Achilles tendinosis treatment | Sports Injury Bulletin




Achilles tendinosis treatment | Sports Injury Bulletin

As most SIB readers will be aware, the Achilles tendon is the largest tendon in the human body and is very vulnerable to injury, probably because of its limited blood supply and the variety of forces to which it is subjected during activity ("Common Conditions of the Achilles Tendon", American Family Physician, Vol. 65(9), pp. 1805-1810, 2002.) Achilles-tendon maladies may account for 5-10% of all athletic injuries, and they are a major problem in almost every sport. Strangely enough, however, the exact mechanism which produces the debilitating pain of chronic Achilles tendinosis has remained unknown (see also SIB issue 19). Researchers have shown, though, that neovascularisation - the growth of many new blood vessels into damaged areas - is present in the painful Achilles tendons of individuals with chronic Achilles tendinosis, but not in pain-free, normal tendons. As a result, researchers at the University of Umea in Sweden hypothesised that such ingrowing blood vessels - and perhaps the nerves which accompanied them - were the true source of pain in tendinosis. The Umea group decided to test their hypothesis by sclerosing (hardening and closing) the invasive blood vessels in the Achilles tendons of 10 patients (eight walkers, one runner, and one golfer) suffering from painful, chronic, Achilles tendinosis ("Ultrasound Guided Sclerosis of Neovessels in Painful Chronic Achilles Tendinosis: Pilot Study of a New Treatment", British Journal of Sports Medicine, Vol. 36, pp. 173-175, 2002). The average duration of symptoms in this group was 17 months.

The sclerosing chemical of choice used by the Swedish scientists was polidocanol (5 mg/ml), which has long been used in sports medicine as a local anaesthetic. Color Doppler (an ultrasound technique) was utilised to make the diagnosis of neovascularisation and to identify the entrance of the new blood vessels into the Achilles tendon. The polidocanol injections were accomplished dynamically, with ultrasound used to guide the needle to a spot close to the blood vessels. Enough polidocanol was injected to ensure that all blood vessels were closed, and all individuals were allowed to resume their normal activities on the day after treatment. During a three- to six-week follow-up period, the subjects were re-examined, and injections were repeated in case neovascularisation had returned until there was no detectable ingrowth of blood vessels in painful areas.

To assess pain levels, the Swedes used a visual analogue scale (VAS), and subjects recorded the amount of pain they experienced during activity. On the VAS, a total lack of pain is recorded as zero, while maximal-possible pain is scored as 100. Before the polidocanol injections, the average VAS rating among the Achilles-tendinosis sufferers was 74 (range 39-89), but after six months the mean VAS score dropped to a puny 8.4 (range 0-29) in eight individuals who were satisfied with their treatment (these individuals were able to return to their full, desired schedules of activity). Just two of the 10 subjects reported a lack of relief, and - interestingly enough - neovascularisation had returned in this pair during the six-month follow-up period (neovascularisation was not present in the eight happy patients). Average VAS score for the hurting duo was 71.

The source of pain
Another key finding was that Achilles-tendon pain disappeared immediately after the polidocanol injections, probably because polidocanol can act as an anaesthetic. Since the injections were made at the sites of neovascularisation, there is an implication that the neovascularised area is indeed the source of pain in Achilles tendinosis. Pain returned after six hours, as the anaesthetic effect subsided, but then steadily diminished during follow-up for eight of the subjects. While this research seems to indicate that the sclerotisation of neovascular structures in the Achilles tendons of individuals with Achilles tendinosis can provide a powerful pain-relieving effect and can help such individuals return to athletic activity, certain cautions are in order. First of all, the Swedish work is simply a pilot study; there was no control group, and the Achilles-tendinosis victims were not blinded to what they perceived as a new treatment.

There is also some concern that the blood vessels which were obliterated by polidocanol might have had a beneficial effect over the long term, perhaps by bringing nutrients necessary for healing to the degenerated areas of the Achilles tendons. Thus, although pain was diminished, long-term healing might have been compromised. This possibly negative scenario is relieved somewhat, however, when one realises that the individuals in the study had suffered from Achilles-tendon problems for an average of 17 months. One would think that this extended time period would be long enough for healing to begin, yet the individuals were often close to maxing out their VAS.

What about strengthening exercises?
Is polidocanol treatment more effective than strengthening exercises for the Achilles tendon and its associated muscles? In the Swedish study, seven of the 10 subjects had completed calf-muscle training, with little positive effect (there was no description of the specific exercise programme utilised, however). In other research, calf-muscle training has been very effective, as long as the work has been eccentric in nature (providing elongation of the calf muscles as they are simultaneously attempting to shorten).

