A Tenex procedure for your Achilles tendon pain is a minimally invasive type of surgery. While Tenex has some advantages over other types of surgery, it still shouldn’t be your first option for relieving you from pain caused by an Achilles tendinopathy. This article explains what you should rather do first and also what pitfalls to avoid. Remember, if you need more 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 our articles.
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How surgery for Achilles tendonitis works
Your Achilles tendon consists mostly of collagen fibres arranged parallel to each other, and this is what makes it so strong. When you get Achilles tendonitis, a part of the tendon is injured, and the collagen fibres are in disarray. So, without the parallel structure, the tendon is a bit weaker, but only in that specific area. Your tendon then becomes painful because it cannot cope with the workload that it usually has to deal with.
The aim of all surgery for Achilles tendonitis, including Tenex, is to remove or decrease the patient’s pain by removing the painful, damaged part of the tendon.
The traditional way to do this was open surgery. The surgeon would make a cut and go in with a scalpel and cut out the damaged tissue. This caused a lot of scar tissue and carried some risk of infection.
Nowadays they mostly do keyhole surgery, where they make a small incision, and they go in through that and cut away the injured parts.
How Tenex for Achilles tendonitis works
Tenex uses ultrasound technology instead of an old-fashioned scalpel to remove damaged tissue.
An ultrasound scan is used to identify the damaged area of the Achilles tendon.
The patient is given a local anaesthetic, after which an incision is made at the affected area. A small probe with a point like a needle is inserted through the incision. The instrument then emits high-frequency vibrations that break up the damaged tissue. The frequency is set so that it doesn’t damage the surrounding healthy tissue. A system within the probe removes the broken-up tissue.
So, if we look at types of surgery, Tenex is a really good option if you absolutely have to have surgery, because it is less likely to cause a lot of scar tissue, it's minimally invasive, and you're out of the procedure within a few minutes.
Tenex is still surgery
However, there are some orthopaedic clinics out there that offer the Tenex procedure that try to make it sound as if it is not surgery, along the lines of, “You don't really have to worry about it, just go in and have it done, and all your pain will magically disappear.”
This claim is just not true. The official Tenex website is at pains to distinguish their procedure from “conventional surgery” or “open surgery”, but in their product overview they explain that it does involve making an incision.
Also, like other types of surgery, it changes the structure of your tendon by removing a part of it.
Why Tenex is not a silver bullet for Achilles tendonitis
Tenex and other types of surgery for Achilles tendonitis may remove or decrease your pain (and this is not the case for everyone), but it does nothing to restore the tendon’s strength back to normal. And its strength won’t come back if you don’t do anything, i.e. if you just rest it.
Because the surgery has changed the structure of the tendon by removing a part of it, you need a rehab programme that strengthens the rest of the tendon, so it is able to cope with the loads created by your daily activities and sport. This means that you can’t just dive right back into your sport and your normal day-to-day activities directly or soon after the surgery – you will likely reinjure your Achilles tendon because it is still as weak as it was before the surgery.
In research terms, the jury is still out on the long-term benefits of Tenex for Achilles tendonitis. A recent review of the available research into the effectiveness of Tenex surgery for the treatment of tendinopathies could find only one high-quality study on Tenex for Achilles tendinopathy. It showed “modest improvement in the short term, but long-term data are lacking”.
So, we know that Tenex and other types of surgery may have a good short-term effect in terms of pain relief, but we don’t know how these treatments compare to other types of treatment over a period of 12 months or longer.
What to do (and what not) before you consider Tenex for your Achilles pain
What we do know is that the current research on the effect of surgery (in general) on Achilles tendonitis advises that you should only consider surgery if your Achilles isn’t better after you have tried at least 12 months of a carefully progressed strength training rehab programme.
The correct type of rehab programme should take the following things into account when it is prescribed to you by a physiotherapist or other medical professional:
Your tendon’s current strength.
Whether any of the exercises cause you pain.
Daily activities other than your rehab exercises that put strain on your Achilles tendons.
Your aims in terms of what level of sport/activity you would like to get back to.
Gradual progression in the difficulty of the exercises based on how you experience your current level of difficulty and how well your tendon tolerates them.
Some people do try other things before wanting to go for surgery, but often these are the wrong options.
Wearing an orthopaedic boot for more than two weeks. This actually weakens the tendon even further through inactivity and the tendon quickly becomes painful again after you have removed the boot.
Stretches. This will likely increase the pain in an Achilles tendon that’s already painful.
Painful exercises. The load you put through that tendon in rehab has to be at the level that the tendon can actually sustain. If the exercise is making it feel worse, it's either the load's too much or the range of motion you're working through could be too much.
The wrong type of exercise. The very commonly prescribed exercise regime for Achilles tendinopathy is the Alfredson method, where you do eccentric heel drops over the side of a step. I don't find that program very effective for most people because it only trains one part of the action. We move and use the Achilles and the calf in the up and downwards motion, and if it's somebody who's not well trained and quite sedentary, that protocol often flares them up. Also, if your Achilles tendon is really sensitive to being stretched, eccentric type exercises done over a step can make it feel worse. Further, you may need to add some plyometrics to your rehab programme to get your tendon back to full capacity.
So, in a nutshell: If you’re going to have to do a proper rehab programme anyway to regain your Achilles tendon’s former strength after Tenex or any other surgical procedure, why not try such a programme in the first place and thereby possibly avoid having to go for surgery at all?
How we can help
Need more 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
Challoumas D, Clifford C, Kirwan P, et al. How does surgery compare to sham surgery or physiotherapy as a treatment for tendinopathy? A systematic review of randomised trials. BMJ Open Sport & Exercise Medicine 2019;5:e000528. doi: 10.1136/bmjsem-2019-000528
Vajapey S, Ghenbot S, Baria MR, Magnussen RA, Vasileff WK. Utility of Percutaneous Ultrasonic Tenotomy for Tendinopathies: A Systematic Review. Sports Health. 2021 May-Jun;13(3):258-264. doi: 10.1177/1941738120951764. Epub 2020 Nov 30. PMID: 33252310; PMCID: PMC8083144.