I’ve been having problems with chronic Achilles tendonitis. An ultrasound study showed a tear in the right tendon. The doctor thinks it’s from overuse (too much running). I have a choice in treatment. I can either take the slower rehab method or try steroid injections. I’d really like to get back to running and stay with it. Which treatment approach is best?

A rehab program for this problem is based on rest of the tendon. This means avoiding any activity that makes your symptoms worse. Sometimes a heel wedge is placed in the shoe. This unloads the calf muscles that attach to the Achilles tendon.

Exercise is a key part of the rehab program. This includes stretching for flexibility. Stretching also helps with tendon healing. Strengthening is important, especially starting with the muscle in a contracted position and lengthening it against resistance.

The use of steroid injections for tendonitis is hotly debated. There is a risk of tendon rupture with this treatment. Some doctors have tried injecting the drug around the tendon rather than into the tendon. This hasn’t been shown to work well.

A new approach is being tried using a skin patch with topical nitric oxide (NO). NO is a gas present in the body at all times. It’s released during soft tissue injury to help open blood vessels and bring more blood to the area. Early studies show good results in three-fourths of the patients with tendinopathy who used these skin patches.