For example, in a separate study carried out at the University Hospital of Northern Sweden, researchers found that 12 weeks of heavy-load eccentric-calf-muscle training had a very positive effect on Achilles tendinosis ("Heavy-Load Eccentric Calf Muscle Training for the Treatment of Chronic Achilles Tendinosis", The American Journal of Sports Medicine, Vol. 26, pp. 360-366, 1998). In this investigation, 15 athletes (12 men and three women) with a long duration of symptoms (18 months) of Achilles tendinosis were unable to engage in their normal running training because of tendinosis-related pain. The athletes had tried conventional treatments (rest, non-steroidal anti-inflammatory medications, changes of shoes, orthoses, physical therapy, and ordinary training programmes), to no avail. These 15 athletes were matched with a group of 15 similar athletes (11 men and four women) with the same diagnosis who underwent Achilles-tendon surgery instead of the heavy-duty eccentric training. All 30 individuals had the typical signs and symptoms of Achilles tendinosis, including thickened Achilles tendons, irregular tendon structure, disarray of the protein fibres within the tendon, separated tendon fibres, stiffness, and pain during running.

What the workouts involved
Two eccentric workouts were performed per day, seven days a week, for 12 weeks. Each workout consisted of three sets of 15 repetitions for two key exercises (to be described in a moment). Normal running training was permitted if it could be completed with only mild discomfort and no significant pain. The exercises proceeded as follows:

The athletes stood on their forefeet only (on both feet) close to the edge of a step, with the non-injured leg providing the force needed to rise up onto the forefeet. The non-injured leg was then lifted off the step, so that full body weight was supported only by the forefoot of the leg with the hurting Achilles tendon; the heel of the hurt leg was then slowly lowered until it came into position well behind and below the edge of the step (basically, the ankle moved from plantar flexion to dorsiflexion as the heel went down). This provided a strong eccentric contraction for the calf muscles attached to the damaged Achilles tendon, since they were contracting actively to slow the descent of the heel and yet were elongating as the heel dropped downward. No subsequent concentric loading of the calf muscles associated with the hurt Achilles tendon was carried out; the non-injured leg was used to provide the force necessary to return to the starting position.

For the first exercise (the first three sets of 15 reps), the injured leg was kept straight at the knee; during the second exercise (the next three sets of 15 reps), the injured leg was bent at the knee to activate the soleus muscle, which lies beneath the main calf muscle, the gastrocnemius. Possibly because there were just two exercises in the workout and because the exercises were straightforward to carry out, there were no drop-outs during the training period; all 15 athletes completed the 12-week programme.

An especially positive feature of this eccentric training was that it was progressive. When the athletes could perform the eccentric, loading exercise without experiencing pain or discomfort, they increased the load by adding weight placed in a backpack. If very high weights were needed, the athletes used a weight machine to increase the eccentric strain.

And the results?
As it turned out, the eccentric training produced dramatically positive effects on both concentric and eccentric calf-muscle strength. Before the eccentric training was begun, the injured-side calf muscles had significantly lower concentric plantar-flexion strengths at 90? and 225? per second (12 and 18%, respectively) and significantly reduced eccentric plantar flexion strength (11%), compared with the non-injured-side calf muscles. After 12 weeks of training, however, the eccentric plantar-flexion strength and also the concentric plantar-flexion strengths at both speeds had improved considerably, and the there were no differences in strength between injured and non-injured sides. In contrast, the 15 athletes who underwent surgery were unable to bring their injured-side strength up to par with the injured side through the utilisation of conventional calf-muscle exercises and physical therapy, even after double the time period (24 weeks). Scores on the VAS were similarly positive. In the group which undertook eccentric calf-muscle training, the average VAS score was 81 before the 12-week training programme commenced but plummeted to a miserly 4.8 after the 12 weeks of daily work. All 15 individuals were able to resume their normal running training in a pain-free manner after 12 weeks of training. In the control group (consisting of the individuals who underwent surgery), VAS scores dropped from 72 to 21 over 24 weeks, but, as mentioned, strength in the injured-Achilles leg remained sub-par.

