A Personal Experience with Regenerative Treatment and Chronic Injury
***Disclaimer: This post is not necessarily medical advice, and you should contact your doctor for specific medical advice matching your individual needs.**
The past 8 years, I have been dealing with a chronic injury that comes and goes. Over the past year it has gotten progressively worse and I came to the conclusion that if running is something that I want to continue to do consistently the rest of my life I need to address these issues and heal. This blog post will detail out my history with this injury and the treatment itself, concluding with my opinion on the effectiveness of the treatments.
I have always known myself to be a runner. From participating in the district mile run in 4th-6th grade to winning my first cross country meet in 8th grade in a dramatic come from behind kick, it has been my passion. The fire and drive really began in winter of 2008, setting out with the goal to break 5 minutes in the mile. I remember training diligently that winter - wheeling out every 400m split around my neighborhood and putting in long, hilly weekly runs once a week and tracking every mile of it on a calendar. That winter I learned to enjoy the process of training and thankfully was able to reap the rewards, running 4:56 that spring. The process and day to day work that this sport requires is something I have never stopped enjoying and the reason I’m still getting after it today. From there I enjoyed a consistent high school career where in hindsight lacked high end aerobic development but was able to consistently improve to a level that allowed me to run in college (16:18 for 5k, 10:12 for 2 miles, 4:40 for the mile)
In fall of 2013 I packed my bags and made the move down to Colorado Springs to run at UCCS, a highly competitive NCAA Division 2 school. I trained extremely hard through the summer of 2013, hoping it would be enough to not embarrass myself that fall. Fortunately, the freshmen class (including Jarrett Eller, Forrest Hough, Derek Tao and others) that year all showed up on the first day of practice fit from putting in similar work. We found ourselves not the best on the team but certainly competitive enough for it to be encouraging for our futures. It was a fun fall of pushing each other and learning how collegiate running works. Similar to the winter of 2008, I left that season motivated and determined to train harder than ever to make that next fitness jump.
That spring I had the chance to travel down to Mesa, Arizona with my Dad over spring break to visit my Grandparents. I decided I might as well find a sea level 5k to hop into to test my fitness. I signed up for a night 5k at Paradise Valley Community College, threw on my spikes and ran my first track 5k. The race was competitive but nothing crazy (the winner ran a low 15 minute time) and I ended up running 16:30, which was a decent first showing. The next day, I decided to run a medium long run around the park, and that is when I noticed pain in my Achilles tendon. It progressively worsened to a point that I could not continue running. Every time I tried to run again that spring, it resulted in the pain worsening. It turned out that I had partially tore the achilles on my left foot. I cross trained hard that summer but it still took a long time to get back. When I began running again in late July, the pain was still present but I pushed through it, leading to poor mechanics and developing compensation patterns that have stuck with me to today. My body has always felt “off” since that summer and in hindsight I know that it is because of the poor mechanics I developed while compensating, trying to just get back in time to have a cross country season that fall.
For the next couple years, I would get periodic tendon injuries in my ankles due to these poor mechanics. Eventually I stopped getting the major injuries because I learned how to “manage” the pain. After every hard session my ankles would become painful and I could barely walk let alone run properly the next day. I have learned ways to cope and get by but the training has certainly never been optimal. There have been good stretches with little pain and rough stretches where I can hardly run, but it has always been present at some level.
2020 was what I consider my best year in running. I logged the most miles in a year (3,000 miles), was in half marathon PR shape in the spring (no races due to COVID), and then got in the best overall competitive shape of my life in the fall concluding with a 21:13 4-mile time trial at 5,000ft and an essentially solo 16:08 5k on the track. Beginning in March 2021, the state of my body started progressing downhill. I was able to get by until the fall. I would have a couple good weeks, develop pain in my Achilles tendon that was so bad I could barely walk after a long run or workout, take a few weeks to heal, and then repeat that process again. The low point came in February 2022 when I competed in an EAT indoor mile time trial, running 5:06 (4:53 converted). In my state of poor fitness, my feet hurt so bad afterwards that I could not even walk to go hangout with my friends in the evening. I decided that was time to seek treatment.
I went to see a Regenerative Sports Medicine facility. At the first visit, I received x-rays and an ultrasound of both ankles. I was diagnosed with insertional achilles tendinopathy, which is characterized as degenerative changes inside the insertion of the Achilles tendon at the heel. The left Achilles tendon was so bad that the doctor said if I did not stop running and get some type of treatment he would be concerned about it rupturing soon. He prescribed a 4 week aggressive treatment plan with two injections and a series of interim therapy.
The first injection to initiate treatment was prolotherapy. This involves injecting a sugar/saline substance into your tendon where it purposefully inflames it and acts as an irritant. Your immune system recognizes the irritant and initiates a healing response in that area. This procedure caused a massive inflammation in my ankle about 5 hours post injection. It was so inflamed it hurt laying in bed, but went away quickly after one day of pain.
The second injection in week 3 was an extracellular matrix injection. “Chondrocytes are cells that are the building blocks of cartilage. Imagine a brick wall is your achilles that has holes in it. Our body calls the chondrocytes to the area where the wall needs to be patched. The chondrocytes are the bricks. The bricks are useless without mortar to hold them in place. So the chondrocytes secrete an extracellular matrix, their own mortar” (Hauser, Caring Medical). This injection signals to the tendon that there are healing capabilities available and provides the means to bring in the necessary processes to heal the tendon. This procedure really messed me up. Not only was the procedure itself extremely painful, but unlike the prolotherapy, this one caused a tighter, more vague pain and seemed to really weaken the entire ankle. It was difficult to push off when walking and any eccentric loading such as going down stairs was out of the question for at least a week post treatment.
In between injections I received therapy from a few different specialized machines. The first machine used was a Winback machine, which helps relieve pain by blocking the nerve impulses. This provided a heating sensation which would get the blood moving in the area. After that, low-level laser light therapy was used to promote tissue healing in the tendons. Finally, there was the Piezoelectric impulse therapy. This machine sends pulses into the tendons and assists with removing built up scar tissue, which although painful at times resulted in a more smooth feeling in the ankles when walking around post treatment.
Racing in an Elmwood Athletics Team kit in the winter of 2021. Here’s hoping that I’ll be able to put on a kit again soon to compete.
Recently I have concluded the injection and machine portion of the therapy and have entered the rehabilitation phase. I am working hard to strengthen the tendons in the ankle as well as the calf, gluteus medius and right hamstring muscles. I am working hard doing 45 minutes worth of exercises twice a day outside of lifting three times per week and biking 3-4 times per week to stay fit right now. I have seen progress in the last week and am hopeful things will continue to progress.
Stay tuned for the next part of my rehabilitation!
References
Caring Medical. Ross Hauser. 2022. https://www.caringmedical.com/prolotherapy-news/extracellular-matrix-osteoarthritis-joint-healing/
Chimenti RL, Cychosz CC, Hall MM, Phisitkul P. Current Concepts Review Update: Insertional Achilles Tendinopathy. Foot & Ankle International. 2017;38(10):1160-1169. doi:10.1177/1071100717723127
