Joined: 12 Jun 2023
Ohio, United States
|Posted: Mon 12 Jun 2023 02:58 pm GMT
This post is for anybody else out there who might be dealing with achilles tendonitis or bursitis in your ankle. I’ve had a 2.5 year journey dealing with both issues, and recently completed my first 50 miler in 11:08. I thought I’d share my training adaptations and lessons-learned for anybody else struggling with these issues too. Note: I’m *not* a doctor, though I’ve spent a ton of time seeing doctors, sports chiro’s, massage therapists, physical therapists, etc over the years for this issue. Take this like a conversation with a crazy trail runner friend over of a nice cup of coffee, or better yet, a nice cold beer. I hope it’s helpful!
I started trail running in summer 2020 after about 18 years of casual road running. I was never competitive, but I did complete two marathons in college. I started running trails for fun with my ‘crazy’ ultra-running friends in fall 2020 and heard countless stories of their races, learned their training tips, and signed up for my first 50k in May, 2021.
Late fall 2020 my rapid switch to trails caught up with me, and I started experiencing a burning pain in the back of my ankle, near the heel. After a few doctor visits and an ultrasound of my achilles (this is important, please do this if you suspect achilles issues!). I found out that I had bursitis due to insertional achilles tendinitis. I was assured by multiple doctors that my achilles itself was fine, but the tension in my weak-a$$ calves was pulling on everything downstream and causing the inflammation. I ran through that pain and somewhat ignored the PT exercises I was given, also half-a$$ing my training for the 50k (the longest run I did was an 18-miler, and I never did my back-to-backs on trails - only the long run was on trail). I did finish that 50k (it was a spicy one to boot, with over 5,000ft of gain on technical trails), but finished thoroughly broken with an average pace of 14:30.
I took 2022 ‘off’ from racing and was feeling good enough in November 2022 to sign up for my first 50M. But I still had bursitis, along with some other issues like high hamstring pain and pain in my right hip. Here’s where the changes started. I was going to do this right this time.
First, I got a solid PT and orthopedic doctor based on the recommendation of a local trail-runner friend - a doctor that understood runners and wasn’t just going to tell me to stop running. In January 2023 I hit the PT exercises hard. Hundreds of calf eccentrics (heel lowers to ground-level only) each week, hamstring eccentrics to help with high-hamstring pain I developed, and lots of single-leg work with the leg press. I also worked on my hips using a band doing clamshells, monster walks, etc. I continued every single exercise throughout training up to the week before my race, which was June 3rd, 2023.
Second, I decided this time I wasn’t going to wing it: I was going to follow *a plan* (gasp), but adapt it so I spent less time running, more time cross training to take stress off my ankle. I got a Trail Runner Mag. subscription and gobbled up every article I could find: Training plans. Nutrition. Speed work. Hill work. Weight lifting. Nutrition. Hydration. The list went on, and I read it all. I eventually landed on a few training plans I liked (linked after this), and paid close attention to them both while allowing myself some flexibility for my bursitis. I officially started training 22 weeks out from race day, January 7th, 2023.
Key Training Adjustments for Bursitis/Achilles Tendinitis:
When I started training in January the burning pain post long-runs was real. My ankle would “stiffen up” after the long runs, so any prolonged sitting or sleeping made it much worse post-run. I used the following techniques to help with this and today have nearly zero pain while running and very minimal to no pain post-run (even after 18-20 miles!). Now, mind you, my ankle was angry for about 3 days after the 50M, but I expected that. These tactics got me a good 80% better. I still have work to do, but I’m close, and I hope this helps you too!
Run less (but maintain time on feet): Every single 50M training plan you’ll find has you running 5-6 days/week. I knew my ankle couldn’t handle that, so I adapted my plan such that I was only on trails 3 days a week - the long run on Saturday, the back-to-back Sunday, and one mid-week run on Wednesdays, when I also did my hill workouts. I found that book-ending the long weekend runs with two days “off my feet” allowed my ankle time to recover and inflammation to go down. But I wasn’t idle Tuesdays and Thursdays! These days I’d use a combination of elliptical, stairmaster, and treadmill hiking to get in the equivalent miles and time-on-feet necessary, while also ensuring I kept my HR in the equivalent zone to what I’d see on a run. As you’ll see in my race results - THIS APPROACH WORKS! A summary of my weekly plan follows this list.
Calf eccentrics: I’d suggest Googling this (or better, talk to a knowledgeable sports doc), but the basic idea is you rise up onto your toes with both feet then stand on the affected leg and slowly (3-5 seconds) lower your heel down to floor-level. The floor-level part is important based on *which* part of your achilles is damaged (please see a doctor about this!). For insertional achilles issues, I learned you don’t want to lower your heel below ground-level (e.g. on a stair), which is suggested for other achilles issues. I did 2-3 sets of 15 once or twice per day the entire training cycle, except days I was running on trails. I would also leave one day (Mondays) completely off for rest and recovery.
High-drop shoes: I’ve always run in a higher-drop shoes (I wear the La Sportiva Jackal II, which has a 7mm drop). The higher drop takes some load off your achilles.
Heel lifts/shoe inserts: Towards the latter end of my training my sports doc suggested I try a ¼” heel lift in my shoes to help with the bursitis, and it made a huge difference (put one in each shoe to prevent other issues, of course 🙂 ). The idea is: the heel lift takes additional load off your achilles - I wish I had done this sooner. There’s lots of research online about how effective this can be. The only downside is that it changed the dynamics of my shoes, so I had to start heel-lock lacing to prevent my foot from sliding forwards in my shoes. I’d say this was a major contributing factor to why my ankle started feeling a lot better, even in the peak training period.
