I read a new paper today in the British Medical Journal on Achilles Tendonitis. The take away messages that the old new term for the condition tendonosis is actually inappropriate for the chronic condition as it is a chronic recursive inflammatory process. Radiological evidence of neovascularisation in the tendon is now considered pathognonomic for tendonitis. In plain in english long term tendon problems create local inflammation. This triggers new blood vessels into the tendon. Nerves follow the new blood vessels and increase in density around the tendon. Any movement of the tendon causes pain in these new nerve endings, this increases inflammation which closes the vicious circle on tendonitis.
In sports medicine, the “if all else fails” go-to technique to resolve this is to use saline injection to strip the new blood vessels off the tendon. Without the blood vessels, the new nerve ends wither away and vicious circle is broken. In my practice the go-to technique is LED light at 640 and 810nm which has a profound effect in interrupting inflammation, followed by mobilisation and exercise prescription. As far as we are concern a very small percentage of the population would require an invasive technique to resolve calcaneal (achilles) tendonitis. Interestingly for me the new paper recommended new modalities for anti-inflammatory effects. Couldn’t agree more.