Today on the Doc On the Run Podcast, we’re talking about whether or not a runner should try a more aggressive treatment for an aching Achilles tendon.
Today was on a consultation call with a runner who is had a long history of Achilles tendon problems. She’s recently tried some new things that made an improvement. But the problem is she’s not really certain the improvement is from the new treatments she’s been doing. Because she simultaneously decreased her activity a bit.
So now she’s in this place where she is trying to figure out what to do next. Should she continue with some simple conservative treatments that aren’t very risky? Or should she try to just do something riskier to try to get it to finally heal, or heal faster?
If you have had pain for many months, or even years, what is the risk of trying something that is conservative. Think about it. It may just take a couple of extra weeks of healing. But in the grand scheme of things it’s no big loss.
Let’s imagine this scenario. You have pain in a little bit of swelling and some ongoing stiffness which kind of wax and wane’s for years. Then in the last couple of months you had a sudden increase in the persistence of the stiffness of the Achilles. You sense a sort of immediate stiffness the develops right after you do plyometrics or short run.
Of course, that makes you more concerned because you can tell the Achilles seems to be getting worse.
But if you try some simple things like icing and stretching and you decrease your activity a little bit and you start to improve, you become encouraged.
Basically if you have an Achilles tendon injury and you’re just not getting better and the doctor tells you you might want to consider a more aggressive treatment like a PRP injection or surgery you have to think about four basic alternatives.
1. You could try to adjust your running form in a way that decreases the loading and stress applied to the Achilles tendon.
Provided all of those simple treatment you have already been doing are actually helping you, then you might actually get to a place where you can get back to running without aggravating the Achilles tendon.
The risk with taking the time and effort to adjust your running form and see if that helps is simple. It will take time. But again in the scenario you’ve probably already wasted a whole lot of time without running the way you really want to run. There is also some risk that attempting to change your running form and resuming running will continue to injure your Achilles tendon.
But every cloud has a silver lining. For runners who have developed Achilles tendon injuries, my experience is that those runners have become very attuned to the changes and subtle sensations within the Achilles tendon.
You notice the weird sort of tension that develops around the Achilles tendon when he becomes very slightly inflamed. You notice when you land a certain way when you are running that can cause sharp pain.
Of course as an experienced runner who has a very keen sense of the sensations going on in your own body you make adjustments appropriately. For that reason, this approach may not be as risky as some doctors may think.
2. You could try a short period of immobilization in a specific fracture type of fracture walking boot designed to reduce the tension and stress on the Achilles tendon.
If you have had Achilles tendon issues for a long time and they seem to get a little bit better and a little bit worse you actually might be in a pretty good position for healing.
It may simply be that the activities you are doing, and the stress that you are applying to the tendon on a day-to-day basis are simply canceling out collagen regeneration and healing that is taking place with in your tendon.
If so, a short period of immobilization, and dramatic reduction in the amount of stress on the Achilles tendon may be sufficient to get you over the hump and let the actual healing take place.
The risk with this treatment is that any time you get immobilized in a fracture walking boot or cast or other external bracing device 24/7, you will get weakness and stiffness in that lower extremity. See you want to do that for the shortest time possible.
3. You could do a PRP injection.
A PRP or platelet rich plasma injections is invasive, but it’s not nearly as traumatic as surgery.
The platelet rich plasma injections is designed to harness and concentrate all of the healing cofactors with in your platelets and deliver them directly into the damaged area of your tendon.
Many doctors will recommend this treatment before they would recommend you attempting to make adjustments in your running form. One reason they would recommend this treatment is they get paid for it.
Let’s face it, if I see you in your home, bring a centrifuge, draw some blood out of your arm, spin down your blood, separate out the platelets, and inject it into your tendon, I am going to get paid for the procedure.
If I recommend you sign up for an online course like RunRx to teach you how to adjust your running form, I don’t get paid anything. Valerie Hunt, the person who made that course gets paid. But I don’t even collected affiliate commissions on those referrals.
So your doctor may be similarly motivated to recommend treatments that involve reimbursement, especially reimbursement to the doctor.
The second reason your doctor would recommend the PRP injection is that she actually believes that the injection is most likely to help you turn the corner and get you on the path to healing. So just because your doctor will get reimbursed for the PRP injection does not mean it is wrong to offer the treatment to you.
If you have a PRP injection you should expect a period of immobilization in a fracture walking boot while using crutches. Not all doctors do it this way but my experience has been that is the most helpful approach in runners. So you should expect a short period of disability immediately after the PRP injection.
Because we take a large needle and poke it through the tendon multiple times there is also a small chance that you could actually have a rupture of the Achilles tendon because we have weakened the tendon when we did the injection. Your doctor will almost certainly explain this risks to you when they have you sign the consent form before doing your PRP injection.
4. You could have Achilles tendon surgery.
In my mind when you decide to have surgery you didn’t lose the battle, you lost the war.
The idea with surgical intervention with Achilles tendon problems is that we will go in, cut the Achilles tendon and open and remove any disease and damage portions of the tendon.
The hope with Achilles tendon surgery is that we remove that rotting portion of the tendon and prevent the spread of the damage and disease within the tendon.
But make no mistake we are not stimulating regeneration. We are actually making the tendon smaller and weaker as a consequences removing a portion of the tendon itself.
It may not surprise you to hear that the longest period of disability after any of these options is after surgery. It just takes a long time to recover from surgery and there is more risk with surgery than any other treatment.
Many of your closest friends, family members and love ones will tell you that you should just give up and have surgery.
But we’re not talking about removing a broken alternator from an automobile and replacing it with a new one. We’re talking about trying to make a guess on what to remove, what to leave in place and how to sew it up in a way that it will still be functional as you run down the road.
And remember, there are only two guarantees with any surgery:
1.You will get a scar.
2.You will get a bill.
So whenever you go to your doctor and you’re trying to think about what you should do when you have an Achilles tendon problem you should think about all these for broad approaches.
Each of these treatments has risk. But the risks are all very different.
I truly believe there is an appropriate solution for every runner with an aching Achilles tendon. Even if you’ve tried many different approaches, if you’re not getting better, you just haven’t found the right approach for you.
So if you’re in this scenario when you’re trying to figure out what to do next, the most important exercise you can do right now is to sit down and figure out exactly what your goals are.
And remember, your goal is not to get your Achilles tendon pain to go away. Your goal is to qualify for Boston. Your goal is to do Ironman Hawaii. Maybe your goal is just to run 5 miles with your spouse every Saturday without thinking about your Achilles tendon.
If you haven’t done it yet, print out the runners goal worksheet and fill it out. We have already created it for you and you can get it here for free. Print it out. Fill it out. And it really will help you decide what is most important to you as you get back on track and figure out what you need to do to get back to running as quickly as possible.
One simple step you can take is start with the Healing Runner’s Goal Worksheet.
It will help you take what you know about goal setting in running and use what you already know to focus your healing. It’s free.
Go get it now!
If you have a question that you would like answered as a future addition of the Doc On The Run Podcast, send it to me PodcastQuestion@docontherun.com. And then make sure you join me for the next edition of the Doc On The Run Podcast!