4 Weeks To Running After Achilles Tendonitis or A Soleus Strain

Give Me The Fish (GMTF): Running injuries suck, but if you have pain in your lower leg that might be either Achilles Tendonitis or a Soleus Strain, I might have a solution for you. Fight the status quo, keep moving, train the injured areas, mobilize your restrictions, and get back to running. It could be less than 4 weeks until you are back on the road stronger than ever.

If you didn’t see my previous article on how to determine different injuries in lower leg pain from running, it might be worth a read before you continue on. There I not only discussed what led to and caused my injury, but also the underlying mechanics of how those come about.

I’m not a doctor or a physical therapist, and this is most definitely not medical advice, but this is an account and record of what I learned and personally did. I went from using walls as supports to get around my house to finishing 2^nd in a 100-mile race 4 weeks later.

Bodies Healing Process

Before we get into how to recover from a running injury, it’s important to understand what your body is already doing. Because at the end of the day, it’s the one doing all the work.

The goal is to help your body do the work.

While this process can be complicated, to simplify it (break it down to my level), the body essentially heals itself in three stages. First, it seals off the damaged area. Then it begins the healing by laying down a latticework (collagen/scar tissue), and then for the third phase, it builds across the “chasm” that has now been joined. This is similar to building a bridge from the sides of a river.

First, you string cables, then place girders, and finally, you fill in the gaps from there.

Like in the figure above, overtime enough resources are applied where it completely heals across. While it is different, it’s similar enough for our purposes here with tendons and muscle fiber. The differences that matter for this discussion come down to a few things.

For one, a tendon doesn’t have as many resources (blood flow) as muscle tissue. But, it also is primarily made of collagen, unlike muscle cells. This means the “lattice” work we mentioned before primarily becomes the final product.

Rest and Recovery Isn’t Always The Best Plan

So, here is the rub.

If you follow the typical advice of just rest and recover, the negatives are not usually talked about.

Unless of course, you are an athlete.

Picture from https://collagenmd.guna.com/collagen/

In the figure above, A) is what your tendons typically look like and B) is after injury with no dedicated recovery efforts (this is in rats) where the tendon naturally healed.

Most medical advice is not based on athletes, but on the average individual.

This is really shown by the typical medical advice of “take it easy and let it recover”.

As an athlete, those words mean something different.

“Taking it easy” means getting weaker as your body regresses all of it’s hard fought progress. While this is always detrimental, it’s almost unthinkable when a race or competitive event is coming up, especially if you have spent months, if not years preparing for it.

But, that is not the only negative.

The problem is that the advice given doesn’t look at the cause. If an injury is not caused by biomechanics the problem is weakness.

So, the weakest link is now getting weaker (no more stimulus) as you “rest and recover” when really it needs to be getting stronger.

Along with that, tissue adherence issues are now coming to the forefront.

Scar tissue is purposely placed by the body for both muscle and tendon repair as a structure to “build the bridge”.

This scar tissue while being built can lead to tissue adherence issues like Dr. Kelly Starrett frequently talks about. But as shown above, can also lead to malformed tissue.

While sometimes rest and recovery is necessary, if you are able to avoid it, you should. This is the benefit of finding a physical therapist. By breaking down tissue adherence issues, mobilizing through injuries and developing strength in weakness, not only will you be recovered, you can be stronger than before.

The goal is to get moving as quickly as possible.

Why I think I Had Achilles Tendonitis and Why It Doesn’t Matter

So, when I first got injured I wasn’t sure what I had. The problem is that low Soleus injuries can be confused with Achilles tendonitis injuries. So, knowing this and my limited time available, combined with having lots of experience with doctors just telling me to rest and recover, which in this case especially was not an option with a 100-mile race around the corner, I decided it was best to handle this myself.

I do not advise you to do this, but I personally have found better luck in recovering quickly as long as I’m willing to put in the time to understand the issue and find proven methods of recovery (also cheaper).

So, I started doing a lot of research into both types of injuries. For one, my tendon had a bump on the back, which is a telltale sign of tendon injury, also, very minimal swelling.

But, there is another test that you can do. Since we know that the Gastrocnemius spans both the ankle and knee and the Soleus spans just the ankle, we can isolate the muscle and test it.

When you bend a joint that spans a muscle connection point, you essentially inhibit further movement.

If you do a calf raise with your leg straight and there is limited pain and then you do it again with your knee bent. You have essentially isolated your Gastrocnemius out, so the only thing that is pulling is your Soleus.

And, just like that, you know you have a soleus strain. Otherwise, it’s likely Achilles tendonitis. Not always, but this is a good guess.

But, it turns out that if you just train everything with both straight and bent legs, you cover all of your bases. So, that’s what I did.

Everything was done straight and bent kneed which allowed me to eliminate the risk of self-miss-diagnosis in the process.

Taking The Offensive On The Injury

So, now we are in the same headspace.

