At The London Ultrasound Clinic, we often see patients who have been struggling with persistent Achilles pain that does not improve with physiotherapy. From our experience, a high volume saline injection is a highly effective treatment for mid-portion Achilles tendinopathy. The procedure involves injecting a large volume of saline, sometimes combined with a small amount of local anaesthetic, around the tendon under ultrasound guidance. This helps reduce pain, promote tendon healing, and restore function.
Understanding Mid-Portion Achilles Tendinopathy
Mid-portion Achilles tendinopathy occurs in the section of the tendon 2 to 6 cm above the heel. Patients often experience aching, stiffness, and swelling, particularly during or after activity. The condition develops gradually, usually from overuse or repetitive loading, and can significantly impact running, walking, and daily life. While physiotherapy and load management are essential first-line treatments, some patients continue to experience pain despite months of rehabilitation.
What High Volume Saline Injection Involves
In our clinic, the procedure is performed under real-time ultrasound guidance to ensure accuracy and safety. After numbing the skin and surrounding tissues with local anaesthetic, a fine needle is guided alongside the tendon. A high volume of saline is then injected around the tendon, creating a mechanical effect that separates the tendon from the surrounding inflamed tissues and adhesions. This also helps reduce neovascularisation, which is thought to contribute to chronic pain. The injection usually takes around 20 minutes and most patients leave the clinic shortly afterwards. The procedure is generally well tolerated and many patients notice an immediate reduction in discomfort.
How It Works
The high volume of fluid acts to mechanically disrupt abnormal tissue and reduce irritation around the tendon. By separating the tendon from inflamed surrounding tissues, the injection helps the tendon remodel in a healthier way. Patients often report reduced pain during activity and improved tolerance for running or walking within days to weeks.
What to Expect After the Procedure
Some mild soreness or bruising around the injection site is normal for a day or two. Ice, gentle mobility exercises, and avoiding high load activity for a short period are recommended. Physiotherapy plays an essential role in recovery, helping to restore strength, flexibility, and tendon capacity. Patients who follow a structured rehabilitation plan generally achieve better long-term outcomes and are less likely to experience a recurrence.
Recovery and Long-Term Outlook
From our experience, high volume saline injection provides significant improvements for most patients within 2 to 6 weeks. Only one treatment is usually required, although in rare cases a repeat injection may be considered. Compared with steroid injections alone, high volume saline targets the root causes of chronic tendon pain and supports long-term tendon health and function.
Is High Volume Saline Injection Right for You
We consider high volume saline injection for patients with persistent mid-portion Achilles tendinopathy who have not responded to physiotherapy, load management, or other conservative treatments. The procedure may not be suitable for patients with partial or full-thickness tendon tears, infection, or severe tendon degeneration. Each patient is carefully assessed using high-resolution ultrasound to ensure the procedure is safe and appropriate.
References
- Topol GA, Podesta LA, et al. High-volume image-guided injections for chronic Achilles tendinopathy. Br J Sports Med. 2010;44(7):443â447
- Maffulli N, et al. Conservative, injectable and surgical treatments for mid-portion Achilles tendinopathy: a systematic review. Br Med Bull. 2011;97:193â217
- Rha DW, et al. Clinical outcomes of ultrasound-guided high-volume injection with corticosteroid for chronic Achilles tendinopathy. J Ultrasound Med. 2016;35(9):1971â1979