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Rog

Running and achilles issues - what else to do / next steps

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Hey guys,

 

I'm hoping to tap on the collective wisdom and experiences of others to see if you can help me work out what to do next to try and get rid of a nagging issue I've been having with my achilles since January this year.

 

I have seen 2 or 3 different physios, podiatrist, masseurs and I don't think any of them have been able to figure out exactly what my problem is.

 

The issue seems to be localised somewhere near the heel bursa rather than your typical achilles area - from what I can understand this is where the achilles tendon connects with the heel.

 

This area swells after my runs (there is a noticeable bump) and there is residual pain for at least a day or sometimes two depending on how I manage it straight after the runs. I can literally put my finger where the pain is and there is absolutely no pain around the mid-achilles area.

 

Icing seems to help a lot, as does (I think) rubbing a bit of voltaren gel in the area, wrapping it in cling wrap and putting socks on before going to bed (this was a tip from a physio).

 

The typical calf raising exercises don't seem to help at all, in fact I think they actually aggravate the problem. The same goes for calf stretches.

 

It's been 3 weeks since my last run (Cairns IM) and even though there is no pain as such (1 on a scale of 1 to 10), if I put pressure on the source of the problem I can feel a kind of "nerve" pain. As I was writing this I actually tried to find it and it seems to be a bit on the side rather than right in the middle of the heel now.

 

On the image below, I'd say the pain is located closer to where the arrow is pointing at the calcaneous, maybe slightly above it.

 

I guess the things I am trying to work out are

 

1) Have you had anything similar to this and if so, how did you treat it?

2) Given the background above and all the things I've tried so far, what else can I do to try and identify what's causing this and make it better? X-Ray? MRI? I have no idea!

3) Anything else I haven't done / thought of that you think might help?

 

Cheers,

Rog

 

heel_spurs.jpg

Edited by Rog

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You might think I talk shit and don't like me but I have had more Achilles problems than hot dinners so I feel I can contribute. I bet it doesn't hurt to ride ? But does after ? With the stress of cycling on the Achilles if it was really

Serious you could hardly pedal.

It sounds like a bursa somewhere I think it is called ? A sack of inflamed fluid on the insertion point. Honestly try massaging the heal and see if the pain moves around. I know this sounds stupid but after 2 snapped Achilles and numerous operations I end up with this problem whenever I do more than about 350 km a week.

U might find that your bike set up has changed and can cause this. I ride with my cleats a bit further back to take the pressure off.

For running see if you can put a wedge under the heal to lift it slightly in the shoe it seems to work for me also put it in your work shoes to take the pressure away and let the inflammation go down.

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Stuart Watson is a genius, I've done 11 ironmans post his handywork that I never should have done. He also got melinda gainsford to an Olympic final after doing some work on her too which is serious good juju.

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Stop guessing and get an MRI.

 

Having said that, my guess is that it sounds like a bursar issue...

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Almost regards of an exact diagnoses I would recommend relatively high rep with low impact. Don't let the area get tired, just work it easy. Sometimes the hardest part of training is putting in less effort. But you gotta give it some proper healing time at some point, and the sooner you do it the shorter that healing time will be. So stop running and start jogging, no bike sprints or mashing gears, kick lots when swimming.

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Hey guys,

 

I'm hoping to tap on the collective wisdom and experiences of others to see if you can help me work out what to do next to try and get rid of a nagging issue I've been having with my achilles since January this year.

 

I have seen 2 or 3 different physios, podiatrist, masseurs and I don't think any of them have been able to figure out exactly what my problem is.

 

The issue seems to be localised somewhere near the heel bursa rather than your typical achilles area - from what I can understand this is where the achilles tendon connects with the heel.

 

This area swells after my runs (there is a noticeable bump) and there is residual pain for at least a day or sometimes two depending on how I manage it straight after the runs. I can literally put my finger where the pain is and there is absolutely no pain around the mid-achilles area.

 

Icing seems to help a lot, as does (I think) rubbing a bit of voltaren gel in the area, wrapping it in cling wrap and putting socks on before going to bed (this was a tip from a physio).

 

The typical calf raising exercises don't seem to help at all, in fact I think they actually aggravate the problem. The same goes for calf stretches.

 

It's been 3 weeks since my last run (Cairns IM) and even though there is no pain as such (1 on a scale of 1 to 10), if I put pressure on the source of the problem I can feel a kind of "nerve" pain. As I was writing this I actually tried to find it and it seems to be a bit on the side rather than right in the middle of the heel now.

