If you have pain and / or injury to the Achilles tendon, you have probably been diagnosed with one of the 4 – Tendonosis-Tendonitis-Tendinopathy-Tear of the 4 T.
What is the 4 T? Tendonosis – tendon injury or wear without inflammation. Tendinitis: injury with inflammation. Some doctors have now grouped tendonosis and tendonitis under the umbrella term tendinopathy, which simply means degeneration or disease of the tendon. Of course, a tear is a total or partial tear or micro tear in the tendon.
Now that you’ve been qualified with a diagnosis, your doctor has likely devised a general course of action and you may have some questions because Achilles injury can be confusing and inconsistent with standard treatment beliefs.
What injury do you have? The Achilles tendon is the largest tendon in the body. It connects the powerful calf muscles with the heel and is prone to great stress in medium and long distance runners. As such, the high demand placed on the tendon when running accounts for about 1 in 10 injuries when running.
The most common of Achilles injuries is that caused by wear and tear or overuse. Poor footwear, anatomical disorders including leg discrepancies, weak calf muscles, and excessive or insufficient pronation of the feet are also the main causes.
Recent medical studies have also implicated that antibiotic and cortisone treatments increase the risk of Achilles injury.
Treatment When the Achilles tendon becomes painful to the touch and some degree of weakness is felt, doctors will treat the tendon for wear damage (in the case of a complete tear, surgery is usually the only answer).
In tendonosis there is no obvious swelling. This is not good because the body’s immune system is no longer trying to repair damage to the tendon. Why would the body give up? Connective tissue, like ligaments and tendons, does not have a good blood supply. This is obvious to anyone opening a book on anatomy. The tendons are whitish in appearance, while the muscles that hold the bone are bright red. Without the blood supply, healing and rebuilding tissues, such as collagen, never reach the injured tendon. Poor blood supply is nature’s design to allow for tendon elasticity and tensile strength in support of powerful muscles. But when an injury occurs, nature’s design is not always the best.
Typical treatments for tendonosis include immobilization (rest) to allow the tendon to heal. But, if there is no blood supply, there is no cure, so a movement may be prescribed to increase circulation to the achillies tendon.
Obviously, anti-inflammatory drugs are out of the question because they block collagen biosynthesis and inhibit inflammation.
Tendonitis occurs when there is inflammation and irritation. Now you can think to yourself, this is when I take anti-inflammatory drugs. The answer is surprising.
In tenonosis and tendonitis, Achilles tendon tears cause two different reactions. In one, there is no inflammation because the body has decided that the tendon cannot be repaired without medical intervention of some kind. In tendinitis there is inflammation because the body is still trying to heal the tendon, but in chronic conditions it does not heal.
Avoid anti-inflammatories and generate more inflammation In tendonosis and tendonitis, the answer is inflammation, doing more, but under controlled circumstances. If we can create inflammation in the areas of the tendon that are damaged, in sufficient quantity, the tendon can heal.
In my opinion, there is only one treatment that can do this: prolotherapy. Prolotherapy works by introducing a mild irritant through an injection at the exact points where the Achilles tendon is most painful or weak. This irritant is usually something as benign as simple dextrose. What dextrose does is create a small controlled inflammation at the injury site that speeds healing and restores strength and endurance to the tendon. In cases of remission, PRP (platelet rich plasma) is used as a stronger proliferant.
Prolotherapy is gaining traction among athletes because it is minimally invasive, does not require long periods of inactivity, and in fact, a prolotherapy physician will generally recommend a supervised activity or recommended training plan to get the athlete back on the field as quickly as possible. .
One to six treatments is typical for the competitive athlete, spaced at weekly intervals.