November, 2010 Update: The below story was written about a year ago and it has an open-ended conclusion. The current update is that my injury is about 95% healed via eccentric exercises, and therefore, I consider myself to be a complete success story with eccentric exercises. 

When I was about 16 years old, I jumped off of our first-story back deck to save the family miniature dachshund from what appeared to be an inevitable confrontation with a neighborhood dog. I succeeded in saving the dog but strained my right Achilles' tendon in the process. Being young of age, it seemed to heal relatively well during a period of about six months. However, in the years to come, it became evident that this injury had not healed completely.  Strenuous activity and sports like snowshoeing (in which there is a strap placing constant pressure on the tendon) caused some degree of aggravation in only the right tendon, but not the left.  

By the time I was 30 years old, the weakened tendon was not enough of a nuisance to drive me to seek medical attention.  I was still able to participate in the many athletic activities which I so loved.  That is, until January of 2009, when my wife and I were on vacation in San Francisco and decided to race each other up the steep city streets (literally almost 45 degree climbs). I was a bit out of shape but nonetheless sprinted for about half a mile straight uphill.  

After this stunt, over the next few weeks, it became clear that I had done some real damage to my right Achilles tendon. The left tendon was fine. The right one had apparently developed a predisposition to further injury as a result of the past traumas. It became inflamed and hurt even to walk on. Achilles injuries can be devastating because they not only involve a part of the body that is constantly in use during daily life, but also a part of the body that is among those which receive the least amount of blood flow and therefore, heal the slowest. Furthermore, in addition to almost constant use, the Achilles' tendon is subject to brutal load and force during regular use.  

My background includes contending with many poorly understood health problems (Lyme disease in particular, a subject on which I have written four books), so sorting out new health challenges is nothing new to me. However, after the San Francisco incident, I was not convinced that this Achilles injury was that type of problem.  I figured it was just like any other bruise, strain, or pulled muscle, and that a little R.I.C.E. (rest, ice, compression, and elevation) would do the trick to heal it.  Boy was I wrong.  

In the weeks that followed my San Francisco trip, I diligently did the right things to take care of this injury, and after about three weeks I found that it was just … not going away.  In fact, I found myself having to alter my lifestyle quite significantly in order to nurse and baby my right Achilles' tendon and avoid pain in it. Walking hurt all the time, as did standing on any type of uneven ground such as grass, gravel, or sand. “OK,” I told myself, “everything will be fine but this is going to take a while to heal.” At this point I was a little bit frightened, but I was aware that tendon injuries take longer to heal due to poor blood flow, so I hunkered down and did more R.I.C.E.  

Things slowly seemed to get better.  The pain diminished and nearly went away completely over the next 2-3 months. I was able to get back on my mountain bike for short, 10-20 minute, moderate rides, avoiding big hills. My wife and I even returned to San Francisco for another weekend getaway, and I could walk the streets and enjoy myself without any issues. I thought I was on the way to recovery. There remained a strange feeling in the right Achilles' tendon that was difficult to describe, but it didn’t feel like an injury and was not painful. Everything appeared to be heading in the direction of recovery.  

That is, until a beach barbecue a few days later. It was about 6 p.m. and we parked about 200 yards from the beach well equipped with the necessary trappings to set up for a couple hours at waters edge and enjoy the sunset. Myself, my wife, and my 2-year-old were with about a half dozen friends. It was assigned to me to carry several items, including a bowl of salad and a relatively heavy bag. I would guess that the bowl and bag together weighed about 20 pounds. About half way to the beach, after walking perhaps 150 yards, my 2-year-old didn’t want to go any further so I had to leave the bowl and bag on the ground, carry him to where we were setting up, and then return for the items. This was the beginning of what would turn out to be enough strain during this evening to re-injure my Achilles.  

The evening was enjoyable and I experienced nothing unusual with the Achilles. Circumstances required several more trips back and forth from the car, and a bit of additional moderate lifting/carrying. Still – no pain. I went home and went to sleep.  

I woke up that night at about four in the morning with intense, acute pain in the right Achilles (one of the hallmark symptoms of Achilles tendonosis is pain and stiffness in the morning more than any other time of day). Even half awake, I knew what had happened, and my emotions were already beginning to get the best of me. Many people have said that Achilles injuries can be among the most frustrating and depressing, due to the length of recovery, the likelihood of re-injury, and the lack of confidence amidst the medical profession on the best course of action for healing. Not to mention the realization of an athlete’s worst nightmare: a sedentary lifestyle.  After months of optimism and diligent work to heal myself, now this. I felt defeated.  I mean, it wasn't like I tried to go on a 5 mile run. It was a beach barbeque. I kept asking myself, “if I can’t even walk back and forth to the beach a few times after months of R.I.C.E., what does that mean for my recovery?” Sitting there in bed in excruciating pain at four in the morning, I felt like this Achilles injury was going to be a bigger deal than I could have possibly imagined.  