 

On the image below, I'd say the pain is located closer to where the arrow is pointing at the calcaneous, maybe slightly above it.

 

I guess the things I am trying to work out are

 

1) Have you had anything similar to this and if so, how did you treat it?

2) Given the background above and all the things I've tried so far, what else can I do to try and identify what's causing this and make it better? X-Ray? MRI? I have no idea!

3) Anything else I haven't done / thought of that you think might help?

 

Cheers,

Rog

 

heel_spurs.jpg

 

Rog... you have exactly the same symptoms as me. Lump, pain at insertion points... I have been fighting this for three (actually, twenty) years, and it got to the point before IM Melb that I had to stop running. I pulled out on the bike anyhow, and in retrospect, I'm glad I did. I have only run once since then, in a sprint tri in the first week of April.

 

I have a problem called Haglunds Syndrome, caused by a Haglunds deformity. http://en.wikipedia.org/wiki/Haglund%27s_deformity

 

I would suggest going to see a good sports doc or physio to get this diagnosed.

 

I have had three injections into the achilles in the past three months, because the inflammation was ridiculous... and am walking without pain in the morning for the first time in years. I am back at the doc tomorrow morning to see where it's at.

 

I can't even wear shoes without padding at the moment, because rubbing on the heel starts the vicious cycle.

 

As I said - get to a good doc/physio - maybe even two or three - because mine wasn't picked up for years.

 

 

EDIT - the injections weren't into the achilles, they were into the general area 'above' the achilles. Needed to be clarified.

Edited by Nick777

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Thanks all for the info so far.

 

Do I need a referral to see a sports doc and if so do I get one from my GP or physio?

 

I assume if I do get a referral I can claim some of the expenses on Medicare right?

 

Cheers,

 

Rog

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Nick, what exactly did they inject into the area? I've got achilles tendinosis and lately it's moved to the insertion area.. farking pain in the arse for years, frustrating

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technically you need a GP referral to claim a higher rebate for a Sports Doc visit. Most will see you on a Physio referral but may not get as much back from medicare.

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Nick, what exactly did they inject into the area? I've got achilles tendinosis and lately it's moved to the insertion area.. farking pain in the arse for years, frustrating

 

 

I was injected with cortisone. The doc needs to get it right, because if they inject into the actual achilles, it can weaken the tendon & tear it.

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Got the MRI done today and am booked to see specialist again on Monday (thanks Parky for the tip re: Dr Stuart Watson)

 

From what I can see the achilles is clean, it's the bursa that seems to have a bit of fluid deposit near it which seems to be the exact source of my pain.

 

I'm guessing retrocalcaneal bursitis and a cortisone injection will have it sorted.

 

Anyone care to take a punt?

 

IMAG0192_1.jpg

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Rog you've really only been a consistent trainer for the last 12-18mths and done very well. Be patient.. It will take time until those tendons work consistently how you want them to. The achilles is one of the least understood and tuned into by a lot of runners. Just small changes in technique, the shoes you wear and day to day adjustments to your training will keep it going well and going stronger. That goes for all the little tendons and muscles in your foot too- least seen and felt and talked about but some of the most important

 

a bit of running through pain in a good way is part of the process of adjustment too- need to understand good and bad

 

the answer is rarely just a shot of cortizone and bobs your uncle

Edited by Jimmy C

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I used to have a bursar in both heels...but chronic problems led to one being cut out 22 years ago. Make sure you get it right first time.

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Got the MRI done today and am booked to see specialist again on Monday (thanks Parky for the tip re: Dr Stuart Watson)

 

From what I can see the achilles is clean, it's the bursa that seems to have a bit of fluid deposit near it which seems to be the exact source of my pain.

 

I'm guessing retrocalcaneal bursitis and a cortisone injection will have it sorted.

 

Anyone care to take a punt?

 

IMAG0192_1.jpg

How much did the MRI set you back?

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$500 odd bucks but you get $300ish back from Medicare. Just need to make sure you're getting it done in a rebatable MRI machine.

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a bit of running through pain in a good way is part of the process of adjustment too- need to understand good and bad

 

Hey Jimmy I get what you mean and know this one is bad, and it will stop me from running if I don't look after it.

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Just had a shoulder MRI in Melbourne - referred by Karne Holzer (made her money out of CEM) and that was $199 special.

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Got the MRI done today and am booked to see specialist again on Monday (thanks Parky for the tip re: Dr Stuart Watson)

 

From what I can see the achilles is clean, it's the bursa that seems to have a bit of fluid deposit near it which seems to be the exact source of my pain.

