What about the tendon that hasn’t ruptured (yet)?

As I’ve mentioned before my main concern now is the other tendon. Both sides have felt equally bad for years. Though apparently I’m unusual in that most rupture victims don’t have symptoms leading up to the event - I’d be interested to hear if that’s the case for others on here!

Whilst trying to do my own research online, I came across a couple of podcast interviews with Seth O’Neill on the subject of Achilles and tendons in general. Apparently there isn’t a huge amount of research out there on this subject, but Seth is one of those trying to do something about that:

Session 6 – Achilles Tendons with Seth O’Neill
Session 11 – Treating Tendons with Seth O’Neill

Seth researches and lectures at Coventry and Leicester universities, and has a private practice in Nottingham which is only an hour or so away from me, so I gave him a call and booked in to see him.

I found this really useful - he explained all the science and evidence behind what his current beliefs are in laymans terms that I could understand - drawing diagrams and using props to help explain. He also made ultrasound scans of both legs and tested my calf strength on both sides.

He covered far more than I can go into here, and I’d be worried I’d get stuff wrong through Chinese whispers, but I’ll write about the two key points I came away with:

Stretching Damaged Tendons is Probably a Bad Idea

One of the main things I’ve been told to do in the past (and what seems to be the conventional wisdom) is stretch the calf. I was determined to fix my issues so I was doing a lot of stretching. Apparently it’s not clear why this advice is given. Seth went into a lot of detail about this but the main thing I came away with was, whilst the symptoms of Achilles tendinopathy might make the calf as a whole feel “stiff”, a damaged tendon is actually more “stretchy” than a healthy one. So it’s probably not wise to try and stretch it even further.

Strengthening the Muscle & Tendon is Probably a Good Idea

Seth pointed out that studies have found a correlation between Achilles tendon injury and calf muscle weakness. For example, this study of army recruits during six-week basic training.

In his own studies on runners he’s found that those with healthy tendons you can usually expect to be able to produce a force of 200% of their bodyweight through the calf (knee bent). Those suffering Achilles tendinopathy can be as low as 130%.

When landing on the toes the calf muscle contracts in order to absorb the impact. What could be happening is that those with weaker calf muscles are unable to absorb this impact as effectively, meaning the tendon has to take more of the strain.

For this reason he prescribes calf strengthening exercises, which basically means weighted heel raises. Bodyweight is probably not enough to have an adequate strengthening effect (he suggests buying 25kg bags of sand from DIY stores and putting them in a backpack - much cheaper than a gym membership).

For me he prescribed heel raises with isometric holds and various points throughout the range of motion, more info on this in the podcasts above and articles below.

For the same basic reason - completely resting is also a bad idea. The muscle and tendon need to be loaded in order to stay strong and healthy.

My Results

The ultrasound scans showed that the left achilles is healing well. He showed me the site of the rupture and the damage but the scan showed it is healing as well as it feels like it is. Whilst setting up for the scans he also noted that there was a good level of resistance when he went to brace my foot for the scan, as in the tendon has healed at a good short length. I’m really glad my physio was adamant about me not stretching in the earlier weeks. Seth basically confirmed that I’d been given good advice throughout my rehab.

The other tendon (the one I was really interested in) actually didn’t look too bad. He showed where there is some damage (it was exactly where he predicted it would be based on where I feel pain) but it’s far from the worst he’s seen. I’ve been doing the rehab exercises on both sides so maybe this plus the forced rest from vigorous activity has helped it to heal? I hope so. I don’t want to go through this again on the other side!

In terms of strength testing - he predicted that because I’ve done a fair bit of strength training in the past - I’d probably come out better than the 130% of bodyweight that he observes in runners with these issues, but less than the 200% that he’d see in healthy runners. Conveniently I weigh around 100kg so he was expecting somewhere between 130kg and 200kg of force. Exactly right. On the right-hand side I was at about 180kg and on the left (ruptured) side I managed 140kg (which apparently is OK 6 months after rupture and another indicator that it’s healing pretty well). In a way I was disappointed that the right-hand side wasn’t lower, as that would finally give me an obvious reason for all these Achilles problems, but given the studies were on runners with likely very slight builds I guess I should really shoot for a way above 200kg. It’s worth a try anyway!

