John Bowman was a family doctor who now specializes in sport medicine. He is the Medical Director of the Collingwood Sport Medicine and Rehabilitation Centre.

A NEW TREATMENT FOR AN AGE OLD PROBLEM (ACHILLES TENDINITIS)

by Dr. John Bowman, M.D.

Many people have symptoms resulting from irritation or damage to tendons. Tendons are tough bands of fibrous tissue, which anchor muscles to bones. After the age of forty or so, the blood supply to some tendons becomes less efficient, causing them to be more easily injured. If such a tendon is repeatedly overstressed, some of the fibres weaken and tear, leading to pain, swelling and a loss of ability to function. Occasionally part of the tendon starts to deteriorate.
Although this process is commonly called tendinitis, more accurate terms are tendinopathy or tendinosis. Areas commonly affected include the shoulder (the rotator cuff), the elbow (tennis and golfer’s elbow), the knee (jumper’s and runner’s knee) and the Achilles tendon.
The latter, named after the Greek hero Achilles, can be particularly troublesome. It is one of the biggest tendons in the body, anchoring the calf muscles to the back of the heel bone. It exerts a strong force on the foot allowing us to walk, run, jump and climb. Damage to the tendon usually results from a phenomenon called “too much, too fast, too soon”. This typically occurs if one decides to start (or get back into) an intense physical activity without gradually building up to it: for example playing competitive tennis, training too quickly for a marathon or starting a high level step aerobics class.
Pain occurs either in the body of the tendon or at the attachment point to the heel. Because of the relatively poor blood supply, some of the fibres in the centre of the tendon soften and degenerate, often causing the tendon to swell. Recovery can be very slow and on occasion the tendon doesn’t heal at all.
There are numerous treatment options, including anti-inflammatory medications, physiotherapy, ultrasound, laser, shockwave treatments, acupuncture, soft tissue release, night splints and heel lifts. In spite of these, the condition can persist and become chronic. Occasionally surgery has to be done to relieve symptoms.
A new and innovative treatment for Achilles tendinopathy has been developed by a group of Australian doctors. It is based on a six-month study, which used nitroglycerine patches to try to stimulate healing. These patches, usually prescribed for patients with angina, were cut into quarters, applied over the affected area of the tendon and changed every twenty-four hours. It was theorized that the nitroglycerine was slowly released into the tendon and hastened healing, primarily by improving the blood supply.
The patches had very few side effects and showed quite promising results, even at the three-month point of the study. In addition to wearing the patches, the participants were also advised to avoid stressing the tendon, to use heel lifts and to do a stretching and an eccentric strengthening program.
If you have Achilles tendon problems that aren’t getting better, this new treatment option may work for you.