Further confirmation
Other studies have suggested that eccentric muscle strength training works well for the rehabilitation of tendon injuries ("Eccentric Exercise in Chronic Tendinitis", Clinical Orthopaedics, Vol. 208, pp. 65-68, 1986).The mechanism underlying this beneficial effect is uncertain, with one theory suggesting that the stretching of the muscle-tendon unit which takes place during eccentric activity actually permanently elongates the muscle and tendon, leading to less strain per unit length of muscle and tendon during ankle-joint motion. Another possibility is that the eccentric loading induces a special kind of "remodelling" within the muscle-tendon unit, including hypertrophic changes in the muscle and tendon. Long-term ultrasound examinations of athletes undergoing eccentric training should help resolve this issue. The eccentric calf-muscle training is safe: no new injuries occurred during the 12-week period. The training is also inexpensive: only a step and a backpack with a few weights are usually needed, although some individuals will certainly graduate to using a weight machine in a gym. In addition, once the 12-week training period is over, just small amounts of further training seem to be required to keep the problematic Achilles tendon healthy; in this study, just one to two eccentric workouts per week kept the formerly injured Achilles tendons happy.

And finally?
How should chronic Achilles tendinosis be treated? Athletes with Achilles tendinosis should definitely try a heavy-load eccentric training programme similar to the one described in the University Hospital of Northern Sweden study. Note, though, that the 10 individuals with unresponsive Achilles tendinosis in the University of Umea investigation had already undergone strength training for their Achilles tendons, with little positive effect (their training was not heavily eccentric, however). At any rate, it is likely that eccentric strengthening programmes will not be successful in all cases. In situations when they fail, the new treatment - sclerosis of neovessels with polidocanol - appears to be very promising.



Bone Spurs




Bone Spurs

Experiences and Testimonials of others
A submission directly to EverythingEssential.me. Our thanks to:

Kathy Longhurst
sandhollow@aol.com

Kathy -I had a dramaticexperience with the AromaTouch Technique class in St. George, Utah. Ihad a lump (bone spur?) on the top of my right foot about 2"from my 4th toe - it was on the top part of my foot andlooked gross, like a volcano about to blow, it kept growinghigher and higher and the night before the class it washurting so bad I could hardly sleep. It protrudedbetween 1/2 to 3/4 inch high. About 8 in the evening,after I had received the AromaTouch Technique, I kicked offmy shoes and looked down at my foot and the lump was almostcompletely gone, it was just a mass under the skin, like apuddle. The next day the mass was gone, it completelydissolved - I was amazed! Since the class it has grownback and I am anxious to have another AromaTouch Techniqueto see if it reduced again!



Samara - My husbandjust called from the doctor's office and he has a bone spurin his heel. That explains the pain he's been having, butis this something that oils can help?

Robert - I had a vicious bone spur on myelbow. It would send shooting pains up my arm if I waslaying in bed and put pressure on my elbow to roll over. After some studying on effective essential oils and blendsthat people had used on bone spurs, I came up with thefollowing blend. I don't know if its the best one, but mybone spur is gone. I took a couple weeks before it stoppedhurting during pressure, and I continued a couple dropsmorning and night for another 2 weeks.

Bone spurs blend:

?? 4 drops Wintergreen

?? 4 drops Eucalyptus

?? 4 drops Marjoram

?? 4 drops Cypress

?? 4 drops Helichrysum

?? 4 drops Peppermint

?? 4 drops Frankincense

?? 10 drops coconut oil carrier

Also supplement with magnesium and doTERRALife LongVitality supplements!! (Magnesium will help dissolve bonespurs.)

Other blends and oils to consider;

?? Deep Blue

?? Aroma Touch

BK - I've had a bone spur on the bottom of my right footfor several years. I mostly controlled any pain by havinggood shoes, and padded commercial soles. But if I got upout of bed at night or was getting ready for the day in themorning without my shoes on... I would sometimes putpressure on the right place, and I might as well havestepped on a scorpion. Awful pain shot up my leg.

I also had a small bone spur or calcium growth on thepalm side of my pointer finger knuckle on the carpal"s bone,right next to the metacarpals bone. (right hand, and I'mright handed) It bothered me sometimes, but I just livedwith it. It felt like it was a half size marble under myskin.

Back a few months I started using a blend of Eucalyptus,Marjoram, Cypress, Lavender Peppermint, Thyme and Basil. 5drops each in an 15ml bottle then match the amount ofessential oil with coconut oil. I would rub this blend on myright foot every morning and night. Without fail for 3months. One day it was strange, I realized that it wasalmost gone! It seemed almost overnight or I just hadn'tbeen paying attention. I continued for another month or sixweeks, and here's the funny thing... I realized one day thatthe bump on my hand was gone too! I LOVE THESE OILS!!

