Still Fighting It

Another doctor's appointment, another update.  Dr. Nicola decided that we should do one more session of prolotherapy, as I still have some tenderness in the area of my Achilles.  I was able to discuss the injury with Dr. Nicola again to try to get a better handle on exactly what's happening, just for my own understanding more than anything else.

Basically, in a very specific, small area—where the initial impact from a bike pedal, which caused this injury, occurred—the tissue is stuck in chronic inflammation.  As Dr. Nicola explained, a normal inflammation process, essential to healing, goes through several stages.  Starting with acute inflammation, the body normally cycles through these stages, marked by different proteins /growth factors/ etc. in the blood, until the tissue matures and is normal again.  My problem is that I'm stuck somewhere in the middle.  

The idea behind the prolotherapy is to get me out of this chronic inflammation.  The diluted dextrose/lidocaine solution causes some cells near the site of the injection to burst, which releases some chemicals that initiate a new acute inflammatory process.  As I understand it (and, as always, this is just my lay understanding from our conversation), if the prolo works like it's supposed to, this new healing process will progress and complete like a normal inflammatory response, and in the process, bring the chronic inflammatory process to maturation as well.

So what that means for me right now, is that I've got about another 3+ weeks until my next appointment, with the following training/therapy protocol.  First, a day completely off (today).  Then I do 7 days of cycling for exercise, along with my normal GS/core work (including eccentric loading of the calf), ice 2x daily, and self massage.  Then I have 3 days of uphill treadmill walking, while continuing all those other things (including the bike).  Then I add running every other day, building up from 2 miles, adding a mile at a time.  So my next appointment is October 23, and I should be running 8 or 9 miles by then, and we'll have a good idea of where we stand then.


  1. Sorry you are still dealing with this. So am I...ugh. Going on 15 months now. What's worse is my latest prolo session (full blood injection done by my MD) left me with a nodule on the tendon. Suck. This is my latest protocol:

    4 x per week - 4x10 eccentric drops, building up sets. I have tried progressing int he weighted ones a few times but they always seem to do more harm than good. I've also tried every day as most eccentric protocols recommend but it doesn't make sense to me. When you weight train you take time off to recover - right? Why not with tendons. So I only do the drops on days when I lift.

    Light running when able. Not sure if this helps or hurts, but I've been trying to run when the achilles feels like it can deal with it.

    Daily icing by sticking an ice pack in my sock, ice cup, and sometimes dipping into ice bucket. I really dig into that nodule with the ice cup to try and break it up.

    Self ART with a golf ball in my calves.

    Nightly I sleep with my foot in a foot splint with a heat pad in there.

    I also just bought a brace and will be wearing it during most waking hours to try and take any stress off of it while not exercising. I would just take every day but it's a pain in the ass. If the brace doesn't work, that's what I'll do.

    I'm going to see a new sports med guy too. The guy I'm going to see is big into prolo...which I've already had like 5 sessions of. So we'll see what he has to say.

  2. Been a bit touch and go with running the last week. It's seemingly a bit better, I can run essentially pain free at points, but it's up and down. So kind of going by feel at the moment, waiting until my next doc's appointment on the 23rd (Tuesday), so we can discuss. Before the most recent encouraging runs, I was ready to throw in the towel on prolo, didn't think it was working for me. But now I think I've seen some progress with it; so I'd be willing to entertain the idea of another session of it to see if it can help more. But I'm also not 100% convinced that that's the right course of action. I'd like to discuss how else chronic inflammation in that area might be treated. So we'll see on Tuesday.

    Thanks also for posting your routine; always good to pool knowledge. Sorry you're dealing with this stuff as well. Hopefully we'll both come out of it eventually.

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