Failure of PRP Tendon Injections: Achilles Tendonitis in a Rock Climber
Our practice is located in one of the rock climbing meccas of the world, close to Boulder, Colorado. As a result, we see a good number of climbers with many different chronic problems including climber’s elbow and hand injuries. YSL is a twenty something rock climber who hadn’t climbed in two years due to chronic Achilles tendonitis whose case I’d like to highlight because of what was missed and as a result, what didn’t work. He had multiple issues that caused him to stop climbing, but his Achilles tendon pain was the biggest thing keeping him from returning to climbing or running. He ultimately saw another provider in an orthopedic practice for PRP (platelet rich plasma) injections into the Achilles tendons, which after 5-6 tries gave him some relief, but he was still unable to run or work out at high levels. He had seen multiple physicians who were all concentrating on the area where he hurt and had gotten surgical opinions from surgeons who wanted to treat these areas with a surgical tenotomy (usually cutting small grooves into the tendons to get them to heal). When he was first evaluated a few months ago, what struck me was his description of “numbness” in the back of his Achilles and heel areas. Since a patient with garden variety Achilles tendonitis shouldn’t have numbness, but more soreness or pain in the back of the heel, this made me suspicious that something had gone undiagnosed. His exam showed decreased sensation in the nerve areas that come from the lowest part of the low back, so we ordered an MRI of this area. This showed disc bulging at two lumbar discs, which matched up with his exam. Since the S1 nerves in the back can cause numbness and pain in the Achilles tendons, calves, and heels-we likely had our culprit. We then proceeded to perform a Regenexx-PL-Disc procedure to help reduce swelling and improve healing around the affected nerves and discs. When I evaluated him this week, despite the fact that we hadn’t treated his Achilles or feet, his heels and his Achilles tendons were feeling much better. Why? Again, the S1 nerves from the back travel past the bulged L5-S1 disc and were being irritated by the disc bulge. These nerves go to the areas of the heel, Achilles, and feet where he had pain and numbness. Rather than spend time looking for the cause of the pain, his care to date had focused on his heels and feet, which hurt. While injecting PRP in his heels and Achilles tendons helped a bit, since the real problem was an irritated nerve in the back, injecting his Achilles tendonitis with PRP was never going to solve the problem. I will continue to follow YSL and hopefully we’ll be able to get him back to climbing by focusing on treatment of the cause of his problems, rather than a symptoms.