As I mentioned in my previous article on the difference between Soleus Vs Achilles Tendon injuries, I was in the middle of a 30-mile training run when my injury reached its peak. I was quickly realizing that continuing to push through was no longer an option.

When I finished my run that day, I was frantic to find a solution. When a big event is coming up, to me, the only option is to throw the kitchen sink at it. And, that is exactly what I did.

While some of the below might not be as effective as others, I wouldn’t know. I’m not willing to be the Guinea pig. But, for your benefit, I have listed what I did in order of the most scientifically backed and in order of what seemed to be the most effective.

5 Methods To Getting Back To Running after a Soleus or Achilles Tendonitis Injury

1. Eccentric Heel Drops increasing in both volume and intensity

There is a lot of research to back up the use of heel drops. This protocol is known as the Alfredson Protocol and is effective with 82% of participants who had chronic Achilles tendonitis.

That’s crazy, think about it.

People who had long-term damage who could not find effective solutions over a period of time were able to find success with heel drops.

And, get this, the protocol is just doing 180 eccentric heel drops a day for 6 weeks.

Now, they weren’t exactly cutting into people to see the results on their tendons, but with ultrasounds and some hypothesizing, there are some good guesses on why.

The dumb-down idea of it is, they believe the movement is essentially tearing away, or the stretching out, of the non-linear scar tissue and leaving only the straighter healthier tissue left.

By then rinsing and repeating this a lot (180 times), eventually, you finish this regimen with more effective and healthier tissue than you would have otherwise.

This is why it’s effective for long-term as well as for more recent injuries.

And, surprisingly in a study done by Dr. Obst and his associates, there is actually immediately freed up tendon length upon doing eccentric heel drops, assumingly from the straightening of the regenerated non-linear tendons.

To make this even a better deal, while the Alfredson Protocol has you doing 180 reps of eccentric heel drops a day, in a study done by Dr. Stevens and Dr. Tan it was shown that the same amount of improvement was shown with a “do-as-tolerated” protocol.

Having a great experience with the Ultimate Lower back fix, and having applied that to shoulders as well, I applied the same principles here.

Essentially, every day, I added more tolerable reps in both straight and bent knee eccentric heel drops and eventually made the movements weighted as well. I did this all the way up until three days until race day.

There are two ways of doing heel drops.

Bent and straight-legged.

While I did both, if you are choosing one, there was a study that said the bent leg version was not as effective in terms of Achilles tendonitis repair.

So, why include it?

Because as talked about in the ultimate lower back fix. It is essential to keep training muscles that are injured. But, it must be done in a controlled fashion. This version of doing heel drops with a bent knee effectively trains the soleus muscle, hence covering down if you do have a Soleus muscle strain.

Then every two-three day’s I would do progressive overload resistance training using the same method of movements. This was combined with an equivalent of alternative cardio.

While I was training for an ultra and was trying to hit 75-mile weeks. There is no need to mimic what I did. But, essentially, I replaced all running with a mix of biking and walking with a 55lb weight vest for the equivalent time that I would have been running.

I tried doing a mix of run walks in the beginning but quickly realized that was a mistake and axed them out entirely after I re-injured the tendon.

If it was going to be a 20-mile run and I expected that to take me 3.25 hours. I would instead walk two miles and bike for three hours because if I was running the two miles that would roughly take 15minutes

You would likely have a better conversion with water jogging (there is a lot of research backing this up) but I didn’t have easy access to a pool. And, I thought biking will help with my lack of hill training.

While the below is not exactly what I did, because you should do this based on how you feel, the below is a good approximation. If you can handle more pain, do more. If you can’t or it feels like a re-injury, stop.

Monday

3 x 15 straight legged eccentric heel drops

3 x 15 Bent legged eccentric heel drops

Tuesday

3 x 20 straight legged eccentric heel drops

3 x 20 Bent legged eccentric heel drops

Wednesday

3 x 15 weighted straight-legged eccentric heel drops

3 x 15 weighted bent legged eccentric heel drops

3 x 5 Heavy seated calf raises

5 x 2 Deadlifts

Thursday

3 x 15 straight legged eccentric heel drops

3 x 15 Bent legged eccentric heel drops

Friday

3 x 20 straight legged eccentric heel drops

3 x 20 Bent legged eccentric heel drops

Saturday

3 x 15 weighted straight-legged eccentric heel drops

3 x 15 weighted bent legged eccentric heel drops

3 x 5 Heavy seated calf raises

Sunday

3 x 20 straight legged eccentric heel drops

3 x 20 Bent legged eccentric heel drops

Then just rinse and repeat as you keep adding reps and weight. By race day, I was around 5 x 40 for both bent and straight-legged every day.

2. Rollout and compress upstream muscles

Overuse injuries are aggravated, if not caused by upstream issues.

You have to not only mobilize the injured area, but the connected tissues as well.

