There are several components to the treatment of achilles tendonitis and certainly some conflicting opinion on how to effectively treat this condition. The ending “itis” in the word usually suggests that there is inflammation present. I was aways taught in massage school that you would treat any sort of inflammation with ice, because you would never want to add heat to a condition where there is already heat present. Inflammation is part of the healing process and brings blood and lymph to the site of injury, so that is a good thing. However, by applying ice, you are reducing the inflammation and are stopping the inflammatory action. That is bad.
The great proponent of the recovery regime of Rest, Ice, Compression and Elevation (RICE) was Gabe Mirkin MD who, in his best seller book in 1978, recommended this as the most effective way of treating athletic injuries. However, the American Journal of Sports Medicine, June 2013 suggests that applying ice may delay swelling and pain but does not necessarily hasten muscle recovery. By exercising intensely, this is employing the same immunity biological mechanisms that kill invading pathogens. The body’s response to either germ or muscle damage is an inflammatory response. (Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999). Inflammatory cells (Macrophages) release Insulin Growth Factor (IGF-1) into the damaged tissue and helps the healing process. Ice would suppress the release of IGF-1.
Perhaps the solution is to follow a recovery program that is moderate - that doesn’t totally exclude the use of RICE but includes an exercise program that gradually increases in intensity. Total rest is not a successful option.
A RICE program for the first several days will help overcome the pain, swelling and discomfort from the injury. During this time you can exercise areas that do not affect the achilles tendon. Compression bandages can help reduce movement of the tendon and elevation above heart level at night can reduce swelling.
After the initial 48 to 72 hours, you can begin a program of slightly more aggressive exercise. From an injury, scar tissue will have formed much like the scab resulting from a cut. This is a mishmash of collagen which, if left to itself, will not leave the tissue as strong as it was previously. The object of exercise will be to realign the tendon fibers and activate the lymphatic system so that toxic material is removed from the injury site. It is important, however, not to engage in any exercise that is likely to re-injure the tendon. Another aim is to increase oxygen flow to the injured area and this can be obtained by ultrasound, TENS (the use of an electrical pulse) and light massage to break up the scar tissue. You can now start applying heat. Gradually you can increase the intensity of the massage to address the problem area.
You are now on the road to recovery. In my next blog I will cover ways to avoid future re-injury and rehabilitation.