So here is the awkward thing about being diagnosed with persistent ankle tendonitis or any other kind of persistent tendonitis for that matter….. science has essentially proven that it doesn’t exist. Bear with me here! Much like the classic earth isn’t flat discovery of old we now know that persistent ankle tendonitis was little more than an assumption based on appearances … an assumption that has been blown out of the scientific water.
There is solid scientific data that shows very clearly that persistent tendon pains like the ones we often get long after an ankle sprain are underpinned by ‘cartilage damage’ and ‘soft tissue thickening’. When we look under the microscope at tendon pain the role of inflammation (tendonitis) is either very transient or completely non existent.
These discoveries have given way to new and more careful choice of wording by researchers and professionals who are interested in keeping up to date.
The old out of date diagnosis was Ankle Tendonitis – inflammation of a tendon. Rarely seen, even after ankle sprains and appearing to be essentially nothing to do with stubborn pains in the ankle. A possible cause of temporary pain after an injury.
The new and improved diagnosis is Ankle Tendinosis – microscopic degenerative changes in the collagen cells of the ankle tendons. Basically this what causes stubborn tendon pain and it’s a kind of microscopic wear and tear.
If you have stubborn ankle tendon pain it’s very likely you have tendinosis. Although of course you can’t accurately and safely diagnose yourself here on google so seek professional advice !!
Ankle tendon pain is not caused by inflammation. Under the microscope what we actually see is degenerated cartilage and disorganised attempts at healing of the tendon, but there are no inflammatory cells.
The good and perhaps most important news is that regardless of what the exact nerdy classification is of your ankle pain there is much that can be done to relieve and treat it.
One of the cornerstones of successful treatment of stubborn ankle tendon pains is to go even deeper than this understanding of ‘ankle tendonitis’ and ‘ankle tendinosis’. This means understanding that the changes in the tendon are merely a symptom of something much bigger and more significant… ‘Mechanical Overloading’ of the tendon.
Mechanical stress caused by some imbalance, old ankle sprains, some weakness or some overuse process. Whatever the nature is of this overloading of the tissue, it is that which is the true diagnosis.
Mechanical Overloading is the ‘virus’ .. ankle tendinosis is merely the ‘cough’ or the ‘sneeze’. Changes within the tendon are a symptom of mechanical issues !!!!!
Setting aside ankle tendonitis, ankle tendinosis, ‘to-may-toe & to-mar-toe .. getting stuck into and resolving the underlying causes of ankle strain and ankle pain will always be king of the castle.
A practical point for those of you who have suffered with ankle sprains in your lifetime and perhaps now have ankle pain a recurrent mini-sprains. Many of those of us who have a sprained ankle at the root of out ankle issues have ankle tendonosis (and similar ligamentous changes) that was ‘set up’ by the initial sprain. This equation (‘tendonosis’ coming from an ankle sprain) is basically caused by a need for rehabilitation. Rehabilitation of old niggly or weak ankles that cause pain can resolve the tendonosis and equivalent changes and should then focus more on the strength dimension of the ankles supporting muscles.