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BODY WORK: INJURIES: The Achilles Heal for Runners

Cutting-edge treatment options for runners battling chronic Achilles tendinopathy.

Achilles tendinopathy is a major medical injury that afflicts somewhere between 10 and 30 per cent of runners, characterized by localized pain and swelling of the Achilles tendon. It used to be referred to as “tendinitis,” but clinicians have realized that the condition is more complicated than the simple inflammation implied by the -itis suffix.

Three theories:

The conventional view of Achilles tendon injuries is that they’re caused by wear and tear from quick accelerations and decelerations, which place a lot of stress on the tendon. But this overuse theory can’t explain why some diseased tendons improve with exercise, why certain tendons are more susceptible than others, or why even people who don’t exercise can suffer from spontaneous ruptures.

One alternative is the “vascular theory,” which argues that inadequate blood flow to the tendon makes it prone to injury. Alternately, the “neural theory” places the blame on nerves supplying the tendon that trigger destructive inflammatory signals. Most likely, Achilles tendinopathy results from a combination of all these factors.

The first response to an Achilles injury is RICE – rest, ice, compression and elevation – along with ultrasound and eccentric exercises. Traditionally, if it’s not better after three months of this, then surgery is recommended. But there are some newly emerging options that you might want to consider.

Nutritional supplementation:

Several key nutrients can significantly reduce the inflammation and improve the regenerative healing capacity of a traumatized Achilles tendon:

Vitamin A increases the number of white blood cells at the injured area, and promotes collagen cross-links, which enhance tendon strength. (5000 IU daily)

Zinc doesn’t do much during the initial inflammatory stages of repair, but it becomes important as the tissue begins to regenerate. (8-11 mg daily)

EPA (eicosapentaenoic acid), found in omega-3 fish oils, enhances collagen synthesis and healing. (4 g twice daily with food)

Bromelain, found in pineapple, contains a proteolytic enzyme that breaks down the scar tissue that reduces the elasticity of injured tissue.

Curcumin is an extract of the spice turmeric with anti-inflammatory properties, which speeds healing by manipulating the cytokines that regulate cell growth. (0.5-3 g daily in divided doses)

Cutting-edge approaches:

Researchers have been searching for alternatives to Achilles tendon surgery for many years. Here are some of the techniques that show promise:

Extracorporeal Shock Wave Therapy (ESWT) involves sending focused sound waves through tissue to break up scar tissue and stimulate soft tissue regeneration. The high energy produced by ESWT can be uncomfortable, so sedation may be required. A placebo-controlled, double-blind study by Danish researchers in 2008 found that ESWT improved Achilles tendinopathy.

Platelet-Rich Plasma involves drawing blood from the patient, spinning it in a centrifuge to obtain concentrated platelets, and then re-injecting it into the injured area. The platelets release growth factors that stimulate the regeneration of tissue. Recent studies of growth factors such as GDF-5, IGF-1 and PDGF-2 on tendons and ligaments suggest they can accelerate healing.

Aprotinin is a serine protease inhibitor that inhibits the breakdown of collagen by enzymes known as matrix metalloproteinases, which are highly elevated in runners suffering from tendinopathy. Aprotinin injections have been used off-label to treat tendinopathy for more than three decades, and recent studies have shown that they are superior to alternatives such as corticosteroid injections, and particularly useful for Achilles problems.

In addition to these treatments, there are numerous other possibilities ranging from the well-known (acupuncture, Active Release Therapy) to the obscure (frequency-specific microcurrent, low-level laser). If you’ve tried conservative treatment and you’re considering any of these options, consult your doctor.

Dr. Mark Lindsay, a world-renowned chiropractor and soft-tissue specialist based in Toronto, personally designed and oversaw the treatment and rehabilitation of sprinter Donovan Bailey after his Achilles tendon injury.