Platelet Rich Plasma Injection for Achilles Tendinitis

Limits walking and standing

Tendon deteriorated with no specific injury to start the process. 2 years of pain and lots of PT and one PRP injection (was pure hell) that didn't help and made it more sore. 2nd opinion finally and the surgeon recommended a 'strayer' procedure on my calf to lengthen the muscle and take the pressure off my tendon. That worked about 80%. I can walk now and if I over do it - it gets sore. But way better than before the surgery. My tendon has scar tissue on it but is working and I can function again.

I could write volumes about achilles tendinosis. I've had it off and on (bilaterally) for the better part of 18 years. It has been a significant limiter to my training and race participation over the years. I've spent $1,000's in wasted entry fees and canceled travel plans. Looking on the bright side, I've learned to think positively, to persevere, and most importantly not to take this sport too seriously. Anyhow, here's a summary of my experience:

July 4, 1997: pain started in left AT. After 4 months of physical therapy including all the standard stuff: rest, ultrasound, cross friction massage, iontophoresis I could run again at an acceptable level of pain.

1997-2006: fluctuating pain levels in both ATs. These nine years of running/cycling frequency dictated by pain levels. Saved hard/long runs mostly for race day. Tried just about every non-surgical remedy under the sun, multiple times. gazillion doctor visits, more physical therapy, MRI's, eccentric calf raises, pissed a lot of money on useless orthotics. I spent a significant amount of time researching tendinosis and discovered that most orthopedics and podiatrists really don't know what to do. I saw a dozen different doctors over this time period confirming this at least for me. You can confirm this as well: arm yourself with list of questions requiring concrete, detailed responses prior to visiting your doctor and watch them squirm for answers. (One supposedly world-renowned ankle reconstruction orthopedic didn't even attempt to find a solution, looking me straight in the eye instead and said nothing could be done; I should stop running and play golf)

July 2006: By this time, I couldn't run more than 10 feet. Left AT was a mess. After more research, I concluded that topaz microdebridement surgery might work for me. I flew from Fla where I was living at the time to Santa Monica, CA to have the procedure done by a podiatrist who appeared to have some success with procedure. Surgery required general anesthesia. Post surgery, non-weight bearing boot for 2 weeks, followed by weight bearing boot for another 4 weeks. I wasn't able to run for 7 months - long rehab period. However, after 7 months I was cured. No more pain. Unfortunately, soon afterward, my right AT became more of a limiter.

Nov 2009: Went back to Santa Monica for my right AT (now living in CA). Tried PRP. Fail.

Dec 2009: Topaz microdebridement on my right AT. I was a better patient this time so rehab was more like 5 months. However, this time I'd say the success was about 80%. A portion of the painful tendon didn't fully heal but was good enough to run somewhat unimpeded.

~2012: right AT getting more bothersome and hampered running.

~2013: MRI on right AT. Tendinosis confirmed. tried acupuncture, more PT, loads of eccentrics to no avail.

August 2014: pain in right AT (which had been pain free for 8 years) came on strong day after race. Now I have it in both legs again.

October 2014: went back to Santa Monica. Tried PRP twice in both legs over 8 week period. FAIL. In my view, PRP sucks and is a waste of time and $. I knew that before but, against my better judgement, allowed the doc to talk me into it. $1,500 down the tubes.

March 2015: Here's where it gets interesting, at least to me. After more research and internal reflection, I decided to go to the king of achilles tendons. So, I contacted Hakan Alfredson in Sweden (of the Alfredson eccentric protocol fame) and booked an appointment to see him.

March 28, 2015: Flew from CA to Umea, Sweden. Three days later, I was on the table and Prof. Alfredson was performing bilateral AT surgery (ultrasound+Doppler-guided mini-surgical scraping). It was under local anesthesia. I felt no pain. The surgery took about 1 hour and I got up from the table and walked back to my hotel room which was about 200 yrs from his office. By the way, nobody in the U.S. is doing this yet. And, it's been a successful procedures to the many professional athletes that travel from all over the world to see him. I flew home on 4/2.

April 4, 2015: Here it is less than a week after bilateral surgery and I am walking almost normally and with no pain. I can't believe it. The rehab procedure calls for me to begin light running in 5 to 7 weeks, and I am very hopeful that this works. Here's some info on his procedure:

http://omicsgroup.org/...ts-2165-7025-213.pdf

All the non-invasive PT treatments failed, although Graston temporarily felt great for few minutes right after the sessions ended.

PRP did zero for me other than HURT a real lot. Big needle, big platelets. Threw up about 5 minutes afterwards from the trauma (HTFU, I've heard it before). Not too expensive, maybe $500 cash out of pocket for the procedure. Health insurance covered the blood draws.

ESWT worked and repaired about 70% of the injury. Outpatient procedure under general anesthesia. Paid 100% cash out of pocket because it's experimental and not a covered procedure. Paid $3k cash. Totally worth it. It was really nice not being in pain just from walking. I think the Ossatron branded device is manufactured in the US, which is administered as a single treatment. The French machine requires 3 dosesx1 per week, to get the same effect. My podiatrist did not own the machine, so it became logistically too difficult to line up a second treatment. I could still use another round to clear all of the scar tissue.

I changed my diet and went mostly gluten-free and low carb. The lesser discomforts went away, which for me gets to about 95% injury repaired. Achilles tendinosis is not inflammation, but there was something going on involving diet and the affect on healing.

I'm still doing eccentric drops, but now just beginning to look a running again. But with a lot of focus on technique and form. I can run on the treadmill for a mile and have zero achilles issues.

I suffered an Achilles injury right after Boston Marathon this year...partial vertical tear. I tried a bunch of things for a few months (eccentrics, rest, prolotherapy, massage, etc.) with zero improvement (based on ultrasound of the tendon). Finally gave PRP a shot in mid August. I should note that it was incredibly painful. Felt markedly WORSE for a couple weeks after the injection, no anti-inflammatories allowed, but was told this is normal as that is part of the healing process. Resumed the heel drops afterwards and slowly improved. The tendon tear DID heal in about 8 weeks after the PRP treatment (based on ultrasound), but was still quite sore. The doc recommended EPAT, and I had 5 sessions of that. Started run-walking again in early October (after starting EPAT), very gradually building up the mileage...just did a 12 mile easy run this weekend as part of a 30mpw block. Not discomfort free but Id call it 85-90% better. I think the combination of PRP and EPAT was phenomenal for my situation.

If you don't have a tear, maybe give the EPAT a try first...it is relatively painless, quick, and no recovery period. The PRP is likely gonna set you back a bit before you get better.