i got PRP for my achilles 8 days ago. my doctor did not send me home with any kind of rehab protocol as she just said - first week in a boot, 2nd week start swimming, walking and eccentrics, third week try to run. from all my searching on the net, i find this quite different from what others have done for rehab. the polar opposite in fact.
has anyone had PRP on their achilles and could help me with the post=injection rehab. i was in a boot for the first week and my achilles now is very very tight and cannot not really even do a heel raise. the original achilles pain is still there but before the injection i was able to do tons of heel raises.
i am afraid to do anything too soon and ruin the platelet injection but don’t want to do nothing - i want to help with theh ealing process.
thanks in advance.
I had PRP on my Achilles in 2009. Your protocol sounds roughly the same as what my doc had planned for me. Unfortunately, I developed a blood clot in my calf the week after the PRP (not related) and I was out of the boot unless than a week.
I had some immediate, significant improvement from the PRP…but responses seem to vary. Some people require multiple treatments.
I would err on the side of caution before getting to aggressive in your therapy, especially at this time of the year.
Remember what the PRP injection is trying to accomplish - take a chronic condition (i.e. Achilles tendinosis, paratendinosis) and make it acute again so your body can heal it. This isn’t likely going to happen in 3 weeks, though it depends on what exact pathology is being treated, how long, etc. The Achilles is of course notoriously slow to heal and I usually tell patients to figure about 100 days for a good turnover time no matter what is done (whether I’m repairing a complete rupture to a case of chronic tendinosis).
I do perform PRP injections, but I’m not seeing great results with chronic Achilles tendinosis. If I had failed all other typical conservative therapy (i.e. aggressive gastroc/soleus deep tissue massage/ART, eccentric heel drops/weighted, icing/deep heat, etc.) I’d probably have it done on myself since no real downsides. Unfortunately, studies mostly only show time and eccentric heel drops to be the most successful with all kinds of anecdotes for everything else under the sun for treatment (prolotherapy, accupuncture, healing crystal, witch doctor).
thanks RRoof. it’s been 8 days and of course i was not expecting a miracle. my question basically is what do you recommend for post-injection rehab, if anything. i am afraid to start the eccentrics (though i did try) – they hurt and i don’t want to ruin anything. this was big bucks!!! is there anything you could tell me to do so that i don’t mess that up - i.e., when to start eccentric strengthening, stretching. could i swim and not push off the wall?, bike? i am totally in the dark here.
It depends a bit on your initial pathlogy - bit of a difference between achilles tendonitis, tendinosis, paratenon issues, longitudinal tears, etc. Also, I find PRP injection(s) work best if up near the watershed area (about 1.5 inches up from the insertion) rather than down near the insertion (posterior heel pain).
Normally, tendonitis issues (which in theory you now are after the PRP injection) I prefer immobilization vs. treating tendinosis type issues, where immobilization isn’t desirable at all. I don’t now where on the timeline of your achilles issue you are and some treating physicians are more aggressive than others with PRP, so can’t really make any recs. Always have to defer to the treating doc. But in general, I have patients in a CAM boot at least 2 weeks, avoid any ice and especially oral NSAIDs like ibuprofen, Alleve, etc. for 4-6 weeks. Transition to NWB posterior calf stretching therapy at about 2 weeks, eccentrics only when ready at about 4-6 weeks out. No way would I have someone trying to run in 3 weeks. Nothing is that magical ;-(
thanks for your help. this is a chronic tendonosis beginning in april but something i was plagued with in 2009, 2010 and now 2012. mri said mild tendonosis and ortho said there was more good tissue than bad. to date (injury began in july) i have done dry needling, ART, graston, 3 weeks in boot, then followed the boot with 10 PT sessions. in september i started to run again because i was frustrated. i had low grade pain while running and got up to 8 miles. the last run i did, my achilles got very acute again. i already made my appt. for the PRP so the injection came just in time. so basically the PRP was my last resort.
i can stay in the boot - do you think i can swim w/o pushing off the wall or maybe sit on a bike? (wishing)
sounds like from your experience with PRP i am in for a chronic achilles for the long haul. i really am not sure if there is anything left to do.
I’d stay in your boot a bit longer than, esp this time of year. I’m acutely in tune with type-A athletes, but some downtime around the holidays (sorry if I’m assuming religious beliefs) is actually good timing. I’d swim, but just drag a pull buoy around. Obviously don’t push off/flip turn. Don’t even spin on a trainer the first 2 weeks, but you can likely do that after the boot is off - spinning easy. No standing/mashing/FTP work. That should be enough to keep you somewhat sane for a few weeks
But most important of all since this has been on/off for 3 years now is to figure out what biomechanical or poor training issues are causing this.
I tore (not ruptured) my achilles about a year ago, I had PRP on Oct 1st, and had intense PT for three months. In Nov. I started running on an Alter G tread mill 2x per week for about a month. I started at 50 % wt. and worked up to 85 %. I was biking and swimming ( no push offs ), a couple of weeks after the injection. Not hard just doing it to keep active. I ran one mile in Jan, 2012, regular TM, and did my first Olymp Tri in April. During the year I did four Olympics, and two 70.3’ s including the worlds . While I didn’t do any thing stupid, I had no problems.
