I usually ride mycenturies in September, using the whole season to train, increasing myconditioning and my mileage base. The MS 150 takes place in late June, so Itrained a little harder, a little faster, a little more competitively. MyAchilles tendons started to ache a bit. Oh well, I thought, my godfather’sright again. I stretched as I usually do, applied cold packs, and took someanti-inflammatories. It didn’t seem to affect my cycling.

After the MS 150, Idialed down my mileage but continued to ride into the fall. I rode the windtrainer in the winter, and then jumped out to nice a spring regimen thefollowing year. My Achilles tendon still hurt, but no big deal. Right?

Spring riding means spinningin low gears for the first 500 miles and increasing mileage slowly, 10 percenta week. Sensible cycling, like I’ve done every year for the past 30. Except myAchilles tendon never stopped hurting. But I could stretch it and ride. I couldlive with this.

Memorial Day weekend hadme riding into the wind and hills at a moderate-to-fast pace, 30 miles or soevery 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.” Anhour later, I could barely walk.

Sure, using 20/20hindsight, I can see the pattern that was developing. But as a typical amateurathlete, I rode an irritating overuse injury into a degenerative condition thathas affected me for almost a year and it is not healed yet. Where did I gowrong?

My mistake wasn’tignoring the problem, but ignorance of the true condition. I turned what I thoughtwas annoying tendinitis, an inflammation, into tendinosis, a chronicdegeneration of the collagen fibers in the tendon. Tendinosis is anaccumulation of small-scale injuries that, over time, don't heal properly. Itis a chronic injury of failed healing says Laurie Erickson on her website www.tendinosis.org.Tell me about it.

Tendons are differentthan muscle tissue, connecting bone to muscle. The Achilles tendon connects theheel to the lower calf muscles. This is the spot on the body where the mythicalAchilles was held as he was dipped into the river Styx by his mother to makehim invulnerable to injury. Except, of course, in that one spot where theTrojan Paris shot him with an arrow.

Tendons don’t have asmuch blood flow as muscles. So when injured, they heal slowly. And according toDr. Khan in his article “Overuse Tendinosis, Not Tendinitis” the medicalcommunity is only now using a different paradigm to diagnose tendon problems.When I limped into the medic’s office the very next day and the doctor took alook at my Achilles tendon, the diagnosis was quick: tendinitis and perhaps abit of bursitis. No mention of chronic tendinosis, even after I described myyearlong problem. Fortunately, the treatment for the injury is similar. I wentinto physical rehabilitation the very next day, using low level laser therapyand ultrasound to increase the blood flow to the injured area, moderatestrengthening exercises for the calf muscles, stretching exercises for thetendon itself, and a very gradual return to cycling. Very gradual.

After I completed thesix weeks of rehabilitation my insurance would allow, the therapist told me Icould 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, thatkind of reduced time in the saddle is like kissing my sister. And I don’t evenhave a sister. I got up to about an hour a day and the tendon started hurtingagain. Almost a year later and it still does.

I continue to cycleindoors, stretch the tendon, and strengthen the calf muscles. But if the situationdoesn’t resolve itself soon, the next step is a surgical debridement of theaffected tissue, a big step involving 12 weeks in a walking cast and morerehabilitation. 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.

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Copyright (C) 2007 Alain Georgette / Copyright (C) 2006 Frantisek Hliva. All rights reserved.