For the Achilles tendon, I used both a lacrosse ball, barbell, and a foam roller to free up the tissue along my entire lower leg and into my hamstrings. I would spend 20-30 minutes each day, staying in any painful spot until the pain melted away and then went on the next.

Does it suck?

Yep.

Is it worth it?

Yep

After that, I would then use a compression band and wrap it around the foot and ankle and do a series of Squats, walking, and jumping until the wrap felt claustrophobic and/or it started going numb.

*You can also use an old cut-up tire tube like I use

Then I would wrap my calf, my knee, and then my upper leg, doing the same motions throughout.

Only once or twice did the injury actually hurt during this. If it did, I just stopped doing whatever caused the pain and moved onto the next area.

3. Intermittent Fasting – Autophagy

Admittedly, this is getting into more experimental areas. I only did this for 2.5 weeks and then stopped so I could have 1.5 weeks to get back in my old diet routine.

I would fast 20 hours and eat for 4 hours. I would make sure I still hit all of my calorie/macronutrient/micronutrient profiles. Just a force-feeding frenzy.  I know it sounds crazy.

While there is less research into the effects of intermittent fasting on autophagy there is quite a bit on the two separately. Healthline is an interesting short article on this.

What theoretically happens is, your body still needs nutrients, so it removes old and broken down tissue and uses that for protein, and then uses fat stores for energy.

Why is this good?

Because like we talked about above, this healing process you are going through is creating/breaking down a lot of tissue. Autophagy in theory removes excess and damaged tissue that is no longer needed.

On top of that, studies have shown an Increase by as much as 5 times baseline Human Growth Hormone (HGH) after fasting for two days. There is a shown a corresponding decrease for a decreased amount of time fasting. As in, less time fasting, less HGH release.

Human Growth Hormone is essential for tissue repair.

All of these benefits were too good for me to pass up.

And, honestly, I realized I didn’t mind it. I would get hungry for maybe a couple of hours before I could eat, but it got easier to deal with over the first couple of days. I would eat between 4 PM and 8 PM, but any time would work.

If you decide to follow any of this as a woman, I highly recommend you skip this part. While there is a lot of good research for men doing intermittent fasting along with corresponding success, it has not been so promising with women and caused some pretty big fluctuations in hormones.

4. TENS Unit

This is the hokiest thing I did. I don’t really think it had that much effect and I only did it because I had bought it a couple of weeks earlier to play with.

Turns out, The only successful and conclusive research with these units has been with rats on partial and completely ruptured Achilles tendons.

So, having already owned it and seeing that there was some research behind it, I used it.

Only 20 minutes a day on a pulsing setting at the highest setting I could tolerate. The idea behind it is, that it irritates the area. This irritation convinces the body to send more blood flow, hence more resources.

I bought the cheapest one with decent reviews from Amazon and called it a day. Mine has a bunch of random settings, but I ignored them.

 Since there is very limited research, the settings can’t be based on anything legitimate. So, I just tried to match the study as close as possible. Essentially just placing the ads directly on either side of my tendon and let the device run.

5. Replace Shoes

Ok, obviously no science behind this, but I noticed that my shoes were extremely worn down in the heel. Since I run in zero drop shoes, I was essentially running on a constant decline, adding huge amounts of constant and extra strain.

Shoes in good condition are one of the most important pieces to injury free running.

As a side note, there is a lot of sites that recommend heel inserts or to get bigger heels on shoes. I tried the first and reject the latter.

The first, while it did help with pain, it changed my gait, which is a recipe for injury, and added a weird pain to the bottom of my foot due to the different leverages, all of which I’m not ok with, especially for a 100-mile race.

The last is for the same reasons as above. I’ve trained with no issue on a certain kind of shoes for thousands of miles, I’m not switching it up right before a race, but you do you.

Should You Use This To Quickly Heal your Lower Leg Pain?

Like I said before, I’m not a doctor, I’m not a physical therapist, but this is my personal account that proved pretty effective.

This did work for me and it is based on conclusive studies that hs been replicated and I would do it again. That being said, this is not a magic fix. It requires dedication, perseverance and does not guarantee pain-free running. In fact, I had some of this reoccur during my race.

The point of this is to say that if you are going to ignore medical advice and not take the time off to recover. This might be a better way to do it.

If you decide you want to try this, do it at your own risk. Regardless of what laws say or people say, you are the sole keeper of your own body.

You have the sole responsibility for your bodies safekeeping and building it’s resilience. This is why we train. It’s also why you need to evaluate what you need to do for your own circumstances and not follow anyone’s advice blindly. That does not mean that you shouldn’t use this as a starting point for a discussion with qualified individuals that might be able to help you on your journey.

Good luck and I hope to see you on the trails.

Best,

T

*All research has been done on my own or has been learned through my certifications. If you believe any is in error, please notify me, with the supporting evidence attached so we can all benefit.