So that is when I finally decided to make an appointment with a local orthopedic surgeon to get his opinion on my options. Living in South Lake Tahoe, CA, we have some of the best orthopedic specialist in the world due to the ski community here.  

Up until this point, writing a book on this topic had never crossed my mind. I figured that the orthopedic specialist would just know what to do. Although I do not have much confidence in many aspects of the medical profession (due to my experiences with Lyme disease and the abundance of physicians who aren’t educated on how to properly deal with it), when it comes to sports injuries, I guess I have always believed that the process of diagnosis and treatment is pretty straightforward and uncontroversial.  

The doctor explained that this was a very complicated injury and my history, which included symptoms and degeneration over the past 15 years or so, made my case even more complicated. At this point I learned that there are basically two treatment options for Achilles' tendonitis: “conservative” treatment and surgery. Conservative treatment is basically everything you do to try to avoid surgery, such as R.I.C.E., and even more serious measures like physical therapy and immobilization with a “bootie” style leg brace or AFO (ankle foot orthotic; described in more detail later in this book). Surgery involves literally severing the tendon, removing the diseased portion of it, and then reattaching the two ends.  

I also learned that in many cases chronic Achilles tendonitis can be more difficult to treat than a full Achilles rupture (also referred to as a 100% tear).

By this point in time I had already read about eccentric exercises on the internet, and I asked the doctor about them. He didn’t have anything to say, so like most patients in doctors’ offices, I took his neutrality to mean that he thought there were better options for treatments. For the following several weeks, I forgot about the eccentric exercises and began contemplating my situation, attempting to formulate a treatment plan, and doing intensive internet research.  

My next appointment was with an orthotist, who is a professional who measures, designs, fabricates, fits, or services orthoses and/or prosthetics. An orthosis (or orthotic) is a device that supports or corrects musculoskeletal deformities and/or abnormalities of the human body. My orthopedic physician and I had decided that immobilization for a while seemed like the logical next step after my own attempts at rehabilitation failed, and the orthotist was who you went to see to get the right device for your needs. The two options for immobilization were, as mentioned, a “walking bootie” or an AFO (ankle-foot orthotic). I elected to have an AFO made for my leg because it could be worn inside the socks, pants, and shoes, and was a little bit more sleek than a bootie. In my line of work (I own a publishing company) I am required to move heavy boxes and other items frequently, so the AFO was appealing due to its low profile. Despite the fact that my wife had been doing most of the lifting at my business since the re-injury of the Achilles, I still wanted to have the option of doing it myself, and the AFO seemed like the best option.  

I had a long conversation with the orthotist and really picked his brain for the better part of two hours.  He was very knowledgeable and I came to like him a lot. He genuinely wanted to help me. He casted my leg then immediately took the cast off; he would later use the cast to mold an AFO that was made just for me. I found out that the AFO would cost about $800, which would end up being out-of-pocket since my health insurance deductible had not yet been met. “Oh well,” I told myself, “what choice do I have?”  

I asked the orthotist if he had ever heard of eccentric exercises. I received pretty much the same answer that my orthopedic doctor had given me; “yes, I’ve heard about them, but I don’t really have any strong feelings one way or another on whether or not they work.” By now I had talked to two professionals, neither of whom encouraged me to look into the eccentric exercises further. The eccentrics went from being on the back burner in my mind, to being largely forgotten about completely.  

On the drive home with my wife (we live about an hour away from the orthotist’s office), I was feeling very depressed again. This injury was going to require a lot of time, money, patience, and maybe even luck; and to make matters worse, I knew that many people never recover from it and end up having chronic Achilles tendonitis for years. To make matters worse, my Achilles was definitely at rock-bottom. I was experiencing more pain and disability than I had ever experienced before. Walking even 15 feet was a great struggle, and my job was very difficult for me. And worse, the injury was clearly on a downward trajectory; getting worse, not better.  

I really see this point in my recovery as the turning point. I could have pursued the expensive, time-consuming, and relatively ineffective methods recommended to me by my orthopedic doctor and orthotist, and if I had done that, perhaps I would have gotten better over time, but perhaps not. Even if I had gotten better, that course of action would have certainly been draining in a number of ways. As a busy business owner, father, and has been, I loathed the idea of having to travel to physical therapy several times per week.  

Thankfully, though, something jolted my consciousness and reawakened my desire to look into the eccentric exercises which I had read a small amount about on the internet. I mustered up the time and energy to really dig deeper on the Internet and find out what these exercises were all about. Most people do not know that many of the articles from professional medical journals that doctors read are available for free on the internet through a website called PubMed (www.pubmed.com). According to the website, “PubMed is a service of the U.S. National Library of Medicine that includes over 19 million citations from MEDLINE and other life science journals for biomedical articles back to 1948. PubMed includes links to full text articles and other related resources.”  

