I was surfing around the web a bit and came across Dr. Stephen M. Pribut’s Sport Pages.
I don’t have a lot good to say about how most doctors deal with tendonitis (generally not even calling the condition by its proper name), but here’s one who does at least gets that part right. On his page, Dr. Pribut has this to say about Achilles tendonitis (the emphasis is mine):
While the term that most people use and that most individuals will search for on the web is “tendonitis”, most Achilles tendon problems could better be called a tendinopathy and more specifically a tendinosis and are a non-inflammatory problem of the tendon. Inflammatory cells are not found on microscopic examination.
So for all the people who think that I’m blowing smoke, here is a gen-u-ine MD saying exactly the same thing. It’s enough to make me weep.
Of course, the good doctor then goes on to prescribe more or less the usual treatment, including ice massage and NSAIDs. If he realizes that “tendonitis” is not really tendonitis (i.e., not inflammation) but tendonosis (degeneration of the tendon), this is a little hard to understand, as both ice and NSAIDs are for, um… inflammation. Maybe he’s worried about getting sued for malpractice if he doesn’t toe the party line, maybe he’s just covering his bases. Or maybe it’s because he hasn’t taken a look at any research later than 2002, as is shown by the references at the bottom of his page. (At least he has references, which is better than most other websites.)
At this time there are few significant clinical studies with valid results for treatment. There is often disagreement on approach and much is likely to be changed in the future. At this point treatment and treatment recommendations for this problem remain an art practiced with varying degrees of success. When evaluating new research, it is hard to recommend major paradigm changes in thought and recommendations based on studies of fewer then 20 cases or even 50 cases.
Actually, a quick search on PubMed will show that there have been more than 100 well-designed studies on various treatments for all kinds of tendonopathy in the past decade or so. If you’re having problems with your tendons, you can go spend a few weeks wading through all of that research yourself… or you could just buy my book on tendon pain, which is 34 pages of easy-to-understand English and will show you exactly what to do to fix your problem. 😉