Forums >Health and Nutrition>Achilles Tendonitis Options: Tenex Procedure - PRP Injection
sorry Blaf; but I would see a doctor instead of a chiropractor about medical issues, but to each his own.
+1. Or a PT. Or a massage therapist. Or a witch doctor.
Thank you all. I did not expect so many useful comments.
I saw a sport medicine doctor 3 weeks ago. He told me to stop running for 2 months and come back. Meanwhile to visit RMT and a physiotherapist. He also added that if I continue running, I risk to rapture the tendon completely. I kind of did not like that answer, although it sounds right. I was hoping to get a diagnose from him. I would like to know exactly what the issue is. Is it tendon, bursa, sheath, or maybe the nerve that passes right there and I can feel it sometimes too.
Another thing that the doctor told me is that I have lots of scar tissue on the tendon and that physical therapy would help to clear that. I know that I have scar tissues, it is very visible on the tendon in the area where it is the tiniest. Actually I was hoping that chiropractor would get rid of that with ART (Active release technique).
So, since my last run before the injury (November 24) I managed to get rid of the morning pain. So no pain in the morning when I get up. No pain in general when walk or get up. During a run, it is not really pain, it is more like sensation. I can run through that easily. But the main issue is that the tendon gets inflamed in the area 5-6cm above the ground after the run. That is painful on touch, but it is gone after I ice it. Well, almost gone, takes another day to completely clear.
The question is, what gets inflamed if we said that it is not really inflammation? What really gets so sensitive after a run so it is painful?
Looks like my plan of action for now would be:
Now I am thinking if I should run at all or give it a month to see what happens. What do you guys think?
Also, do you guys do biking, does that effect your AT?
I am 50-54 age group too, I guess that does not help either.
Thank you again for your help.
Age: 52
Runner since 2012
Marathon PB: 3:40:32
Slow and easy, with consistent icing daily and rest for a few days, then see how it feels jogging (not running). You could do what I did NOT do and use the down-time from running to work on core and other strength. Noticeable swelling and heat at the tendon means it's still inflamed. Once the swelling goes down, running can start up again, but short and slow for a week or two, and any sign of it getting worse means to STOP and wait some more. Better to be out for a few weeks to a month than for years.
I'd still like to know exactly what the sports docs do with professional athletes who mess up their achilles; some seem to be back on the court/field in a month, even with a partial tear. It might be total isolation of movement while it heals up for a few weeks, and then strengthening exercises. I have a night brace, which prevents you from pointing your toes while you sleep, and thus allows the achilles to heal in a lengthened position instead of a shortened one. I always had to take it off in the middle of the night because it would bug me.
60-64 age group - University of Oregon alumni - Irreverent and Annoying
One thing they do is EPAT (extracorporeal pulse activation technology). I've had that done several times. It gives some immediate relief. My sports doc who does it, Amol Saxena, has treated several Olympic runners. His specialty though is Achilles surgery. He tells me EPAT is also done mid-game for pro football players.
Yeah I hate that brace. I had to wear it after my Tenex procedure two years ago. Hard to sleep with. But I still have Achilles issues, so maybe I should still be using it.
Thanks guys.
I registered for 80K (50 miles) race at the end of May. That one is not that important, but I would still like to finish it. The other race, 104K mountain ultra that I have last weekend of July is my goal race for this year. I want to be healthy for that one.
I will keep you informed about my progress. I feel like I am almost there, but this could drag for another month or two too. Even longer, who knows.
Do you guys think that I would benefit from that night brace? Is it what they call "Strassburg Sock"?
I have had paratenonitis of the Achilles twice. Lots of pain and the creepy creepy crepitus (tugging feeling between tendon and sheath). Difficult for the physician to determine whether the problem was in the tendon itself or a related structure w/o an MRI in my case.
Physical therapy with extensive work on the calf muscles gave the best relief. Dry needling, especially. I've also had plantar fasciitis problems in the past, resolved with EPAT (to the foot) and also PT work on calf. The moral of the story is pretty easy to figure out.
My doc is not a fan of the strassburg sock or the brace. In my experience they do one thing well: prevent restful sleep.
DukeDB, thank you for your reply.
How did they determine that you had Paratenonitis? Did you end up doing MRI? I was told the same thing, paratenonitis. Apparently, if the painful spot does not move, that is paratenonitis. If it moves when you move your foot, it is tendon.
Did you run through it, what was your recovery process? How long did you take to fully recover?
SMART Approach
You may have tendonisis if you have confirmed scar tissue and this is chronic condition. Tendonosis may mean no inflammation. Tendonosis can cause chronic soreness especially after activity because of diseased tendon. Also, think of 75% healthy tissue (25% diseased malaligned tissue) trying to do all the work.....hence soreness (improper or ineffficient firing of muscle). But you bounce back from it. Icing makes you feel better because it has numbing effect but does nothing to help heal and may be counterproductive if indeed tendonisis. Keep doing what you are doing. Easy and negatives. Negatives in theory will help realign tendons. ART did nothing for my tendonosis. Graston technique may be better however I don't have experience with that on myself.
Run Coach. Recovery Coach. Founder of SMART Approach Training, Coaching & Recovery
Structured Marathon Adaptive Recovery Training
Safe Muscle Activation Recovery Technique
www.smartapproachtraining.com
Blaf;
the sock is a soft wrap that has a strap in the front to keep your toes up, the brace is a hard plastic thing that goes behind your calf and under your foot keeping it in a 90 degree position; the front is open. I tried both and found the sock much more uncomfortable because it puts most of it's pressure on the toes. The brace holds your whole foot in position. There's not much investment if you want to give either a try, especially the brace. Many thrift stores (Goodwill, Salvation Army, etc) have a shelf full of medical braces people have donated after they were no longer needed. I bought my brace and sock for 99 cents each.
