By Dennis P. Devito, M.D.
Question: I ride about 3 times per week, with one ride frequently being a group ride on Saturday morning at 23-25 mph average pace. After my group ride two weeks ago, my Achilles tendon was pretty sore, but not really painful. I couldn’t ride during the week that week, but everything felt fine by the next Saturday, so I rode with the group again. This time I experienced quite a bit of pain a short time into the ride and a swollen bump on my Achilles tendon. I had pain for the next week or so (particularly in the mornings), but I’m feeling pretty good now. I want to be sure I didn’t tear the tendon. Also, any tips for getting back on the bike and avoiding aggravating it again, and for minimizing future risk? Thanks for everything you guys do to make cycling great! – Douglas K.
Dr. Dennis Devito Responds: You’re welcome, Douglas! Achilles tendonitis is a problem that warrants immediate attention and care in order to get off the path of inevitable serious injury, chronic tendonitis, and possible surgery. This is different from other problems of muscle or tendon strain; in fact, the causes are still incompletely understood within the medical field. And these injuries can be very slow to heal.
In general, Achilles tendonitis occurs in 2 areas: the insertional zone (where it is attached to the heel bone) and the mid-substance zone, where it sounds like your problem is. Exercise-induced pain is the cardinal symptom of injury and is confirmed if there is a tender nodular swollen area. This represents the accumulation of micro-trauma; technically, if you have this, you already have a tear.
Continuing to hammer with the “A” group at 25mph will only serve to produce more microtrauma, further tendonosis, and prevent needed tendon repair. On the positive side, it is good that the pain so far has quickly responded to rest.
The design of your recovery plan will ultimately involve you controlling the intensity and duration of any further abuse you inflict upon your tendon. Your age and fitness level are also factors that affect healing. You’ll be happy to note that complete rest is not recommended, since there is evidence that tendons heal better under conditions of load, or stress, so cycling at some level of intensity would be therapeutic (certainly preferred over running, etc.).
Furthermore, ensure that the rest of your body position is optimized on the bike, limb lengths are equal or corrected-for, and that your foot position is stable (excessive pronation/movement strains the tendon). Current physical therapy protocols focus on eccentric overloading of the Achilles tendon to help with the healing process and to prevent further injury. You want to avoid classic concentric strengthening techniques (weight lifting).
It may be worthwhile to begin this under some sort of supervision until you are comfortable with the technique. As you recover, Douglas, you can gradually insert more forceful riding into your regimen (paying attention to any soreness) and bridge the gap back to the pack.
Dennis P. Devito, M.D., is an orthopedic surgeon at Children’s Orthopedics of Atlanta and is an avid road cyclist. His practice is focused on children and young athletes, especially those with spinal conditions. An avid cyclist from a running background, he spent 15 years intensely competing as an amateur triathlete and was a multi-time member of the USA World Long Course Triathlon Team.