Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings.
Aström, M., Rausing, A. Clin. Orthop. 1995. Jul;(316):151-64
163 patients with chronic Achilles tendinopathy, 75% of whom were athletes, underwent biopsy of the painful tendon. Degenerative changes (tendinosis) characterized by abnormal fiber
structure, focal hypercellularity, and vascular proliferation were
noted in 90% of biopsy specimens. Fibrinogen was identified in most and partial tendon ruptures occurred in 19%. Increasing age and male gender were associated with more pronounced microscopical pathology.
Important features were a lack of inflammatory cells and a poor healing response.
Dr. Chris Reynolds notes:
To me, the last sentence reveals the most important findings of this study. "itis" means inflammation, but this did not appear to exist in these patients and the healing mechanism was poor. If there is no inflammation, then what is the cause of the individual's pain which can often last for months or even years?
To me, it suggests a reduced immune response or immunosuppression, possibly due to increased natural steroid levels resulting from prolonged physical and/or psychological stress. I believe autoimmunity is the underlying cause of many such disorders and physical activity simply an aggravating factor.
Wheatgrass is a natural immunomodulator that has helped many patients recover from Achilles tendonitis and related conditions.
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