Having already done the research to write four books on Lyme disease, returning to PubMed was like revisiting an old friend. As I began pulling up studies on Achilles injuries, I was reminded of a critical truth which I had been maybe a little guilty of forgetting since my struggle with Lyme disease: a doctor can be there for you to provide guidance, direction, ideas, and support, but ultimately, one's own health is their own responsibility and no doctor should be given your complete trust. This is not because your doctor doesn't want to help you, and it is not because your doctor isn’t a properly educated expert. Instead, you should take responsibility for your own health because your doctor quite simply cannot know everything about every health problem. Doctors are human beings and have a finite capacity for knowledge. Most doctors have break-neck busy schedules, and cannot possibly stay up-to-date on every new treatment for every health condition that walks through their doors. By doing at least some research on your own, you will be able to cross-check your doctor’s opinion with the opinions of other experts. In many cases, you may find that your doctor was correct in what he or she told you. However, in some cases, you may discover otherwise, and in such cases, the difference in opinion may even be life or death.    

The trend toward patients taking responsibility for their own health is thankfully increasing, especially with the availability of online resources like WebMD. But even WebMD may proliferate certain biases and present only the conventional point of view on various medical topics. For the true researcher (whether physician or layperson), the best resource is PubMed, where you get to read actual raw data from real medical studies, and then, instead of having someone interpret that data for you (bringing forth their own biases or agendas), interpret the data for yourself and make up your own mind about what it means. This was the way I conducted research when writing my books on Lyme disease, and would also be the way I researched the Achilles injury.  

Before moving on, I want to linger for a minute longer on the virtues of taking responsibility for your own health.  Although I am a layperson with no medical training, I have been able to accomplish tremendous breakthroughs in my own health and the health of my family via taking responsibility.  As an example, I will share a few sentences about my experience with my toddler’s severe asthma condition. To keep the story short, I will share just the highlights of this adventure. From the age of about 9 months old, my son began suffering from asthma that was becoming more and more serious over time, until it was keeping his mother and I awake most of the night as we carefully listened to his breathing, fearing he may actually asphyxiate to death right in front of our very eyes. Despite the use of several prescription medications, including Albuterol, we were unable to gain control over his asthma. As parents, we were devastated; our little one would most likely need to be on powerful asthma drugs for the rest of his life. This fear was confirmed after a visit to a world-renowned child pediatric asthma specialist who prescribed three drugs for him to use continuously. After getting home from that appointment, I decided to take the road less traveled and instead of spending evening relaxing and enjoying whatever hobby I chose for the night, I dug up the phone number of a local herbalist. He insisted that I do a food elimination diet on my son to detect any allergies that may be causing the problem. I was skeptical but I complied. It turned out my son was severely allergic to peanuts. Once we removed peanuts from his diet, his asthma went away overnight and has never returned. The world-renowned specialist didn’t figure this out or offer this advice. It was only through the active decision to take responsibility for my family's health that I was able to make this discovery.  

OTHER ITEMS TO INCLUDE IN MY STORY:  

·         Frustration that doctors didn’t tell me about this. I had to do my own research, despite seeing some of the most qualified orthopedic specialists in the world, so you may need to do your own research too. Goal of book is to empower you to do this research and heal.

·         Docs want to help but clearly do it at home cures aren’t profitable for physical therapists or for doctors, so these kinds of answers (do-it-at-home eccentric exercises) are not often talked about.

Book Title: Healing Achilles Tendonitis At Home with Eccentric Calf Exercises  

1.       Introduction to Achilles Tendonitis.

a.       How people usually acquire this injury – causes

b.       Tendonitis vs. tear or “rupture”

c.        Tendonitis vs. Tendonosis.

d.       Insertional vs. non-insertional tendonitis.

e.        Symptoms of tendonitis

f.        Chronic vs. acute tendonitis

g.        Why this ailment is so difficult to cure

                                                               i.      Poor blood flow to tendon, hence slow healing.

                                                              ii.      Hard to heal since you are using the tendon all the time for walking and living.

                                                            iii.      Thick tissue that takes a long time to heal.

2.       My story

3.       Traditional treatments for AT and why they have a low success rate

a.       Tendonosis vs Tendonitis

b.       Physical therapy

c.        RICE (Rest, Ice, Compression, Elevation)

d.       Research this yourself

e.        Immobilization with an Ankle-Foot Orthosis or walking bootie

4.       Eccentric Calf Exercises

a.       What are they?

b.       Efficacy Studies:

                                                               i.      Comparison of different modalities

                                                              ii.       

c.        Why does it work?

                                                               i.      Stretching or Strengthening?

d.       The exercises seem to work even with low compliance

e.        Using Eccentrics for insertional Achilles tendonitis

5.       Eccentric Exercise Regimen

a.       Use info from article.

b.       Should do exercises on both legs equally to ensure balanced training and lack of injury on other leg; other leg can tend to become injured as you modify your walking motion and perhaps apply uneven stress on each leg due to compensating for the painful injury.

c.        Night splint not necessary.