Alternative Treatments for Achilles Tendon Injury


If you have pain and/or injury of the Achilles tendon you have probably been diagnosed with one of the one of the 4 – T’s Tendonosis-Tendonitis-Tendinopathy-Tear.

What are the 4 T’s? Tendonosis – injury or wearing out of the tendon without inflammation. Tendonitis – injury with inflammation. Some physicians have now grouped Tendonosis and Tendonitis under the umbrella term Tendinopathy, meaning simply degeneration or disease of the tendon. A tear of course is a complete or partial rupture or microtearing on the tendon.

Now that you have been branded with a diagnosis, your physician has likely designed a general course of action and you may have some questions because Achilles injury can be confusing and contradictory to standard treatment beliefs.

Which injury are you? The Achilles is the largest tendon in the body. It connects the powerful calf muscles to the heel and is prone to great stress in mid-distance and long-distance runners. As such the great demand placed on the tendon by running accounts for an estimated 1 in 10 running injuries.

The most frequent of Achilles injuries is that caused by wear and tear or overuse. Poor fitting footwear, anatomical disorders including leg discrepancy, weak calf muscles, and an over or under pronation of the feet are also leading causes.

Recently medical studies have also implicated antibiotic and cortisone treatments to increasing the risk of Achilles injury.

The treatment When the Achilles becomes painful to the touch and there is a degree of weakness felt, physicians will treat the tendon for wear and tear damage (in the case of a complete rupture – surgery is usually the only answer).

Tendonosis

In tendonosis there is no obvious swelling. This is not a good thing because the body’s immune system is no longer trying to repair the damage to the tendon. Why would the body give up? Connective tissue such as ligament and tendons do not have a good blood supply to them. This is obvious to anyone who opens a book on anatomy. Tendons are whiteish in appearance while the muscle they are holding to the bone are bright red. Without the blood supply, healing and rebuilding tissues such as collagen never get to the injured tendon. The poor blood supply is nature’s design to allow the tendon elasticity and tensile strength in support of the powerful muscles. But when injury occurs – nature’s design is not always best.

Typical treatments in tendonosis include immobilization (rest) to allow the tendon to heal. But – if there is no blood supply – there is no healing – so movement to increase circulation to the achillies tendon may be prescribed.

Obviously anti-inflammatory medications are out because they block the biosynthesis of collagen and inhibit inflammation.

Tendonitis occurs when there is inflammation and irritation. Now you may think to yourself, this is when I take anti-inflammatory medication. The answer is surprising.

In Tenonosis and Tendonitis, tears to the Achilles tendon are causing two different reactions. In one, there is no inflammation present because the body has decided that the tendon cannot be repaired without medical intervention of some type. In Tendonitis there is inflammation present because the body is still trying to heal the tendon – but in chronic conditions there is failure to heal.

Avoiding the anti-inflammatories and creating more inflammation In tendonosis and tendonitis the answer is inflammation – making more of it – but under a controlled circumstance. If we can create inflammation to the areas of the tendon that are damaged, in sufficient quantity, the tendon can be healed.

In my opinion there is only one treatment that can do this – Prolotherapy. Prolotherapy works by introducing a mild irritant through injection to the exact spots where the Achilles tendon is most painful or weak. This irritant is usually something as benign as simple dextrose. What the dextrose does is create a small, controlled inflammation at the spot of injury accelerating healing and returning strength and resiliency to the tendon. In remittent cases, PRP (Platelet Rich Plasma) is used as a stronger proliferant.

Prolotherapy is gaining adherents among athletes because it is minimally invasive, does not require long periods of inactivity, and in fact, a Prolotherapy doctor will usually recommend supervised activity or a recommend training plan to get the athlete back on the field as fast as possible.

One to six treatments is typical for the competitive athlete, spaced at weekly intervals.


Source by Marc Darrow, M.D, J.D