My Achilles injury is almost 5! In light of my injury’s impending eligibility for kindergarten, I wanted to do a post on why Achilles tendinopathy is “so hard to get on top of,” as my doctor says. Or, as I say, “a pain in the rear.”
My doctor seems to enjoy giving me medical papers to read, so most of this is based on Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research?.* The short version is:
- Achilles tendinopathy is considered “chronic” after 12 weeks… I’m at about 257 weeks.
- Injured tendon cells are understimulated, making it even harder for the injured tendons to heal.
- Tendons generally receive low blood flow, and the Achilles even more that most because it is so far from the heart.
- if you continue to load the tissue frequently, the process of tissue breakdown happens faster than your body can build the tendon back up, and the structure of the tendon starts to change.
- This makes the tendon less efficient, which leads to even more tissue breakdown.
- Inflammation is likely a response to the injury rather than a cause.
- Pain’s utility as a messenger is unclear.
- Pain may be an indication that the injury is getting worse.
- but, deep tendon tissues are far away from the nerve supply and can get pretty messed up without causing pain. This is why people with no history of Achilles pain can rupture their Achilles.
- loading a painful tendon may make you hyper-sensitive of the pain going forward.
- Structural changes are not reversible, and gradual re-loading is needed to return to function.
- In the words of this Australian physical therapy place, “it is . . . important to appreciate that tendinopathy responds very slowly to exercise.”
But at least I can ski
Relatedly, I went skiing last weekend and got in 1,000 feet of elevation gain. It was fun, and my Achilles seems to be holding up pretty well since then. It started hurting towards the end of this week, but I got a great massage yesterday and after an hour and a half, my calf seemed to finally relax. Hoping that the trend continues, as long as I slowly increase the load.
*I last took a science class in high school. While I often read scientific papers for work, medical science is far outside of my area of expertise. If you have a different interpretation of any of this, please speak up in the comments!