How long does it usually take before Achilles tendonitis becomes irreversible?

not when it starts to scar and thicken.

The stages happen like this: pretenditiis-->tendinitis-->tendosis

Your correct to say and all soft tissue has capabilites of repairing it self, however the key is not whether or not it is able to fix itself but whether or not you get 100% function back when it does heal.

JB

So you are saying that once you get to the tendonosis stage, it's impossible to get back to 100% tendon function as far as running is concerned?

Is the scaring/thickening irreversable? What about with the eccentric programs?

Wouldn't it be possible to break up that scar tissue and have it be reabsorbed by the body?

how about Platelet Rich Plasma Treatments. i have read and heard about professional runners having this treatment for achilles tendonosis. it is non invasive.

anyone tried this?

I have had chronic achilles tendonosis for 8 years and just had the PRP treatment done about 6 weeks ago. Time will tell if it works. Was in a boot for 2 weeks then off another 2 weeks and have been doing eccentric calf raises for 2 weeks. If I am back within 6 months pain free then I will deem PRP treatment a miracle.

wow. did you run during your 8 years of tendonosis? was it a mild case diagnosed by MRI? i imagine you tried all the treatments, therapies. did an orthopaedist do the PRP or a pain specialist?

i guess i misunderstood the whole PRP process. i didn't realize that you had to be in a boot, then so much off time. i suppose i thought it wasn't very invasive.

did it hurt?

sorry for the questions. i am thinking of undergoing PRP and was curious to hear from other runners who have had it.

thanks a million. appreciate any input youc could give.

No it's not invasive at all. And yes I ran on and off for the last 8 years--even managed a 1:11 half 4 years ago. The reason I was in the boot is just because my Dr. wants to give this every opportunity to work--ie there really aren't any other options. I will say that my achilles seems much better than it would have been had I just taken off for the last 6 weeks. I have tried taking time off before--up to 5 months at a time and nothing has worked. They used ultrasound to diagnose. The worst thing about the procedure is drawing blood--I almost passed out because I'm squeamish like that. Keeping my fingers crossed!

thanks out of my element for your input.

i am considering the PRP. i am 4 months into my bout of achilles tendonosis. diagnosed by MRI as "very mild tendonosis". well . .. I have not run since. I have tried ART, acupuncture, been in a boot for 2+ weeks by podiatrist, PT (useless), eccentrics. my Chiro who does the ART is recommending the PRP - a pain specialist does it here. is your dr. an orthopaedist?

at present i am trying to do the run/walk thing and see if i can handle that and slowly increase the mileage and live with what's going on and see if it gets worse.

i suppose 4 months isn't that long compared to your 8 years. but will this "very mild tendonosis" get better? reading other people's posts makes me sort of pessimistic.

thanks so much for your input and thanks for letting me pick your brain. i wish you the best.

Uhkileez wrote:

My achilles problems began 9 years ago. For the past 4 it has moved into the tendonosis stage. In that time I competed in two Olympic Trials WITH the injury.

What events did you compete in? I found that doing intervals or time trials that were faster than 4:00/mile pace would make it a lot worse the next day. Last month, an all-out 9:02 3K didn't give me much problems the next day, but my Achilles felt pretty shitty the day after doing a submaximal 1:30 600.

I had a lot of luck with PT. That was only the beginning though, I had to learn to incorporate preventative exercises into my routine, as well as rotating shoes and doing self-massages.

I still have some scar tissue, but it continues to diminish, particularly since I stick to softer surfaces now. I am not sure if this is coincidence or part of the solution, however.

Take care of your body. You only get one. Good luck.

debbie wrote:

i am considering the PRP. i am 4 months into my bout of achilles tendonosis. diagnosed by MRI as "very mild tendonosis". well . .. I have not run since. I have tried ART, acupuncture, been in a boot for 2+ weeks by podiatrist, PT (useless), eccentrics. my Chiro who does the ART is recommending the PRP - a pain specialist does it here. is your dr. an orthopaedist?

A fool and his/her money are soon parted.

Please elaborate, Mr. Barnum.

Marathon was my event, but I did race the mile in the 4:10-4:15 range in that time and a lot of 5k's all of which required a lot of 100m and 200m sprints. My mileage was 120-150 weekly for over 12 years and I was a "streaker".

i think the real killer was the the mountain running. I believed in hills, hills, hills all the time even on my maintenace runs.

Anyhow, the damage is there and it's very real (I even have a right knee issue), but as said, I can still run - I had a nice 13 miler tonight and it had some nice middle miles. There are still days when i scarcely feel it, but you are right that the faster I run the more I can expect pain, but I can always bring it babk under control by going easy.