 

I'm guessing retrocalcaneal bursitis and a cortisone injection will have it sorted.

 

Anyone care to take a punt?

 

IMAG0192_1.jpg

Ganglionic cyst. Fluid is enclosed in a sac which does originate from the bursa, it's more common in the wrist secondary to RSI, repetitive strain injury. The sac might rupture or leak from time time time relieving the symptoms but the fluid will still accumulate. Needs surgical excision from an ortho with a relatively short recovery time.

Edited by kamalarrowsmith

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Got the MRI done today and am booked to see specialist again on Monday (thanks Parky for the tip re: Dr Stuart Watson)

 

From what I can see the achilles is clean, it's the bursa that seems to have a bit of fluid deposit near it which seems to be the exact source of my pain.

 

I'm guessing retrocalcaneal bursitis and a cortisone injection will have it sorted.

 

Anyone care to take a punt?

 

IMAG0192_1.jpg

It's a girl!

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Ganglionic cyst. Fluid is enclosed in a sac which does originate from the bursa, it's more common in the wrist secondary to RSI, repetitive strain injury. The sac might rupture or leak from time time time relieving the symptoms but the fluid will still accumulate. Needs surgical excision from an ortho with a relatively short recovery time.

So it's the ankle equivalent of a Bakers cyst?

 

 

It's a girl!

Now that is very funny.

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$500 odd bucks but you get $300ish back from Medicare. Just need to make sure you're getting it done in a rebatable MRI machine.

Mate, things must be a bit expensive up North. I've had bad hammy problems all year myself similar to your achillies. After X-Rays and Ultrasounds not concluding anything, the Physio (who specialises in running injuries) suggested I get an MRI, but also go to a Sport Doc (Olympic Park Sports Medicine Centre), so to go there, like Parkside mentioned I had to get a referral from a GP to get the rebate (although it was still way expensive). But anyhow, because I went to the Olympic Park, I got an MRI where the out of pocket was only $60 rather than the close to $300 if I had have had the Physio's referral. Not sure how that all works out, seems a bit of rorting...or probably to prevent rorting perhaps, but makes a frustrating process.

 

Oh and for the record, my MRI concluded nothing so still in the same predicament. :(

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The Government tries to create a financial disincentive for the end consumer (the patient) to have expensive imaging tests done as a matter of routine, often inappropriately, by having a scale of rebates according to the expertise of the referrer. Specialists imaging referrals get the best rebate (Orthopods, and now Sports Physicians), then GP's, Physios. They are trying to stop every GP shooting ankle sprains off for an MRI when it is not warranted. Having said that there is a Sports Doc around here who will send every patient for at least 2 imaging tests, including an MRI and his diagnosis is always a rehash of the MRI report summary. Must be costing the Govt hundreds of thousands a year.

 

A negative side effect of the recent propmotion of Sports Docs to a full-blown specialist status is that they now need to have a referral from a GP. This means when the Physio is trying to initiate opinion, imaging or non-surgical medical management from a Sports Doc we have to send you to a GP (who we were probably trying to sidestep in the process), you may have to pay the GP for the appt to write the referral the Physio has already done. Some Sports Docs will see patients from Physios without a GP referral, but you get less back(? nothing) on Medicare that way, some of my patients prefer this, can save a week of stuffing around and the cost is not hugely different.

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Got the MRI done today and am booked to see specialist again on Monday (thanks Parky for the tip re: Dr Stuart Watson)

 

From what I can see the achilles is clean, it's the bursa that seems to have a bit of fluid deposit near it which seems to be the exact source of my pain.

 

I'm guessing retrocalcaneal bursitis and a cortisone injection will have it sorted.

 

Anyone care to take a punt?

 

IMAG0192_1.jpg

 

I'd wait and see what Dr Linklater thinks in his report.

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The Government tries to create a financial disincentive for the end consumer (the patient) to have expensive imaging tests done as a matter of routine, often inappropriately, by having a scale of rebates according to the expertise of the referrer. Specialists imaging referrals get the best rebate (Orthopods, and now Sports Physicians), then GP's, Physios. They are trying to stop every GP shooting ankle sprains off for an MRI when it is not warranted. Having said that there is a Sports Doc around here who will send every patient for at least 2 imaging tests, including an MRI and his diagnosis is always a rehash of the MRI report summary. Must be costing the Govt hundreds of thousands a year.

