Hyaluronic acid for Achilles tendon pain

THE INJECTION SERIES:

• Achilles tendonitis injection overview

• Why corticosteroid injections may not be a good treatment option for Achilles tendinopathy

• High Volume Injections as treatment for Achilles tendinopathy

• PRP injections for Achilles tendinopathy

• Hyaluronic acid for Achilles tendon pain (this article)

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A hyaluronic acid injection might help to relieve your Achilles tendon pain. In this article, I explain what hyaluronic acid (also known as hyaluronan) is, take a look at initial research into its pain reducing qualities for tendons, and caution against seeing the injection as a silver bullet for getting your Achilles injury to heal. Remember, if you need help with an Achilles injury, you're welcome to consult one of our team via video call.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in most of our articles.

In this article:

1. What is hyaluronic acid?

2. Does hyaluronic acid work for Achilles pain?

3. Why a hyaluronic acid injection won’t fix your Achilles injury

4. How we can help

We've also made a video about this:

What is hyaluronic acid?

Hyaluronic acid occurs naturally in our synovial fluid, which is the fluid inside our joints, and it helps to reduce friction in our joints.

One treatment for painful joints, e.g. when someone has arthritis in their knee, is to synthesise hyaluronic acid (Ostenil is one of the better-known trade names) and then inject it into the joint to reduce the friction even more.

Does hyaluronic acid work for Achilles pain?

Recently, the people in the lab coats have been trying out hyaluronic acid on painful tendons. The reasoning is that an injured tendon can be extra painful due to friction as it slides to and fro inside the sheath that envelops it, and that the hyaluronic acid can reduce this friction and therefore reduce the pain.

The initial studies were done on small groups of people, and no long-term follow-up studies have been done yet, so we should be careful to generalise, but it does seem that a hyaluronic acid injection may indeed reduce tendon pain. And I myself have had Achilles injury patients whose pain got less after they’ve had the injection.

Why a hyaluronic acid injection won’t fix your Achilles injury

One pitfall is thinking that this injection will heal your Achilles injury or speed up its healing. It won’t. People who resume their normal sport and/or activities they were doing before the tendon got injured just because the pain is now gone will very likely have a painful tendon once again after a while.

This is because an injured tendon is a weakened tendon, and it has to be strengthened back up to its original state with rehab exercises that start at the right level for you and then get progressively more challenging as the tendon recovers.

The original reason for the tendon injury, for example biomechanical factors, also has to be addressed.

To summarise: A hyaluronic acid injection may help to reduce your Achilles tendon pain, and it would be especially useful if your pain is so severe that you cannot get on with your rehab exercises. However, after the injection your tendon will get better only if you follow through with said rehab exercise programme.

How we can help

Need help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Steph Davies is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports and Exercise Medicine. You can follow Steph on LinkedIn.

References:

1. Kumai, T., Muneta, T., Tsuchiya, A. et al. The short-term effect after a single injection of high-molecular-weight hyaluronic acid in patients with enthesopathies (lateral epicondylitis, patellar tendinopathy, insertional Achilles tendinopathy, and plantar fasciitis): a preliminary study. J Orthop Sci 19(4), 603–611 (2014).

2. Frizziero, A., et al. Efficacy of ultrasound-guided hyaluronic acid injections in achilles and patellar tendinopathies: a prospective multicentric clinical trial. Muscles, Ligaments & Tendons Journal 9(3), 305–313 (2019).