It's a strange injury, there are days you can feel modest pain and run some great intervals through it and then the rest of the day it will actually feel BETTER and all loose the following day. Then two days later it'll get tight again and you'll fel the damage from what you did two days prior.

The only caution I really make is this prickly, stingy pain. That's the danger zone. Halt all intervals immediately until it ceases. That's when it's going to tear.

Your scar tissue is diminishing? My lump is gotten somewhat smaller, but still there. I stopped all treatments except for the eccentrics. I was hopping that this thing will eventually clear itself; though i was investigating the PRP injections. Again, was it an orthopaedist or pain specialist who gave you the shots.

Thanks

To the guy who had PRP... how are things coming?

Debbie, how are the eccentrics working?

Still battling mine....

I developed Achilles Tendonitis in early May, and ignored it, pushed the mileage and workouts, and still got a ton faster, and it just went away in December. I didn't do anything to treat it, and the only thing it really did was make it so I couldn't run in the morning.

I'm at about 90-95% pain free now and should be able to start back running within the next month. I would recommend PRP to anyone who has struggled with chronic achilles problems. It probably won't help everyone but it is almost 100% risk free so I don't really see a downside to having it done.

permanent injury? wrote:

my Achilles still feels stiff in the morning and hurts like hell whenever I move at speeds faster than a slow walk. Will this eventually heal up, or am I doomed to a lifetime of pain?

Update: All morning stiffness has gone away, and it no longer hurts to run fast. I can do some 400 meter "sprints" (my time was slow - only 1:05) without any problem, but any runs longer than a mile will trigger the Achilles pain regardless of how slow my pace is.

I'm not too worried about that, though - I'm just happy that I can go through life and play most sports without discomfort or pain. Maybe I'll try a comeback next year, maybe not. For now, I'll just take it easy and enjoy the time I have before graduation this May.

how long did it take to get better? did you run through it? what did you do to get better?

The effectiveness of PRP is in question. This is one of a few randomized trials to find that it doesn't work. The studies that are non-blinded seem to be the ones finding efficacy. It's starting to sound like an expensive placebo.

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Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy

A Randomized Controlled Trial

Robert J. de Vos, MD; Adam Weir, MBBS; Hans T. M. van Schie, DVM, PhD; Sita M. A. Bierma-Zeinstra, PhD; Jan A. N. Verhaar, MD, PhD; Harrie Weinans, PhD; Johannes L. Tol, MD, PhD

JAMA. 2010;303(2):144-149.

Context Tendon disorders comprise 30% to 50% of all activity-related injuries; chronic degenerative tendon disorders (tendinopathy) occur frequently and are difficult to treat. Tendon regeneration might be improved by injecting platelet-rich plasma (PRP), an increasingly used treatment for releasing growth factors into the degenerative tendon.

Objective To examine whether a PRP injection would improve outcome in chronic midportion Achilles tendinopathy.

Design, Setting, and Patients A stratified, block-randomized, double-blind, placebo-controlled trial at a single center (The Hague Medical Center, Leidschendam, the Netherlands) of 54 randomized patients aged 18 to 70 years with chronic tendinopathy 2 to 7 cm above the Achilles tendon insertion. The trial was conducted between August 28, 2008, and January 29, 2009, with follow-up until July 16, 2009.

Intervention Eccentric exercises (usual care) with either a PRP injection (PRP group) or saline injection (placebo group). Randomization was stratified by activity level.

Main Outcome Measures The validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire, which evaluated pain score and activity level, was completed at baseline and 6, 12, and 24 weeks. The VISA-A score ranged from 0 to 100, with higher scores corresponding with less pain and increased activity. Treatment group effects were evaluated using general linear models on the basis of intention-to-treat.

Results After randomization into the PRP group (n = 27) or placebo group (n = 27), there was complete follow-up of all patients. The mean VISA-A score improved significantly after 24 weeks in the PRP group by 21.7 points (95% confidence interval [CI], 13.0-30.5) and in the placebo group by 20.5 points (95% CI, 11.6-29.4). The increase was not significantly different between both groups (adjusted between-group difference from baseline to 24 weeks, –0.9; 95% CI, –12.4 to 10.6). This CI did not include the predefined relevant difference of 12 points in favor of PRP treatment.

Conclusion Among patients with chronic Achilles tendinopathy who were treated with eccentric exercises, a PRP injection compared with a saline injection did not result in greater improvement in pain and activity.

Trial Registration clinicaltrials.gov Identifier: NCT00761423