Coaches Panel: How to overcome Achilles tendon problems

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Overcoming Achilles tendon problems

Dear coaches,
Hi, I’m a 24-year-old cat. 2 road cyclist and have a question regarding Achilles tendon pain.

I developed the pain at the end of November when making the transition from base work to on-the-bike power work. To give you an idea — Achilles pain on the bike (right foot) but only mild sensation when walking soon after riding.

My right femur is longer than my left, I ankle while pedaling, am flat footed, and over pronate. I haven’t changed anything regarding fit, shoe, cleat, or saddle position since spring ’09 and have completed a full season of training and racing since. I do not have any history of Achilles injury, but have meniscus issues on the right side once in a blue moon, but only If I slack on stretching during hard racing/training.

The day after the pain surfaced I went for a short ride to see if it subsided but as soon as I started climbing it started to hurt. I live in a mountainous area so a flat/easy spin only happens on the trainer. When I got home there was very minor swelling in the area. To describe the pain it feels like I have a cut on my achilles or the back of my upper heel. I decided to take a week completely off and rest (R.I.C.E) After that I rode easily on the trainer and felt fine. The next day I went to the roads and after about an hour of easy spinning felt the pain creeping in.

Now, I took two weeks completely off, after that I rode on the trainer every other day for 1 week for 45 mins to an hour, easy spinning — no pain. This week I started on the road again and after about two hours of the easiest spinning I could possibly ride I started to feel a dull pain coming back.

I’m hesitant to stretch to much at this point and am even questioning mobilization vs. immobilization. There are a few races in early March I targeted to win and the next major ones for me are in the summer. Every day that passes now I’m starting to come to the grim realization that the early races might not even be possible.

I do not have health insurance at the moment so it’s down to doing it Balboa style, which is fine but need the proper advice so I’m not digging my hole deeper. I’ve done research and talked with people about the issue and have heard everything thing from, ” it’s going to be like that for the rest of your life now but just tolerate it when you ride”‘ to “2 to 6 months completely off the bike” !! Any advice or help your able to give is always welcome.

Thank you!
— Jordan

Jordan,
Sorry to hear about the pain. Let’s try to make some progress.

It sounds like you are doing some of the right stuff off the bike. When possible, try to use a lower gear, even if just one click. I know you mentioned there are hills in your area and I understand this may be tough. But, all the help you can provide the Achilles tendon will give you the best shot at recovery and getting back into full action.

I will try to keep the rest of the answer related to the equipment as best as possible and be mindful of your current situation regarding insurance.

First:
You need to move the cleats toward the heel of your shoes. I like Speedplay road pedals best for this because they sell an aluminum fore-aft extender base plate. You can see more on their Web site under “The Ultimate Fit Tech Videos” section.

If your pedals/cleats do not allow for more movement of the cleat towards the heel of the shoe, it is time to switch pedals. If you are already all the way back with a Speedplay cleat, now is the time to get the adaptor plate.

I might consider trying the right cleat back one or two millimeters more than the left. Generally, I don’t like to suggest this but I think based on your symptoms it is worth consideration. This may add a bit of leverage (advantage) to your pedal stroke on the left side, which you mention has the shorter femur. Without this adjustment, the longer femur can sometimes have a bit more leverage which would add just a tab bit more stress down the leg while under load.

Second:
You mention that you “over-pronate.” I can guess your knees move inward toward the top tube during the down stroke while pedaling. This tendency is a classic sign of the need for wedges. I would suggest starting with 2 cleat wedges, at least, per foot. The thick part of the wedge should be on the inside of the foot (this is under-the-cleat wedges and not In-the-shoe wedges).

You can also see the installation of cleat wedges with a Speedplay cleat on their Web site. Add another wedge after a few rides if your knees still move inward. You will probably also need to move your foot in closer to the crank. You do this by pushing the cleat outward and away from the crank.

Finally:
It would appear you probably need more support inside the shoe, as well. Some inexpensive options are Superfeet or Specialized BG insoles. For simple over-the-counter products, they can be very good options.

I know you won’t like this. But, start back slowly on the bike after these changes. Hopefully, your current Balboa-style approach (including off the bike care) will help you get back on track.

And, let us know how it’s going …
— Paul Swift

An eight-time National Elite Cycling Champion and founder of BikeFit.com, Paul developed the Bicycle Fitting System (BFS), which includes products like the Cleat Wedges. The BFS helped bring the “front view” of a cyclist into the bike fitting world. BikeFit.com offers tools and education for bike fitters worldwide, helping them to better position humans on bicycles.

Any information or advice offered by the members of the Coaches’ Panel should not in any way be viewed as personal medical advice. The recommendations made in this column are offered as general information for healthy, physically fit amateur and professional athletes. None of the information provided by members of the Coaches’ Panel should be viewed as a replacement for personalized, professional medical treatment or to replace the advice or services of your physician. While some members of the Coaches’ Panel are Licensed Medical Doctors, Licensed healthcare professionals, and certified coaches, their advice in no way establishes a doctor-patient relationship between the writer and readers of this column. If you are beginning or resuming a vigorous exercise program, it is important to visit your health care provider for a complete physical examination in order to identify and treat any potential risks you might face.