I don't know if these do much good when you aren't injured, but they are a useful tool for recovery.
From what I can tell, increased blood flow to speed up healing, eccentric heel drops to align the collagen, and reducing the chances of re-injury during the healing process are the broad lines to color inside of after the initial inflammation goes down. Increasing bloodflow is where a lot of creativity and quackery takes place. Compression and massage are two of the methods that have shown increases in bloodflow in studies. Unverified but logical methods like ultrasound therapy and alternation therapy (ice, then heat; repeat 5-10 minutes each for an hour etc) might be useful. Graston technique (focused deep tissue massage) might also be useful, but be wary of any practitioner that makes claims of anything but muscular system recovery (such as claiming curing cancer, headaches, or internal organ problems). Graston is massage with tools, not magic.
DukeDB, thank you for your reply. How did they determine that you had Paratenonitis? Did you end up doing MRI? I was told the same thing, paratenonitis. Apparently, if the painful spot does not move, that is paratenonitis. If it moves when you move your foot, it is tendon. Did you run through it, what was your recovery process? How long did you take to fully recover?
I've had this problem in each ankle. I had an MRI both times, to confirm that there was no rupture/tear. I did not run while awaiting the MRI results but started running once those came back clean, so about 2 weeks off each time. Recovery wasn't too bad. First one was at the beginning of a marathon training cycle and I built mileage at the normal rate but to a lower total (40 mpw). Did not run back-to-back days, did no speedwork, and cross trained a lot (pool running, elliptical, stationary bike). Physical Therapy with heel drops and manipulation of calf. Had an OK marathon for that cycle and PRd the next one after a good strong training cycle.
Next injury was right after a marathon, fall of 2016. I'd signed up for a 50 mile trail race six weeks after. Diagnosis consumed the first 3 weeks of that. Again, PT with much manipulation and, this time, dry needling. Limited running, mostly to get used to the trail. Achilles did not hurt during or after race, though it wasn't a good day for me otherwise. I continued the PT for several weeks post-race and haven't had problems since. Independent of the injury, I'd decided to take 2017 off from the full marathon and longer and followed through on that. I've been building to marathon mileage since October and feel fine now. We'll see what the year brings. Good luck & keep us posted.
Thank you guys. This is great help.
So you convinced me to following:
No icing after a run.
I might give the sock a try.
I will continue with easy running. But not every day. I will run every second day, easy, up to 1 hour. That will be 30-40km per week.
I will use stationary bike on non-running days. I noticed that stationary bike does not bother me, elliptical maybe not be the best option.
I will continue with eccentric heel drops.
I am going to see a physiotherapist and share this with them to make sure they agree with this.
I went for a run last night. 52 min, total 10km on indoor track. A bit faster than I wanted. I warmed up before and used foam roller on my calves after. No significant pain during the run. Just some tingling around the heel, and tightening between the calf and tendon closer to the end. After the run, tendon was more sensitive that before the run. But I did not ice it, as I do not want to stop healing. Also some dull pain around the ankle and tendon later on from time to time.
We have thermal imaging cameras at work. Below is image of my left and right foot. This is totally amateur shot, but it is interesting to see that bottom of my left calf is super hot. That bright yellow area. And that is where I really feel tightness during a run and after a run. I am going to take a couple other shots, for example shot from the back, both Achilles at once.
actually, you DO want to ice after a run. You use heat before a run.
I'm looking forward to updates on your achilles adventure!
I will follow this thread closely too.
Similar story. Ran for about 10 years, upwards of 70 miles/week and a few marathons a year. About 5 years ago, starting having difficulty with my right AT. Since I was always in some kind of a training cycle, I would pop a few Advil and just keep going.
Fast forward to about 3 years ago and the tightness (I wouldn't call it "pain" most days) is so bad that it is VERY difficult to walk in the mornings. Took almost a full year off running (tried to get out a few times almost always felt the AT immediately).
So I've been pretty much on the bench for 3 years now with no clue how to get this fixed. It has never "torn" but I have a ton of scar tissue in there that almost completely locks it up (right AT used to be about an inch wider than left) Went for graston and shock therapy. Both worked at reducing scar tissue, but still not much strength in what's left for running. Have been doing some shorter runs, but really getting no push from the right side - If I try, I can really feel it within a few hours.
Have worked on posterior chain (glutes, hamstring, calves) but I find it VERY difficult to stretch my calf muscle out without putting a ton of stress on the achilles. If I try to stretch the calf, I feel the tearing in the AT. Have done eccentric calf exercises pretty religiously for a couple of years.
Almost wish the damn thing would just tear completely and start over.....
2018 Goals
Figure out the achilles thing...... and THEN try to get running regularly again.
No racing goals
I had tendinosis in my left Achilles for years. As you know, it's bearable, but I felt it on every run. I tried a lot of things, all of the common answers, but nothing worked.
I ended up trying EPAT. It's not covered by insurance, so it'll cost you a bit, but I got it once a week for six weeks while also taking off from running and it went away. I'm sure it's not guaranteed to work for everyone, but it worked for me.
I also have been going through EPAT. It certainly helps to reduce the amount of scar tissue, but I still feel my AT is quite tight. Maybe I need a few more and/or continued maintenance?