Achilles Tendonitis-the two types, and how Acupuncture helps

A very common injury in sports. Most cases I’ve seen have been with joggers who log a lot of miles or who frequently run up and down hills. It also occurs in sports that involve jumping or pivoting on the foot, like basketball or tennis, among others. 

Let’s talk a little about what achilles tendonitis is before we discuss how it responds to acupuncture. It is more accurately called achilles tendinopathy because not all cases involve inflammation, which is what the suffix “-itis” means. Tendonopathy is a more general term which can be applied to two distinct tissue injuries of the achilles tendon.  In both cases, the primary complaint will be pain. Often there will be a recent history of increased sporting activity—running for longer periods or spending more time on the basketball or tennis court, for example.

Two types of achilles tendinopathy

The first type is inflammatory and in most cases does not affect the tendon itself. Instead, we find an irritation of the paratenon, a tissue that covers the tendon. When this condition becomes chronic, the tissue of the paratenon can thicken, and tissue adhesions often form.

The second type affects the tendon itself and is non-inflammatory. This condition is often found in older athletes who have a longer history of overuse and is characterized by signs of degeneration in the tendon with disarray of collagen fibers and adhesions.

Both types can occur together. And in both cases it is common to find shortened calf muscles (soles and gastrocnemius), flat feet and excessive foot pronation. 

There are two main locations for achilles tendinopathy—at the insertion of the tendon on the calcaneus, and at the midportion of the tendon, 1 to 2 1/2 inches above the insertion area. If the problem is at the insertion, there will sometimes be bursitis as well, as there are two bursae in this area.

Acupuncture usually helps a lot for patients with mild to moderate achilles tendinopathy. Usually significant pain reduction and healing will occur over 4-6 weeks and the patient can return to their sporting activity. I suggest two treatments per week for two weeks, and if there is continuing improvement, one treatment per week for a few more weeks. I like to combine acupuncture with manual myofascial release techniques to enhance and accelerate the results.

Chronic cases in which there is significant damage within the tendon will respond more slowly and require more treatments. As long as we are making fairly steady progress toward pain reduction and healing, we can continue treatment if the patient is satisfied with a more prolonged treatment schedule.

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