Question from W. Bastendorf: In winter, I contracted painful Achilles tendinitis in both legs while jogging. My GP injected me with a herbal preparation, which alleviated the pain. This was followed by laser therapy, infrared treatment and photochemotherapy. I also stretched my tendons, but this didn't have the desired effect. When I cycle, I get pain after about 30 kilometres, which gets progressively worse. Should I treat the pain with cortisone or could the tendon then rupture? What treatments do you recommend?
Dr Merkl advises: In cycling, concentric muscle actions (muscle tensing and shortening) carry out the power transmission, in jogging so-called eccentric (shortened, tensed muscle is pulled apart in the landing phase). The eccentric load in particular (cyclists switch to jogging in winter) quickly overloads the tendon and ligament apparatus, as the highly trained organism overstrains the tendon systems that are slow to metabolise. Inferior material replaces the elastic connective tissue of the tendons, which leads to irritation. If the pain is suppressed, the process drags on. The most important form of therapy is to reduce the load, otherwise there is a risk of a long ban on sport! All other attempts such as injections of herbal substances, measures to stimulate blood circulation, physical treatments (heat, cold, etc.), physiotherapy, acupuncture, shock wave therapy, heel elevation are only flanking measures. Cortisone should only be injected around the tendon and not into the ligament. Multiple injections favour the not uncommon spontaneous rupture of the Achilles tendon during normal exertion. Less training and relaxed pedalling until everything is completely healed is the most important therapy.
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