Pat - Cypress with Wintergreen seems to work well forsome, also Deep Blue for the pain and believe it or notBreathe which I know is a respiratory blend has beensuggested to dissolve bone spurs. Use each time area ispainful, it can be used often.



Tinas - My Dad hasbone spurs in his back, recently his back has gotten reallybad and he thinks a bone spur is pinching a nerve. Helives in Canada and he can't get to the doctor and will haveto wait for surgery for a long time.

Pat - I would use the Lemongrasstopically, along with Deep Blue and Peppermint for the pain.The Lemongrass should dissolve the spurs, he needs to beconsistent!!



Arch Support Insoles to Relieve Foot, Back, Knee, Hip Pain




Arch Support Insoles to Relieve Foot, Back, Knee, Hip Pain


PEDAG insoles are thin enough to fit in almost any shoe, not like some where you need to buy a larger shoe to accommodate it. These insoles will make an old shoe feel new again, or take a new shoe with little support and give it the feel of a higher quality shoe. I have been in the Footwear business for over 25 years, in my opinion this is the best insole you can buy without having one custom made. When I sell them in my store, I tell customers that they only need to buy one pair and they should switch them from shoe to shoe removing them nightly to air out. Most of my customers return after a week or so to purchase additional pairs for all there shoes because they recognize the benefits to their feet, knees, hip and back, and don't want to move them daily. Below is a lot of technical information about this product, but I will sum it up by stating; if you are having any kind of foot, knee, hip or back issue, stop by Walk About Shoes and try a pair!














Pedag insoles are made of prime quality leather tanned with herbal extracts for the optimum shoe climate. It has a purifying active carbon filter to help prevent foot odor and an anti-bacterial treatment to help prevent the growth of bacteria and fungi. No foams or gel that can make your feet feel hotter or hold perspiration. The carbon filter pulls perspiration away from your foot.




The Longitudinal arch Pad (Support) is made of polypropylene, this support is for the longitudinal arch, it fills the space for high-arched feet allowing the shoe to accept the weight in this area and to act as a shock absorber. This pad helps to distribute weight evenly over the entire bottom of the foot. This cuts down on pronation, the movement or tendency to turn the foot inward.




This insole has an orthopedic design which helps prevent and relieves Splayfoot, by relieving pressure on the ball and arch of the foot. (Splayfoot is a foot "disease" caused mainly by civilization. High heels, hard floors, standing all day and/or over weight are the main causes of "splayfoot". In the case of splayfoot, both the longitudinal arch is weakened (flatfoot) and the latitudinal or metatarsal arch (spreadfoot) is also affected. Remedies include insoles with metatarsal pads which provide support the middle bones of the foot and arches which support the longitudinal arch. Heel cushions also relieve strain on the foot.)




This insole is highly recommended for those who suffer from Plantar Fasciitis. (Plantar Fascia / Plantar Fasciitis is an inflammation of the plantar fascia, the band of connective tissue that runs from the heel to the base of the toes. When stressed the fascia stretch and can cause intense pain and inflammation. Plantar Fasciitis is worst in the morning, after a night of rest the plantar fascia tissue has tightened, when you take your first steps of the day. Remedies include arch supports which reduce tension on the plantar fascia. Stretching the calf muscles, night splints and injections to reduce inflammation may also help relieve pain.)




Viva features a sturdy support for the longitudinal arch and a built-in orthopedic insert/pellet for the latitudinal arch (metatarsal). These supports allow the foot to maintain and to regain an anatomically correct position. Viva also has a heel pad which relieves pressure and impact on the heel.




While I can't make any guarantees, I have many customers claim these insoles have not only relieved foot pain, but helped with knee hip and back issues. By putting the correct support under your foot and getting better weight distribution throughout your foot, you will notice an improvement in your overall comfort. You don't have to have a specific problem to use these insoles, everyone can benefit from adding additional support to their shoes. Proper supports in your shoes may even prevent a foot ailment!




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´╗┐Walking Shoes For Plantar Fasciitis


The best bet, if the pain has not subsided after a few days of rest, is to visit your doctor for an accurate diagnosis and to determine the severity of the condition. Your doctor should complete an examination of your foot, and will take a case history to help diagnose the condition. Since plantar fasciitis is not always directly diagnosable, a history is often one of the most reliable ways to get an accurate diagnosis. Plantar fasciitis does not show up on an x-ray, and whilst accompanying heel spurs do, these can be difficult to spot even for a trained professional.

