New Treatments for Chronic Achilles Tendinitis

[gcoe]

Hi therapist101

Some sports physio out there night have some better ideas. However here are a few things that come to mind:

Have you had a look through this systematic review:

PEDro - Detailed Search Results

It does outline a few other techniques other than eccentric training with some evidence to consider.

Have you had it definitively diagnosed by and ultrasound? If not it might be worth doing this to be sure the diagnosis is right and if it is right to also look at the extent of diseased tendon. There are of course a number of related pathologies that may need checking out.

What about other kinesiopathological problems - have you had the balance between your lower limb muscles checked out. Could the achilles tendons be taking the brunt in your sprinting due to a muscle imbalance problem or motor control issue. What about any issues with the posture of the foot - eg pronated hindfeet?

the last thing might be worth considering - do you think you may now have a chronic pain component to the problem - so where the pain you are experiencing is disproportionate to the problem. If this is so taking a pain management approach might help.

[roycar]

as per gcoe, have you been diagnosed through ultrasound? color doppler ultrasound can be used to acscertain the degree of neovascularisation. a good sports doc can set you up with these.

have you given alfredsons protocol enough time, he advocates between 6-12 weeks of eccentric drops? do you perform maintenance eccentric strengthening during the times that you have been painfree?

there is level 2 evidence to support the use of nitric oxide donor therapy and in most up to date protocols this is the next step following on from unsuccessful eccentric strengthening. this is used in conjunction with the continuation of heel drops.

also sclerosing injections have shown positive results in small scale studies when used to treat areas of neovascularisation.

for the above two treatments you need to be under a sports doc. in your neck of the woods you shouldnt have too much trouble finding someone aware of the above treatments. here in ireland however...... i've only come across one doc who has even heard of sclerosing injections!

biomechanical assessment and treatment of soft tissue abnormalities is also nb.

[Yarok]

Hi

I agree with guys above.
Pelvis and lumbar back must be checked up.I can see only complex approach inc. eccentric exer, soft tissues (massage etc), dry needling , acupuncture, physical therapy, taping, even platelets injection, can solve the problem.

all the best
Jarek
Fizjomanual I Fizjosport - Start

[therapist101]

Thanks for all your input.

I had not had diagnosis by ultrasound. I ended up having 2 courses of platelets injection around the tendon. Not sure if I noticed much in the way of changes in the tendon following this.

I ended up flagging the third course of the injection because it was getting too close to my national championships. Each time I had one, the tendon was quite uncomfortable for several days which interfered with training. I ran with pain and managed a 5th place finish in my event with I deemed was reasonable considering my circumstances.

Took complete rest after nationals. Didn't bother doing any rehab at all. Got back into training 8 weeks later completely pain free - and have been asymptomatic for over 12 weeks now. Nothing quite like rest - something the athlete-patient is always extremely reluctant to do.

Now that I'm back into training, I do 3 x weekly eccentric soleus work and regular stretching to keep my achilles free from the evil clutches of Tendinosis.

Cheers.