Saturday, April 10, 2010


A recent post on the cycling coaches' google group reminded me of a few basic things I learned in medical school. The post was in reference to an athlete who had developed bilateral Achilles tendonitis and was asking a coach for help. The original email was detailed and repeatedly mentioned that the athlete had done nothing special to provoke the injury and furthermore he recalled had stressed his achilles much more on many previous occasions with no consequences.

The responses were very typical. Many coaches quickly tried to tie the injury to a recent event. Those of you in medical practice are probably smiling or trying to suppress a smile. Patients and their caretakers almost always come up with a reason for their condition. It is just human nature to try to find a cause and pick up on a spurious correlation.

Secondly, people pick causes that they understand and can work with. So nearly all coaches immediately laid the blame on poor bike fit and other mechanical issues. Many offered solutions although some -no doubt fearing liability issues- quickly pointed out a doctor was needed. One was bold enough to admit that doctors are often as much at loss as to the cause as everyone else.

I happen to have suffered an Achilles tendonitis a few years ago. It had all the visible signs of inflammation including the pain, the swelling and the rubbing, which could easily be felt by an outsider touching the skin over the tendon. I consulted my HMO and was prescribed an anti-inflammatory dose of ibuprofen, ice packs, exercises to strengthen the triceps, and physiotherapy. I was also told to bag my plans to run an IM (two months into the future at that time), and to rest a lot.

In the end, I did finish the two week anti-inflammatory treatment course, which helped maybe a bit -but not much. I applied plenty of ice-packs and later heat packs, which offered the best subjective relief. I participated, albeit somewhat halfheartedly, in a few physical therapy sessions, and I backed off somewhat from running and cycling -the two worst offenders. I did run the ironman though and was able to finish within a reasonable time, although my Achilles did hurt and was rubbing during the run.

Even so, the injury got better and went away by itself after a few months. I finished another IM race before it healed up completely. I made no lasting changes to either my running shoes or bike fit, and I continue to run in the same brand shoes and with the same bike fit to this day. It has been two years now and I haven't had a problem yet.

It would be easy for me to correlate the betterment with all the medical attention, and many would be tempted to do so, but I disagree. If I had changed my bike fit, I would not doubt believe it made a difference and helped me heal, but that too would be bogus.

I can clearly state that the injury came out of the blue and disappeared (months later) all by itself. And I have seen many similar incidents in people I know since that time and they all behaved the same way. It seems likely that these types of injuries go away on their own and that just backing off a bit is the only thing one really needs to do.

I also don't doubt that in a few rare instances this may not happen and things will deteriorate further. Such is the nature of human existence. We also suffer illness and injuries but most of us will heal just fine on our own, with or without medical intervention. A few don't and they suffer chronic illness or disability. But there is simply no way for us to know in advance who will and who won't, nor -IMHO- would we be able to prevent it from happening even if we knew who.

I will advance a hypothesis that explains these matters in my next post.

Workouts this week:
Tuesday, 33 mile bike ride, to top Redwood plus some extras
Wednesday, 8 mile run in the hills with intervals
Thursday, 30 mile ride with Alistair
Friday, 8 mile run to Montclair with intervals

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