How can you really tell the difference between tendonitis and tendinosis? What’s the practical difference? How does the rehab for the two differ, if at all? When can you start trying to rehab, e.g., when you can walk pain free, when there is absolutely no swelling, when the swelling doesn’t get any worse with stretching?
I assume you have had this checked out by either a MD, DO or P.T. IF not you should because there are differences in rehab based on the mechanism of injury and what your training needs are at this point. When I see a patient with an achilles injury, I use the pool and a lot of manual therapy with some kinesiotape (like the kind the beach volleyball girls wore this summer). But don’t just do it on your own and wait till the pain is better with stretching and just try and ramp back up the training because this could be something that causes you chronic problems during your season.
I haven’t gotten it checked out . . . yet. It reared its ugly head about 6 weeks ago, and at first I wasn’t sure what it was because the pain didn’t really seem to be in the achilles (it was more in the heel), so I ran on and off on it for a couple of weeks, but then I had noticable swelling in the achilles. At that point I shut down the running completely and took a week off. After the week off, I then tried some light running for three days (a couple of miles a day two days and three miles one day), but it was still sore, so I’m still in shut down mode (it’s been two weeks with zero running) and there still seems to be some slight swelling. I’ve been biking all along because it doesn’t seem to aggravate it at all.
How can you tell? diagnostic ultrasound or MRI for one. Or, if you can palpate or feel a goose egg along the achilles, you are obviously past “tendonitis” and on to tendinosis (a bad thing).
A good, simple history and physical and exam generally is enough by a competent clinician with the above mentioned imaging modalities if unsure or not responding.
Mike
At this point, get to a good physical therapist. They will be able not only diagnose the problem, but tell you the cause. An MRI of tendinosis, tendonitis, or peritendonitis is nice, but honestly much of the treatment is the same. But the most important aspect is the WHY!
As ortho MD might tel you the problem, they rarely take the time to find the why. A good PT will not only start treatment, but make sure the problem (like decreased weightbearing on the opposite leg, toe running, decreased rearfoot mobility, and poor hip extension) is fixed. And correcting the problem AND decreasing the pain is KEY.
Take the time, dont get frustrated with the time it takes, and do your exercises…and you will have the best success.
Good Luck.
Thanks for the advice. I actually just got back from seeing my primary care physician and have a referral to an ortho. in hand. I’ll see what has to say and go from there. Again, thanks for the input.
I injured my AT last July running barefoot on the beach. I began seeing a podiatrist who is a seasoned runner and takes care of numerous athletes including the local University track team. The doc took x-rays to see if there were any underlying bone or foot issues, there were none.
I began PT in mid October and was allowed to begin walking distance in January. I have been building up slowly with very short run segments. The doc also ordered orthodics for me to wear. I have a high arch and we feel that part of the underlying cause of the problem may be that the arch is collaping during the run. So far, the orthodics seem to be helping and as a plus make me stand taller with better posture. 
I still have a slight knot or area of scar tissue just above the heel, but with PT massage and treatment this is beginning to dissipate. The doc told me that the knot or goose egg of scar tissue might take up to 4 months to go away. Don’t know if that is true, but is now half it’s size since Jan 1.
I ice everytime I walk/run even though I have had no pain and continue to do calf raises on the tread of a stair. Takes a long time but I am cautiously optimistic.