) on the spot of the injury.

Here’s the thing: If the pain is intermittent, it probably isn’t a new stress fracture. I’ve had 5 stress fractures—which either makes me an idiot or an expert (I suggest both, the former as the precipitating cause for the fractures and the latter as the reason it’s been two decades since my last one)—and the pain was consistently present. Like with every step. So occasional pain isn’t something to stress (ha ha) over.

On the other hand, you want to make sure that you aren’t repeating the same training mistake—probably overtaining—that led to the original fracture. Bone is a living tissue that undergoes constant renewal. You have cells that dig out old bone, and you have cells that then replace the resultant (very tiny) cavities with new bone. But this process can take three to four months to complete. Train too hard, and it’s like having termites in your house—you remove more bone than you can replace, leaving your bones porous and susceptible to fracture.

WHO ASKED YOU, ANYWAY?

Pete’s freebee training tip: When heading out on a long run, don’t rely on gel packs and snacks to provide the energy you’ll need. Instead, pre-energize the day before your run by eating a diet high in carbohydrates. More carbs leads to fuller muscle glycogen tanks. And studies have shown that we feel better and can run faster and farther when we start our runs with more muscle glycogen.

Have a question for Pete? Shoot us a note.