Today on the Doc On The Run Podcast we’re talking about whether or not a runner should take steroids for chronic tendinitis.
One common problem when runners get tendinitis is that the aching pain an linger for a long time.
Today’s question is based on a submission we got from Derek who had a question about this kind of issue.
He actually quoted what I said on an earlier episode, “The problem with chronic tendinitis is that it’s not like it’s going to rupture but your running is going to be miserable. You’re not going to run as fast as you possibly could. It’s distracting you. It’s annoying you.”
Tendinitis won’t kill you but it can certainly disrupt your running.
If you happen to have chronic peroneal tendinitis, your doctor may recommend a course of steroids to try to shutdown the inflammation and calm down the tendons to get you back to baseline. The hope is that if you get the swelling out, the tendons themselves will actually take up less space and will stop re-irritating themselves.
When you want to get back to running and you’re trying to decide on the best treatment for a chronic peroneal tendon issue, or any kind of chronic tendinitis, there are a lot of different variables you have to think about.
Do you actually have tendinitis?
Do you have tenosynovitis where you have inflammation in the tendon sheath and not the tendon itself? Do you have tendinosis where there is actually some tendon degeneration and damage to the collagen in the peroneal tendon? Is there any possibility you have a split in the tendon or a small tendon tear? Do you have subluxing peroneal tendons? Are you getting too much motion in the tendons because you have peroneal muscle weakness? Are you getting stress on the tendons because you have a pronated or supinated foot type?
No matter what the situation, no matter which running doctor you see, no doctor can make a recommendation on what you should do without knowing the whole story.
But I can certainly tell you the possible concerns I would have about taking steroids for a problem like chronic peroneal tendinitis.
The first thing you have to understand is that any diagnosis ending in “-itis” means inflammation. If you have inflammation, a short course of oral corticosteroids will help to shut off the inflammatory response and reduce the inflammation.
You may hear your doctor mention any number of different medications including oral prednisone, a Medrol Dosepak or Sterapred Dosepack or methylprednisolone. You can think of all of them is basically being different forms of oral corticosteroids that should stop inflammation. Usually it’s a taper of six days. You take a whole bunch of pills on the first day, less the next day, lest the next day and on the very last day only take one pill. In general that’s a dose of 21 pills decreased over the course of six days.
There is no question, when it comes to stopping inflammation an oral course of corticosteroids is an effective treatment, for that problem.
But a lot of doctors use the term tendinitis to describe any irritation in or around the tendons. But just like I described above,
there are many different conditions that can affect any tendon in your foot or ankle.
So there are really three main questions to ask your doctor when you’re considering a course of oral corticosteroids to treat chronic inflammation.
1. Is your doctor 100% certain this is just an inflammatory problem?
2. Is your doctor 100% certain that if you remove the inflammation, the problem won’t just return because you have weakness, instability or some other issue that will caused the tendons to flare up in the first place.
3. Is your doctor 100% certain that you can decrease your activity enough to guarantee you will not develop an Achilles tendon issue?
All of these are valid concerns. And they are fair questions for your doctor.
Achilles tendon rupture is a result of oral steroid therapy has been well documented in medical journals over the years. Most of the time these studies present evidence of a correlation between the use of oral steroids and the development of tendinosis and subsequent”spontaneous” rupture of the Achilles tendon. But there’s a lot less information about how risky it may be when you take a short course of oral corticosteroids like a prednisone taper.
Sometimes as a runner you have to make a decision about things that may seem low risk, but high consequence. Getting struck by lightning statistically is very low risk. But if it happens to you, there are significant consequences. The same is true with Achilles tendon issues in runners. You just have to make sure if you’re pursuing any treatment, it has to be necessary, and should have some reasonable hope of achieving your desired outcome…if you’re going to take on the risk associated with taking that medication.
It took me nine years to get my spot at the Ironman World Championships. And unfortunately I got pneumonia right before the race. I had to take oral corticosteroids preceding and during Ironman Hawaii. Now to be clear, I did the race, but I did not run at all for two months after Ironman Hawaii. I wasn’t resting. I wasn’t recovering. I was concerned that I would develop an Achilles tendon problems as a consequence of running immediately after having finished the course of oral corticosteroids.
I really like to run. So you should think about that for a second before you take oral corticosteroids.
If you take a course of oral corticosteroids and it shuts down the inflammation makes one problem better, but then you wind up with serious Achilles tendon issues…that is not going to help you finish your next goal race. Make sure you understand all of the risks before you pursue any particular treatment for chronic tendinitis.
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!