Plantar fasciitis occurs often in runners and other athletes. Plantar fasciitis is the most frequent cause of plantar (bottom of the foot) heel pain. For many years pain in this region has been incorrectly termed the "heel spur syndrome". It is better termed the "plantar heel pain syndrome" since a heel spur is not always found at this location. While a "heel spur" sounds ominous often the spur is present and does not cause any pain. The formation of a spur is a sign that too much tension has developed within the plantar fascia, partially tearing from its origin at the calcaneus (heel bone).

Tight calf muscles is a major contributing factor to Plantar Fasciitis. Therefore this particular heel pain exercise is very important. Stand facing a wall with your hands on the wall at about eye level. Put one leg about a step behind your other leg, keeping your back heel flat on the floor. Make sure this leg stays straight at all times. Now bend the knee of the front leg slowly, lowering your body until you feel a stretch in the calf of the back leg. Hold the stretch for 15 to 20 seconds. Repeat 4 times. Do the same for the other leg.

Splints are particularly effective at preventing morning foot pain, and are strapped to the foot at bedtime and keep the tissue in its stretched state. Without the contraction the foot is prepared for the first few steps, and the devices can eradicate morning foot pain. Heel seats on the other hand are devices which are placed under the heel and fit easily into most shoes. By elevating the heel the plantar fascia is not required to stretch and flex as much when walking which eases the pain and prevents further damage. They are also particularly effective at easing the pain from heel spurs by cushioning the heel.

The Mayo Clinic website states that plantar fasciitis is a condition that occurs gradually overtime and can affect people in the morning after getting up out of bed. The cause of plantar fasciitis is thought to be from overuse and irritation of the plantar fascia. The American Academy of Podiatric Sports Medicine states that many factors have been looked at regarding the cause of plantar fasciitis, including leg length differences, altered bio-mechanics, low or high arches and improper gait. They state that heel pain can occur from many different factors; no one thing causes plantar fasciitis. Treatmentsplantar fasciitis taping

Foot Orthotics, is the only non-surgical therapy to have been supported by studies rated by the Center for Evidence-Based Medicine as being of high quality. Landorf et al. performed a single-blind experiment in which patients were randomly assigned to receive off-the-shelf orthotics, personally customized orthotics, or sham orthotics made of soft, thin foam. Patients receiving real orthotics showed statistically significant short-term improvements in functionality compared to those receiving the sham treatment. There was no statistically significant reduction in pain, and there was no long-term effect when the patients were re-evaluated after 12 months.

When the plantar fascia, or the thick tissue in the bottom of the foot that connects the heel to the toes, becomes overstretched, it becomes inflamed. This condition is known as plantar fasciitis. This inflammation makes it difficult to walk and perform certain movements of the foot. It may be caused by shoes with poor support; sudden weight gain; long distance running, especially downhill or on uneven surfaces; or a tight Achilles tendon. People whose feet have a high arch or are flat footed are also prone to plantar fasciitis. You Might Also Like Symptoms.

Potential risks include rupture of the plantar fascia and fat pad atrophy. 22 , 23 Rupture of the plantar fascia was found in almost 10 percent of patients after plantar fascia injection in one series. 22 Long-term sequelae of plantar fascia rupture were found in approximately one half of the patients with plantar fascia rupture, with longitudinal arch strain accounting for more than one half of the chronic complications. 22 , 23 On the other hand, one author 24 found that most individuals with rupture of the plantar fascia had resolution of symptoms with rest and rehabilitation. SURGERY

The first step is to stop the activity that caused the pain The person should alter his or her activity or exercise routines to reduce stress on the plantar fascia ligament. You should rest your feet, keep the foot elevated and use ice repeatedly during the first part of treatment. Patients should try not to run or walk too much, instead try swimming or cycling. Regular activity should be increased slowly avoiding pain with each increased level. Common anti-inflammatory medications such as asprin may reduce discomfort, although patients must make sure they get medical advice prior to starting any medication.

In case you simply don't need to invest some cash on the night splint, you may create the plantar fasciitis night splint on your own using ace dressing and also something related. In fact, we don't advise that, due to the fact it could lead to some injury when you can't make it properly. First of all, you need to be aware to the force, too much force will result in side result. Because the foot is indeed essential to your day-to-day existence, you ought to be much more cautious whenever you decide to do the cure.plantar fasciitis taping
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