Elle presented to me with chronic right sided lower calf pain after running a few months ago. She has been unable to run at all and walks with a slight limp; protecting herself from the push-off phase of gait.

Despite this considerable pain, she continues to be very active with a variety of exercises several hours a day.

On exam: 

• her right shoulder and right hemi-pelvis are 1cm higher than the left when standing
• she pronates and has mild ankle instability while balancing on each foot (left worse than right)
• her right achilles tendon is very tender to palpation and thicker than the left
• hamstring flexibility is diminished, calf flexibility was not formally tested

Diagnosis: Chronic achilles tendonitis

Treatment:

 Detailed general information at:

http://www.drpribut.com/sports/spachil.html and rehab protocol at: http://www.athleticadvisor.com/images/Acrobat/Achilles%20Tendinitis.pdf 

One salient point from the articles linked above is:

• There are several factors that can contribute to achilles tendonitis. First, you should know that the biggest contributor to chronic achilles tendonitis is ignoring pain in your achilles tendon and running through the pain of early achilles tendonitis. If your achilles tendon is getting sore it is time to pay attention to it, immediately.

 (I have temporarily lost the ability to post pictures to this site!! Darn wordpress!!, but this is one picture of the problem: http://www.google.com/imgres?imgurl=http://footcarexpress.com/foot-orthotics/wp-content/uploads/2008/12/achilles.jpg&imgrefurl=http://footcarexpress.com/foot-orthotics/achilles-tendonitis/&usg=__nN7ggDZd56pfT6G4YH26VPWyafo=&h=437&w=300&sz=35&hl=en&start=0&sig2=isdaZG6XU78iGXs4PQgg5A&zoom=1&tbnid=YaqPdkrrnio7HM:&tbnh=126&tbnw=86&ei=_xHoTMz7LYL6lwf5nNywCw&prev=/images%3Fq%3Dachilles%2Btendonitis%26hl%3Den%26sa%3DX%26rls%3Dcom.microsoft:en-us%26biw%3D1899%26bih%3D1006%26tbs%3Disch:1%26prmd%3Div&itbs=1&iact=hc&vpx=118&vpy=69&dur=3775&hovh=271&hovw=186&tx=73&ty=304&oei=_xHoTMz7LYL6lwf5nNywCw&esq=1&page=1&ndsp=69&ved=1t:429,r:0,s:0

From: http://www.astana-cyclingteam.com/fresh_brew/watts.html

Steve and the guys at Hed Cycling are all about the numbers and he put me in touch with Andy Tetmeyer (actual title: The Repository of Knowledge).  Andy ran some computer model numbers with riders weighing between 170 lb / 77.3 kg up to 220 lb / 100 kg (FYI, Astana’s Levi Leipheimer runs around 132 lbs / 60 kg – more on LL in a moment).

If we took six riders who each weighed 10 lbs more than the next and sent them out on a flat, no wind 45 km / 28 mi Time Trial course and told them to hold steady at 315 watts, we could expect to see  0.1 kph less speed with every 10 lb increase (Speed Range = 45.5 kph to 45 kph).  The end result?  The heaviest rider finishes in one hour while the lightest rider finishes with a time of 59’20”.

Does a headwind make that much of a difference?  We know riders hate it instinctively… so those riders on the same course, but with a 21 kph / 13 mph headwind, would see a 0.07 kph  less speed per 10 lbs.  Now that doesn’t seem like very much but the heavier rider would now take 81’33” for the 45 km course, and the lighter guy clocks 80’35” – almost one minute faster (Speed Range = 33.5 to 33.2 kph).

Now here’s where it really shows.  Let’s put those riders on a 4% grade, no wind, and ask them to TT uphill at 315 watts for 5km (I’ve done this before in Napa Valley – it hurts): In this scenario we see them lose a whopping 0.9 kph per 10 lbs.  The biggest rider will take 13’27” to get to the line while his lighter friend will be there two minutes ahead at 11’24” (Range = 26.3 to 22.3 kph).

To put this last scenario in perspective, if the heavier guy wanted to do the same speed as the winner, he would have to go from 315 watts to 382 watts, requiring him to work over 20% harder!  And if you bump the grade to 6%, you now have to crank up 25% from the baseline to catch that little so-and-so…

*** Quick reality check: another way to express energy on the bike is watts per kilogram.  So to do the math for our 315 watt test, the 170 lb rider is putting out 4.0 watts / kg and the 220 lb rider 3.15 watts / kg (note a 27% difference).  I checked in with Levi to ask him what his numbers looked like.  He estimated that on a long steady training ride he holds about 6 watts / kg and that at race pace it bumps up to 7 watts / kg!  So if you’ve ever wondered if a pro cyclist is twice as good as you, the numbers say yes – at least when the road goes upward.

This looks like fun, I think I’ll try it!

Joe