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Should I have an injection for my Achilles tendinopathy

Injections for pain and injury have long been utilised for reduction of pain and are a popular choice by many people looking for a resolution. But how well do they work? There are many factors that contribute to Achilles tendinopathy, such as overload, strains, understanding about pain, how robust you are, how well the lower limb functions, and your stress levels. In a world which is moving so fast and constantly changing it is understandable that people are looking for immediate results so they can keep going with their lives. The question is, are injections helping long term, or are they just a short-term fix to delay the pain for another time?



In a recent research trial of people with Achilles Tendinopathy, the participants were taken through a range of tests, injected with anaesthetic into the area of pain, and taken through the same range of tests again. The results were also compared with people who did not have Achilles tendinopathy. The study found that the injection reduced people’s pain and increased their muscle endurance, however, it did not decrease their fear of moving through the symptomatic area (known as fear avoidance). Furthermore, a week after the injection all the symptoms had returned to back what they originally were prior to it. The paper supports the fact that reducing fear of movement, decreasing pain sensitivity though managing how much weight you put through the Achilles and progressively increasing the weight you put through it are still the best way to heel your Achilles tendinopathy.


Current thinking around treating tendinopathy involves a few concepts. Improving function, gradually increasing the weight or load, and decreasing how sensitive you are to the pain.

To improve function, you need to improve the how efficiently the foot, ankle, and sometimes even the knee and hip move. This is because tendons are like elastic bands that need to stretch and snap back to their original shape to propel us into movement. If the joint around the ankle do not allow effective ankle motion, the Achilles tendon cant stretch and can contribute to the pain.


Another contributor to Achilles tendinopathy is that the tendon becomes overused and starts to degenerate as it struggles to cope with the demands laced upon it. Loading (or exercising the tendon help to kick start the heeling process. Sustained holds or slow contractions help to build more tendon fibres or improve the elasticity of them, but this has to be done within mild pain thresholds. To much pain and you are causing more harm then good, too little pain and you would not be putting enough weight through it to promote healing.


Finally, the concept of desensitisation is another key to healing Achilles tendinopathy. Pain is like an alarm bell in our brain, if it feels a threat of damage, you will feel pain. Provoking a mild pain will set the alarm bells off in your brain, but when it realises you’re not putting too much weight through it and your Achilles wont break, the sensation and alarm calms down. Gradual exposure to doing this frequently helps reduce pain, and not doing so is known as fear avoidance (discussed earlier as a detriment to long term healing and resolution).


Our programs for Achilles tendinopathy are built around all of the above concepts, with a step by step approach which ensures you’re doing the right exercise at the right time. Your body can heal itself, and we can show you how.


Credit

Tom Groom review of Chementi. R, et al 2020 for physio-network.com

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