Disclaimer and More Info

Of course I’m not a medical professional and I might have misunderstood/miscommunicated some things. If you’re after more information please do listen to the podcasts above and/or look at the articles below for more information:



If you’re in the UK and not too far from Nottingham I can definitely recommend going to see Seth. He does take evening and weekend appointments and it’s £50 for the consultation I had, which was meant to be an hour, but I’m afraid I realised afterwards I’d kept him quite a bit longer! His contact details are on his website:

Keyworth Physio

Hope this helps someone :)

5 Responses to “What about the tendon that hasn’t ruptured (yet)?”

  1. Thanks morcs, this is interesting. I did a lot of reading about Achilles tendinosis (my diagnosis - insertional Achilles tendinosis due to Haglund’s Deformity) prior to my surgery and it seems eccentric heel drops are the highly favoured treatment, although perhaps not as effective for insertional as they are for non-insertional. I asked my doctor, who himself has done a lot of Achilles reasearch, what my odds are of having the same thing on the other side. He said it’s hard to say, but higher than someone who doesn’t have it on one side. This always seems like a funny stat to me - of course if I have it on one side my chances are higher of having it on both sides than someone who doesn’t have one at all! How can you have 2 if you don’t have 1??!! I do have symptoms on the other side, but very mild, and I’m still hoping they are mainly from being overloaded while I’ve been favouring the bad side for 2+ years. He said that is quite likely. Like you, I NEVER want to go through this again. I’m always telling people, “be kind to your ankles”!! They don’t understand!
    Thanks for the info.

  2. I started having pain on my other foot about two weeks before my surgery. I staryed to panic as my surgery got closer that I might have to go through this twice. A familiar bump is forming on my heel. I talked with my doctor about it and he has to.d me to stay off my feet as much as possible and to ice both feet. While I was under anesthesia, he felymy tendon and says it feels ok. He is going to make me an insert for my “good” foot, and I am making sure to wear a very supportive shoe. I certainly don’t want to go through this again!

  3. Hi shell, They do talk about insertional tendinosis on the podcasts and how it differs (mine is mid-tendon). I remember something about compression of the tendon in this situation that doesn’t apply to mid-tendon injury, but I’m afraid I wasn’t paying full attention to that part. :) I don’t think they cover Haglund’s Deformity specifically but it still may still be useful to listen to. I guess your Doc is comparing the odds of you getting it in the other leg with the odds of someone who’s never had it getting it in either leg?

  4. Hi Julie, I guess yours might also be insertional if it’s around the heel, so might be a bit different? Mine is always in what I assume is the middle of the tendon on the inside (medial) of the leg, basically level with the ankle bone when my feet are neutral. Physios can poke me just about anywhere without pain apart from this one spot that’s super tender, which is basically where the other one ruptured. Sorry that’s probably not particularly helpful!

  5. My doctor told me they don’t know exactly why the bone spurs/haglunds problems occur. He says he does see it a lot in people who are very heavy. My guess is that mine is a result of: tight achilles tendons and small feet relative to my size (5′ 8.5″ and size 6.5 feet, sometimes size 7 depending on the shoe). I suspect the calcification occurs due to the amount of stress continually tugging on the achilles attachment at the heel. Totally a non-scientific guess of course, but it was much worse on my right foot which is my dominant foot and so it gets more pushing off, … I have a bump on my left heel already and can’t do much about it other than continue working to make my achilles more flexible and I’ll do things to strengthen the calf as well. If it slows down the growth of the bone spur that works for me! I looked at the videos on eccentric exercises and started doing those last night as well since my PT said I could do the heel drop on stairs exercises now.