Apply Voltaren and Arnica Cream to affected area: Voltaren is a topical NSAID and Arnica cream is also an all-natural pain reliever. I’d apply these to my ankle at night and wrap it in Saran wrap (I know, sounds crazy), but the wrap helps both absorb into the skin. I’d wake up feeling much better
Vibrants Pain Relief Patches: now this is a little “out there” but these biofrequency patches also worked great for relieving pain and inflammation on my ankle. I’d put them on post-run and my pain would melt away. I’m not sure I’m 100% bought-in to the science behind them (or pseudo-science), but they worked for me, placebo effect or not.
Similar to the above, the KT Tape Wave also was great for pain-relief: a little more pseudoscience that I’m skeptical about, but it works. My sports chiropractor recommended this to me and it absolutely works. It’s also great for relieving muscle pain and speeding recovery overall.
Massages and dry needling: I also got regular massages and dry needling and have a collection of foam rollers, balls, etc to release my muscles at home too. Keeping your calves loose is key to relieving the strain on your ankle.
A note on ibuprofen: overall, ibuprofen never seemed to do much for me. Ibuprofen is known to be a bad idea before/during/after runs because of how it affects your kidneys, so I avoided it altogether.
My training plan:
My training plan was a combination of pure trail runs (I never wasted time running on roads or treadmills), cross training on ellipticals, stairmaster, bike, yoga (almost daily) and weight lifting. I believe the lifting, specifically addressing my weak areas, was key to my race-day success, and I broke it up into pieces throughout the week so my “off” running days focused on upper body and abs. I also believe the mobility work in yoga was incredibly important.
- Saturday long run on trail
The longest run I did was a 50k 4 weeks out, and by then my ankle was handling that distance quite well. I did about 3 other 20 miles runs and a few 18 mile runs
- Sunday back-to-back run on trail
I used a time-on-feet model for Sundays, usually between 1-2.5 hours
- Monday active recovery/upper body weights and abs + yoga
- Tuesday cross training on elliptical//stairmaster/treadmill hiking + leg day (focused on hips) + yoga
- Wednesday speed day on elliptical or hill work on trail + yoga
- Thursday medium length trail run (if it was a speed week) or cross training as above with a bigger leg day (working hamstring, quads, doing mountain legs, all the big ones) + yoga
- Friday active recovery/upper body weights and abs + yoga
Note: I integrated calf eccentrics whenever I could, except for the weekends. I did around 450 calf-lowers every week (done on both legs to keep things even). I put in about 16 hours each week total between running, cross training, sauna, and yoga.
The big day was June 3rd, 2023. The race was the Mohican 50 miler in Ohio (also a 100M and marathon as part of the race). This wasn’t what you’d call an “easy” first 50 miler. The course was nearly 100% single-track on MBT with around 6-7,000 ft of gain, depending who’s watch you’re reading. The day-of was also above-average hot (upper 80’s), so I was very happy I spent 6 week prior heat acclimating in the sauna at my gym (link to the heat acclimation plan I used follows).
The race started at 6am and I felt good in the cool morning air. I noticed around mile 10, after we had apparently completed the first big climb that I didn't feel the climb was all that bad - all that hiking and stairmaster work was paying off! As the day went on the temps rose, but dumping ice water on my head at aid stations and taking s-caps every 30 minutes like it was my job kept me from feeling nauseated and good to keep eating both solid + liquid calories (I used tailwind).
The only major issue I had in this race ended up being my shoe-lacing (classic!). I had loosened my heel-lock lacing prior to the race because that lacing was rubbing on the tops of my ankle, causing some discomfort. Well, when your shoes are too loose you cause other issues, and my feet were sliding forward in my shoes the entire race, leading to some major big-toe pain and blisters.
Nonetheless, I finished with a smile in 11:08, just about 50 minutes ahead of my goal time. I snagged 1st place woman in my age group, and 9th woman overall, 39th runner out of the pack. My ankle didn't’ bother me at all during the race - only when I stopped (of course!). It took about three days for my ankle to recover, but at this point I know how to treat it and keep the pain manageable. I’ll continue to monitor my achilles with my doctor, continue all the exercises I’ve been doing, and get back to running after a few good weeks of recovery!
If you’re dealing with achilles tendinitis, I sure do hope this is helpful! I’ve heard from many that this is an issue that may never fully go away. I’m also convinced that rest is not the answer, because if you aren’t strengthening your calves and your legs, you will never take the strain off your achilles.Training your body to adapt and grow stronger, while not overloading the ankle is key. Take an off-day if you have pain, and see a doctor regularly to make sure you aren’t doing further damage. I hope you have the same success!
My training plan links:
Training Plan 1: https://relentlessforwardcommotion.com/wp-content/uploads/2019/05/Free-50-mile-ultramarathon-training-plan-outline.png
More Specific Training Plan with Hill and Speed Work: https://www.trailrunnermag.com/training/training-plans-training/an-advanced-50-mile-training-plan/
Heat Acclimation Plan: https://trainright.com/ultrarunners-heat-acclimation-cheat-sheet/
Taper Week Plan: https://www.trailrunnermag.com/training/trail-tips-training/a-day-by-day-training-guide-for-race-weeks-and-tapers/