DEAR DR. DONOHUE: I have played in a men’s basketball league for the past five years. This year, for the second time, I have come down with Achilles tendinitis, and I have had to stop playing. A sports trainer happens to be on my team, and he suggests I get a new treatment consisting of platelet injections. Have you heard of this? If you have, what is your opinion? — M.L.

ANSWER: The Achilles tendon is the body’s strongest and thickest tendon. It connects calf muscles to the heel bone. When the calf muscles contract, the tendon lifts the heel off the ground.

Achilles tendinitis implies inflammation. Tendon inflammation was believed to be the problem. Overuse inflames the tendon and produces pain, swelling and stiffness. Today “tendonitis” has been changed to “tendinopathy,” which indicates that overuse has caused tiny tears in the tendon, and that, in turn, has led to tendon degeneration. All tendons have a poor blood supply, so they heal slowly. That’s especially true of the Achilles tendon. The fact is that it takes time for tendons to heal, and not much can be done to speed the process.

Injections of platelet-rich plasma have been introduced as a therapy for speeding up tendon healing. Platelets are small blood cells essential to clot formation. They also contain substances that promote growth, and that’s the reason they are used for tendon healing. The platelets are obtained directly from the patient. It is not a painful process.

Early reports presented this treatment in a favorable light. A recent report from the Netherlands, however, has thrown some cold water on it. I don’t know which view is the correct one. The injections won’t hurt you, but they might not help, either.

The standard treatment and prevention of Achilles tendinitis consists of wearing shoes that absorb the shock of landing on your feet when running and jumping, using heel lifts, taking Tylenol or a nonsteroidal anti-inflammatory medicine and resting. Stretching the tendon, when it is pain-free, is a way to prevent a third injury.

DEAR DR. DONOHUE: I am a 30-plus mile per week jogger. I read and agree with your article that moderate caffeine use before exercise can be a benefit. The problem for me is that I don’t particularly like coffee. Can I get the same benefit from one or two 200 mg caffeine tablets? — R.C.

ANSWER: I don’t want to give the impression that caffeine has magical properties. In moderate amounts, it does seem to increase endurance by encouraging fat-burning while conserving glycogen stores.

One cup of coffee has from 102 to 200 mg of caffeine. On average, a cup contains 132 mg. Two or three cups before exercise are the amount suggested for prolonging endurance. One or two 200 mg caffeine tablets would produce a similar effect.

Caffeine isn’t a banned substance, but urine levels greater than 15 micrograms per milliliter could disqualify a competitor in races sponsored by some governing authorities. It takes six to eight cups of coffee before an event to produce such a level.

DEAR DR. DONOHUE: I am curious about my exercise program.

If I walk 40 minutes or take a bike the same distance but do it three more times, which gives me the greater exercise? — M.G.

ANSWER: Walking speed, biking speed and your body weight have to be considered to give you a truly exact appraisal.

Walking at 3 miles per hour burns around 4.8 calories a minute, 192 in 40 minutes.

Biking at 5.5 miles per hour, a somewhat-leisurely pace, burns about 4.2 calories a minute, 168 in 40 minutes.

Walking wins, but only by a hair.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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