If you have Achilles tendon pain and/or injury, you have probably been diagnosed with one of the 4 – Tendonosis-Tendinitis-Tendinopathy-Tear.

What are the 4 T’s? tendinosis- injury or tear to the tendon without inflammation. Tendinitis – injury with inflammation. Some physicians have now lumped tendonosis and tendinitis under the umbrella term tendinopathy, which simply means degeneration or disease of the tendon. Of course, a tear is a complete or partial tear or a microtear in the tendon.

Now that you’ve been flagged with a diagnosis, your doctor has likely mapped out a general course of action, and you may have some questions because Achilles injury can be confusing and contradictory to standard treatment beliefs.

What wound are you? The Achilles tendon is the largest tendon in the body. It connects the powerful calf muscles to the heel and is prone to great stress in middle and long distance runners. As such, the heavy demand placed on the tendon by running accounts for approximately 1 in 10 running injuries.

The most common Achilles tendon injury is caused by wear and tear or overuse. Ill-fitting shoes, anatomical disorders including leg discrepancy, weak calf muscles, and over- or under-pronation of the feet are also major causes.

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

Treatment When the Achilles tendon is tender to the touch and some degree of weakness is felt, doctors will treat the tendon for wear (in the case of a complete rupture, surgery is often the only answer).

tendinosis

In tendinosis there is no obvious swelling. This is not good 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 ligaments and tendons, do not have a good blood supply. This is obvious to anyone opening an anatomy book. The tendons are white in appearance, while the muscle that attaches to the bone is 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 tendon elasticity and tensile force in support of powerful muscles. But when injury occurs, nature’s design isn’t always the best.

Typical treatments for tendinosis include immobilization (rest) to allow the tendon to heal. But, if there is no blood supply, there is no healing, so movement may be prescribed to increase circulation to the Achilles 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 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 kind. In tendinitis there is inflammation present because the body is still trying to heal the tendon, but in chronic conditions it does not heal.

Avoid anti-inflammatories and create more inflammation In tendinosis and tendonitis, the answer is inflammation, increase it, 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 via injection into the exact places 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, which speeds healing and restores strength and elasticity to the tendon. In remitting cases, PRP (Platelet Rich Plasma) is used as a stronger proliferative.

Prolotherapy is gaining favor among athletes because it is minimally invasive, does not require long periods of inactivity, and in fact, a prolotherapy doctor will usually 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.