When Achilles tendon pain persists, each staircase can be a reminder that rest alone is not always enough. In this context, an injection around the tendon may seem to be the gesture that will “unblock” the situation, especially when running, brisk walking or sports become difficult.
An essay published in The BMJ however, calls for caution. In 192 adults suffering from persistent tendinopathy of the middle portion of the Achilles tendon, large-volume injections did not show a clear difference in pain and discomfort at 12 months compared to a placebo injection, called sham.
What was this injection really testing around the tendon?
The trial, called INJECT, compared injections of saline and local anesthetic around the tendon, with or without hydrocortisone, to a low-volume placebo injection with local anesthetic. This detail matters: it was not a question of a total absence of gesturebut from a comparison with a control procedure.
All participants also received advice and an exercise program. In other words, the injections were not tested against “nothing”, but in addition to active treatment. To place this treatment within the usual bases of care and exercises for the Achilles tendon, the progression of loads remains a central point.
The primary endpoint was pain and disability, measured at 52 weeks by a standardized scale (the VISA-A score). Result : large volume injections did not provide clearly superior lasting improvement to the placebo injection in this specific population.
Why doesn’t quick relief solve the whole problem?
The researchers reported a more nuanced signal with the addition of hydrocortisone: some participants experienced a small short-term benefit. But this improvement was not maintained after one year. This is an important distinction, because a gesture can help occasionally without lastingly modifying the course of the tendinopathy.
Feeling better quickly does not necessarily mean that the tendinopathy is permanently improved.. For a person who is looking to return to running or physical work, this nuance changes the discussion: the objective is not only to have less pain for a few weeks, but to regain reliable capacity, without skipping steps.
The study does not, however, allow us to condemn all infiltrations. It concerns Achilles tendinopathy of the middle portion and large volume injections according to a given protocol. It does not concern tendon ruptures, nor all heel pain, nor all infiltrations performed for other tendons or other indications.
What should you ask before considering this gesture?
For patients, the useful message is less dramatic than it seems: an injection should not be presented as an automatically lasting solution. Before considering it, it is better to ask what you can reasonably expect: temporary relief, help to continue the exercises, or a proven long-term benefit in your specific case.
This discussion can be done with the attending physician, sports doctor, rheumatologist or physiotherapist. It joins a broader evolution in treatment: why an infiltration does not always replace exercises depends on the tendon, the duration of the symptoms and the treatments already tried.
The essay also doesn’t say to stay still. Exercises were part of the treatment in all groups. In Achilles tendinopathy, the challenge is often to gradually readjust the tendon to the constraints: walking, stairs, running, jumping, depending on the pain and the starting level.
The strategy is therefore tailor-made. It may include temporary adaptation of activity, progressive exercises, advice on training loads or shoes, and sometimes other options discussed on a case-by-case basis. To place this pain in the treatment of tendinopathy, clinical evaluation remains essential.
If the pain persists despite several weeks of treatment, the point of vigilance is there: do not decide on an injection alone, but do not abandon rehabilitation either. The right benchmark to ask the caregiver is simple: what benefit is expected, within what time frame, with what limit if the objective is to resume activities sustainably?