 

A negative side effect of the recent propmotion of Sports Docs to a full-blown specialist status is that they now need to have a referral from a GP. This means when the Physio is trying to initiate opinion, imaging or non-surgical medical management from a Sports Doc we have to send you to a GP (who we were probably trying to sidestep in the process), you may have to pay the GP for the appt to write the referral the Physio has already done. Some Sports Docs will see patients from Physios without a GP referral, but you get less back(? nothing) on Medicare that way, some of my patients prefer this, can save a week of stuffing around and the cost is not hugely different.

My experience exactly. The sports doc saw me with a physio referral but that meant I would only get 35 bucks back from Medicare as opposed to 70 if I had a GO referral. Considering I'd have to pay about 30 to see a GP anyway it was not worth the hassle.

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My experience exactly. The sports doc saw me with a physio referral but that meant I would only get 35 bucks back from Medicare as opposed to 70 if I had a GO referral. Considering I'd have to pay about 30 to see a GP anyway it was not worth the hassle.

Yep, same same - plus the time and stuffing around. Was similar when getting an Ultrasound done, I had to get the GP to get the referral for the Ultrasound, although the Physio could initiate an x-ray.

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I was partially right.

 

Diagnosis is fluid in the bursa but also moderate insertional achilles tendinosis (no haglunds deformity)

 

There's a partial tear as well. It affects less than 5% of the tendon but it is not great news.

 

I'll start with a x-ray guided cortizone injection in the bursa and possibly shock wave treatment 3-4 weeks after.

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shock wave treatment 3-4 weeks after.

 

i know lots of guys who have had good results with that.................and patience :-)

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Diagnosis is fluid in the bursa but also moderate insertional achilles tendinosis (no haglunds deformity)

 

 

Great news.

 

(lucky bugger!)

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So 5 months later, 2 cortisone shots, several weeks completely off running, a 3 week course of antibiotics + anti-inflammatory + green tea, podiatrist consultations, strengthening exercises etc etc I am still struggling to get over this issue with my achilles. Some days it is fine, others I can feel it even when I'm walking.

 

Something on the back of my mind keeps saying it could be bike equipment related, and then it manifests itself when running.

 

I've tried new bike shoes and am about to try some of the zero float (black) LOOK cleats (currently using the grey ones). Anyone else had success with this?

 

I'm also going to see Dr John Orchard @ Sydney Uni and possibly try PRP treatment - has anyone had any positive or negative experiences with this as well?

 

I can still run and manage it with icing / heat packs all the time but this is obviously not ideal and I feel it will eventually get out of control as soon as I start running longer... I am also not sure how much I should keep pushing through the bit of discomfort I have. Doing nothing hasn't helped and it is actually not recommended by the specialists. A little bit of stress to the area is supposed to help with the recovery but it's very hard to say how little is too little and how much is too much...

 

Any other ideas, success stories, recommendations?

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Rog - my partners boss at work had it (prp) - both sides - a while back - will check in and see - she is a middle aged netballer and skier so not the same but another one to add to the list

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There is no quick fix with achilles. I remember Motttram saying he had periods of 16 weeks of no running to let his recover.

Edited by CEM

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Agree no quick fix. ok - the missus boss had it and can now is back playing basketball, netball and skiiing and apparently she can wear flat shoes again! Ok that last part may not be relevant? It laid he up for a few days longer than expected and I wouldn't imagine she is putting in the miles you would but it does appear to have worked for her. That is the n=1 case for you.

 

 

Dave

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Tried SCENAR treatment? Physios will shoot me down, but if you have nothing to lose, so find a therapist and give it a go. I had a calf issue that no one or no thing could fix. 3 sessions with it and I was fixed.

I even brought one. It's excellent for all sorts of things including some kinds of headaches. Mozzy bites and more!

A mate was about to have surgery on his knee and tried Scenar first. No surgery required.

As I said this will be considered black magic around here by most, but what have you got to lose?

Edited by Lostkiwi

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Yes heel lifts in all shoes. To my wife's disgust I mostly walk in running shoes (Nike Pegasus), no thongs, barefoot, etc unless it's a social occasion and she gives me "the look".

 

Never heard of this Scenar business but will start googling. Thanks.

Edited by Rog

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I can relate to this topic. I have also been struggling for the last twelve months from inflammation in the same area as ROG described.ie base/back of heal. ie achilles insertion. I have had x-Ray which shows signs of spur which appears to be the problem. I did have one injection in Feb which got me through Husky and Ironman but came back. Also learned injections no good for Achilles - increased risk of rupture.

