How Acupuncture Helps Heal Achilles Tendon Injuries
An Achilles tendon injury can be a huge drag. Chronic pain, stiffness and loss of function can be limiting, stressful and incredibly frustrating. Many folks carry on with symptoms, unaware orthopedic acupuncture treatments can eliminate pain and restore function. A recent review found acupuncture delivers results superior to eccentric exercises alone and comparable to cortisone therapy and eccentric exercises combined.¹ In this article, we’ll discuss why orthopedic acupuncture can deliver phenomenal results and the importance of getting on board with an exercise rehabilitation program.
How Achilles Tendon Injuries Happen
The vast majority of Achilles injuries result from overuse. They frequently occur in athletes who engage in sports involving running and jumping, but they can also plague walkers and hikers. Occasionally, forceful jumping or pivoting can result in a more serious injury such as a rupture (tear) but most Achilles injuries are insidious and worsen over time. Up until recently, most Achilles injuries were being categorized as tendinitis. But modern orthopedic research is finding this is often a misnomer.²
Types of Achilles Tendon Injuries
The term tendinitis is becoming increasingly discouraged because it implies an acute, inflammatory state. Instead, most Achilles injuries are chronic and degenerative in nature, falling under the category of tendinopathy. Tendinopathy is a degenerative condition that occurs when the tendon is repeatedly stressed beyond its maximal load. Hallmarks of Achilles tendinopathy are pain, stiffness, weakness and loss of function. The tendon itself may become thickened (tendinosis) and make a cracking or popping sound when moving the foot. This is reflected on a cellular level as a loss of normal collagen and tissue organization, neovascularization (growth of new blood vessels) and infiltration of proteoglycans (proteins that help tendons resist compressional forces).²⁻⁴ These structural changes are the body’s attempt to stabilize and repair the over-loaded tendon but create stiffness and restriction of movement.
In addition to tendinopathy, an Achilles injury may involve partial or complete rupture (tearing) of the tendon. Of all the tendons in the body, the Achilles is most vulnerable to rupture. While it is typically a sports-related injury, rupture can result from any type of spontaneous physical movement. Pre-existing tendinopathy may also precede Achilles tendon rupture as it involves an inherent weakening of the tendon. This underscores the importance of addressing Achilles tendinopathy in a timely manner. Additional risk factors for rupture include multiple cortisone injections and recent fluoroquinolone antibiotic use.² These have both been shown to cause structural changes that make the tendon more vulnerable to rupture. Achilles rupture often involves longer and more involved treatment than tendinopathy. Depending on the location and degree of rupture, age and health history, surgery may or may not be warranted.
Prognosis of Achilles Tendon Injuries
In addition to injury severity, there is one major factor influencing prognosis of Achilles injuries: location. Achilles injuries can occur in the mid-portion of the tendon (most common) or the insertional region where the tendon attaches to the calcaneal bone (less common).
Insertional vs. midportion region of the Achilles tendon.
Mid-portion Achilles injuries generally respond well to treatment. Insertional Achilles injuries are notoriously more difficult to treat. This is because insertional injuries occur right at the bone-tendon junction and can involve other structural issues including irritation of the retrocalcaneal bursa and/or bony deformities of the calcaneus (i.e. Hagland’s deformity).² Treatment of insertional Achilles tendinopathy is certainly not a lost cause; however, these injuries are typically slower to heal and are more likely to be recalcitrant to treatment.
Why Orthopedic Acupuncture Helps
Acupuncture offers an effective and often untapped avenue of care for chronic pain and Achilles injuries. In a recent meta-analysis,¹ acupuncture was shown to be more effective than eccentric exercises alone and equally as effective as cortisone injections in conjunction with eccentric exercises for treating Achilles injuries. It is a great alternative to cortisone injections because habitual steroid shots may create structural changes over time that may increase risk for rupture.
Orthopedic acupuncture involves gently and precisely placing needles very near to the thin outer layer of connective tissue of the Achilles. This mobilizes the body’s innate healing resources directly to the area of injury. Essentially, acupuncture works by stimulating the release of anti-inflammatory, tissue healing, circulation enhancing and pain-relieving neurochemicals right at the source. These healing agents work locally to mend the injured area of the Achilles. One of the unique advantages of acupuncture is that the needles can be placed at the hard-to-reach anterior surface of the Achilles tendon (the part that is deep to the body). This is why acupuncture can be so effective in addressing injury to the deepest aspects of the tendon.
Electroacupuncture is frequently used during treatment to produce maximal therapeutic results. This involves running a gentle electrical current between paired needles which penetrates the surrounding tissues. This allows the treatment to impact the injured area more globally. Electroacupuncture has also been shown to amplify the release of healing neurochemicals. As intense as it may sound, electroacupuncture is designed to feel quite gentle and is experienced as a localized sensation of light tapping or pulsating.
One question we get asked frequently is how many treatments it will take to see results. While this number may vary based on a variety of factors, including the severity and chronicity of injury, we typically recommend a course of six, weekly visits.
Importance of Exercise Rehabilitation Program
In addition to acupuncture, exercise rehabilitation is a key component for healing any type of Achilles injury. Research¹,² shows it consistently outperforms the ‘wait-and-see approach’ and is necessary to promote tendon healing. This is because appropriately loading the tendon with well-targeted exercises is critical for helping the injured tendon remodel and reversing degenerative changes. In addition to acupuncture, we recommend working with skilled physical therapist as part of a comprehensive recovery plan for maximal results.
Ready to get back on your feet? Contact us or book an appointment today to address your chronic pain with acupuncture.
1. Rhim HC, Kim MS, Choi S, Tenforde AS. Comparative Efficacy and Tolerability of Nonsurgical Therapies for the Treatment of Midportion Achilles Tendinopathy: A Systematic Review With Network Meta-analysis. Orthop J Sports Med. Jul 2020;8(7):2325967120930567. doi:10.1177/2325967120930567
2. Silbernagel KG, Hanlon S, Sprague A. Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. J Athl Train. May 2020;55(5):438-447. doi:10.4085/1062-6050-356-19
3. Yanagishita M. Function of proteoglycans in the extracellular matrix. Acta Pathol Jpn. Jun 1993;43(6):283-93. doi:10.1111/j.1440-1827.1993.tb02569.x
4. Jarvinen TA. Neovascularisation in tendinopathy: from eradication to stabilisation? Br J Sports Med. Jan 2020;54(1):1-2. doi:10.1136/bjsports-2019-100608