Written by: Gerald O. Ryan
Posted: Thursday, 27 March 2008
I usually ride my centuries in September, using the whole season to train, increasing my conditioning and my mileage base. The MS 150 takes place in late June, so I trained a little harder, a little faster, a little more competitively. My Achilles tendons started to ache a bit. Oh well, I thought, my godfather’s right again. I stretched as I usually do, applied cold packs and took some anti-inflammatories. It didn’t seem to affect my cycling.
After the MS 150, I dialed down my mileage but continued to ride into the fall. I rode the wind trainer in the winter and then jumped out to nice a spring regimen the following year. My Achilles tendon still hurt, but no big deal. Right?
Spring riding means spinning in low gears for the first 500 miles and increasing mileage slowly, 10 percent a week. Sensible cycling, like I’ve done every year for the past 30. Except my Achilles tendon never stopped hurting. But I could stretch it and ride. I could live with this.
Memorial Day weekend had me riding into the wind and hills at a moderate-to-fast pace, 30 miles or so every day. No big deal. I came home on Memorial Day Monday and told my wife,“You know, cycling is one of the few things that still make me feel young.” An hour later, I could barely walk.
Sure, using 20/20 hindsight, I can see the pattern that was developing. But as a typical amateur athlete, I rode an irritating overuse injury into a degenerative condition that has affected me for almost a year and is not healed yet. Where did I go wrong?
My mistake wasn’t ignoring the problem, but ignorance of the true condition. I turned what I thought was annoying tendonitis, an inflammation, into tendonosis, a chronic degeneration of the collagen fibers in the tendon. Tendonosis is an accumulation of small-scale injuries that, over time, don't heal properly. It is a chronic injury of failed healing, says Laurie Erickson on her Web site, www.tendinosis.org. Tell me about it.
Tendons are different than muscle tissue, connecting bone to muscle. The Achilles tendon connects the heel to the lower calf muscles. This is the spot on the body where the mythical Achilles was held as he was dipped into the river Styx by his mother to make him invulnerable to injury. Except, of course, in that one spot where the Trojan Paris shot him with an arrow.
Tendons don’t have as much blood flow as muscles. So when injured, they heal slowly. And according to Dr. Khan in his article “Overuse Tendonosis, Not Tendonitis,” the medical community is only now using a different paradigm to diagnose tendon problems. When I limped into the medic’s office the next day and the doctor took alook at my Achilles tendon, the diagnosis was quick: tendinitis and perhaps a bit of bursitis. No mention of chronic tendinosis, even after I described my yearlong problem. Fortunately, the treatment for the injury is similar. I went into physical rehabilitation the very next day, using low-level laser therapy and ultrasound to increase the blood flow to the injured area, moderate strengthening exercises for the calf muscles, stretching exercises for the tendon itself, and a very gradual return to cycling. Very gradual.
After I completed the six weeks of rehabilitation my insurance would allow, the therapist told me I could start to cycle again, using low resistance and backing off on the hills: 20 minutes a day, then 30, 40, etc. Even for a day-tripper like myself, that kind of reduced time in the saddle is like kissing my sister. And I don’t even have a sister. I got up to about an hour a day and the tendon started hurting again. Almost a year later, it still does.
I continue to cycle indoors, stretch the tendon and strengthen the calf muscles. But if the situation doesn’t resolve itself soon, the next step is a surgical debridement of the affected tissue, a big step involving 12 weeks in a walking cast and more rehabilitation. I’m rooting for more conservative measures.
Facts on Tendonosis
How can a recreational athlete recognize that they may be having an Achilles tendon problem?
According to Dr. Joshua Dubin (www.biomech.com), symptoms may include:
• Diffuse or localized swelling and tenderness around the tendon
• Pain with the first few steps after getting out of bed
• Exacerbation of the injury upon walking uphill
What are the risk factors for tendinosis?• Increasing intensity and duration suddenly
• Indulging in repetitive motion activity
• Experiencing symptoms but still "warming up" the injury and indulging in physical activity
• Unknowingly allowing micro-injuries to gradually accumulate faster than they can heal
• Wearing improper footwear
• Over or under pronating; having legs of unequal length
• Taking medications that may weaken muscles and tendons
How do you avoid tendinosis?
• Warm up slowly. Stretch before, during, and after strenuous physical activity.
• Be aware of your body. If something aches or hurts, don't ignore it and think it will go away on its own.
• Review the mechanics of your sport. Cyclists should review the fit of their saddle, handlebars, cleats, and pedals; they should also review their pedaling technique.
• Don't suddenly increase the intensity or duration of activity.
• If you have a problem, back off.
• See your doctor if pain persists.
The road race season in Michigan kicked off in April with Spring Training Series Races in Ann Arbor and Waterford and the Ciociaro Can Am Challenge Series in Windsor. Now that roadies are all warmed up, it's time to stretch their legs in some good old-fashioned road and criterium racing. In the coming weeks road cyclists can look forward to the Grattan Race Series kick-off, the Cone Azalia Classic road race, the Tour of Kensington Valley, the Priority Health Tour De Leelanau, the Tour De Gaslight Criterium and in June, a race that is quickly becoming a favorite among all racers, citizen and professional alike - The Superior Bike Fest in Marquette.
I just received a grim e-mail to end an otherwise unremarkable day. The subject line read "Ryan Shay Autopsy Released." 