 

I had progressed to lower heal/toe drop shoes over the years which I think has backfired. I have returned to more traditional shoes which has helped (I think). I have accepted it may not ever get better but try to manage it. It settles quickly and I don't run consecutive days, only jog and distances are kept down to 10k's.

 

I have not seen a physio :smile1: but may do soon.

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Hard to imagine how much this must suck, it is a long time for an injury to be hanging around like this.

 

Assuming the "several weeks" rest you had is actually between 7 and 11 weeks? I would suggest no running(zero, nada, zip, zilch) for 12-16 weeks. You can maintain a high level of aerobic fitness through cycling and swimming and changing nappies while you let the tendon fully recover.

 

The idea of constant icing and pushing through "discomfort"(lets face it, it's pain and comes with damage) is not a sensible long or even medium term plan. If you had a $800 event paid for or a AAA race that you had be preparing for, for months.... maybe.

 

Race your bike, get a surf ski, or canoo and try some paddling or something for 3 months.

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Yes heel lifts in all shoes. To my wife's disgust I mostly walk in running shoes (Nike Pegasus), no thongs, barefoot, etc unless it's a social occasion and she gives me "the look".

Never heard of this Scenar business but will start googling. Thanks.

Tell her at least you can see your feet.

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I had really bad Achilles after worlds 2012. A good 6 months of debilitating pain and no walkies early in the morning.

 

The only thing that improved it was time. Then strengthening exercises including walking barefoot in sand for a couple of hours once a week.

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My running mileage since Cairns has been an average of 40mins / 7.2kms per week.

 

My longest run has been 45mins / 9km (last Sunday).

 

I have run a maximum of 3 times in one week during this period, but mostly once or twice a week only.

 

All runs on soft surface / grass, no faster than ~5min/km.

 

Surely I am not overdoing it.

 

VERY frustrating :(

 

PS: on a positive note swimming is the best it's ever been :D

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Been through achilles issues a few times. Bit over a decade ago (before triathlon) was doing about 100km/week, developed achilles issues, thought could 'manage' it, kept running albeit less, mistake, got worse. Sports medicine Dr at Olympic Park said only high probability 'cure' then given condition I'd driven achilles into (lumps, bumps and thickening) was take 2 years off and go cross training. That was after seeing many people, doing different things, eccentric heel lifts etc. After 1.5 years it felt good went for a run and relapse; another year off. Then mostly good for 10 years or so.

 

Since getting into triathlons about 5 years ago, had some achilles issues at times, but most was about 3 months - recognise the signs and pull back. Touch wood, no issues last couple of years. That was after changing run technique to be mid-foot from heel-strike. But still back it off if feel real tightness in calves/lower legs.

 

Anecdotally, seems many runners get put out of action with achillles.

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My running mileage since Cairns has been an average of 40mins / 7.2kms per week.

 

My longest run has been 45mins / 9km (last Sunday).

 

I have run a maximum of 3 times in one week during this period, but mostly once or twice a week only.

 

All runs on soft surface / grass, no faster than ~5min/km.

 

Surely I am not overdoing it.

 

VERY frustrating :(

 

PS: on a positive note swimming is the best it's ever been :D

I know exactly how you feel mate but luckily it's on the mend and how good does it feel when swimming feels a lot easier than it ever used to be.

 

Also, I am in the same position of "am I over doing it." Every time I set out on a run the only thing that runs through my mind is am I doing myself more damage even though I am running pain free for 6km every second day. I even added a few 1min pickups last week without any pain so I guess that could be a good sign but who knows. Injuries are the devil...that's all I can say

Edited by alexholbrook

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Surely I am not overdoing it.

 

If it hurts and you need ice at the end then yes, you are over doing it.

 

Walk away from running for a while, before you are forced to limp away from it... forever. *queue dramatic music*

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The older you get the more of the devil are soft tissue injuries.

 

Bloody knee, let me down in earnest mid September, I finally threw in the towel about three weeks later. Solid therapy since late October (I emailed ahead and got an appointment hot off the plane, jet lag and all) and I'm only just starting to sort of run at full body weight. A really slow 2.5km on Saturday was a genuine milestone, no lasting discomfort afterwards. "Just" patella-femoral mis-tracking, but crikey it's taking a long time to resolve.

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Have you tried running on grass or running on dirt tracks? Mix it up a bit, try different surfaces, different shoes, different run distances etc and see what really exacerbates it and what doesn't.

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Re: John Orchard

I saw him 2007 for my ITB he is a distance runner himself and gets it.

 

I ended up going with his recommendation and had the ITB snip. Running since. Not a lot but better.

 

I would see what he says and follow his advise

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