| Months 1–6 (Pre-Treatment) | Followed eccentric heel drop protocol prescribed by physical therapist. Completed PT sessions focused on calf strengthening. Took multiple rest periods from running. Pain improved with rest but returned each time marathon training resumed. |
| ▸ Treatment at City Integrative Rehabilitation | |
| Condition | Midportion Achilles tendinopathy, right |
| Duration | 6 months |
| Activity Level | Recreational runner (marathon training) |
| Prior Treatment | Eccentric heel drops, PT, rest periods |
| Goal | Complete first marathon |
The Presenting Complaint
A 38-year-old recreational runner came to us with a classic story: six months of midportion Achilles tendinopathy on his right side. He’d been training for his first marathon and was determined to cross the finish line. Like most runners with Achilles pain, he’d already tried the standard protocol—eccentric heel drops (the Alfredson protocol), physical therapy, and multiple periods of rest. Each time he’d recover and return to training, only to have the pain flare up again as soon as he increased his mileage.
By the time he reached us, he was frustrated and questioning whether he’d ever be able to run a marathon. He had excellent compliance with his exercises, a strong work ethic, and a realistic goal. What he was missing was a diagnosis of why his Achilles kept breaking down.
Treatment Approach
Focused Extracorporeal Shockwave Therapy (F-ESWT)
We began with six sessions of focused shockwave therapy directed at the midportion Achilles tendon. Shockwave has strong evidence for stimulating tissue healing and breaking up the degenerative collagen that accumulates in chronic tendinopathy. This wasn’t just rest or stretching—this was active biological remodeling.
Anatomy in Motion (AiM) Gait Analysis
The critical discovery came during his gait analysis. We identified that he was overstriding—landing with his foot too far ahead of his center of mass. This forced his calf and Achilles to work eccentrically (lengthening under load) with every single stride. No amount of eccentric exercises could overcome a biomechanical problem embedded in his running pattern. We retrained his cadence and footstrike to reduce this excessive eccentric load.
Dynamic Neuromuscular Stabilization (DNS)
We added DNS calf and ankle proprioception work to rebuild neuromuscular control around the ankle joint, supporting the Achilles during the eccentric phase of running.
Phase 1 Weeks 1–3 | F-ESWT (3 sessions), DNS ankle mobilization and proprioception, gait assessment and retraining (shorter stride, higher cadence) |
Phase 2 Weeks 4–6 | F-ESWT (3 remaining sessions), progression to single-leg calf work, light running drills with corrected gait, continued DNS integration |
Phase 3 Weeks 7–8 | Return to marathon training volume, sport-specific running mechanics, maintenance DNS and proprioception |
Recovery Timeline
| Week 6 | Running 8–10 miles without pain; confident in corrected running form; increased cadence from 165 to 178 steps/min |
| Week 8 | Marathon distance trial run (26.2 miles) completed pain-free; certified ready for race |
The Outcome
He completed his marathon in 4 hours 12 minutes with zero Achilles pain during or after the race. Three months post-marathon, he remains pain-free and has returned to his regular training schedule without recurrence. The combination of tissue-level healing (F-ESWT) and biomechanical correction (gait retraining) proved to be the missing piece that eccentric exercises alone could not provide.
Disclaimer: This case study represents one patient’s experience and is provided for educational purposes only. Results vary based on individual factors, condition severity, and adherence to treatment. This is not a guarantee of outcomes. Always consult with a qualified healthcare provider before starting any treatment program.
Related: F-ESWT | Anatomy in Motion | DNS