? for Phys Therapists

[Velobambina]

I've been suffering with a bad case of Achilles Tendonitis in my left ankle, the result of wearing shoes that lacked proper support (went for a couple longish walks in Nike Free shoes---don't do it if you overpronate!!). Went to the podiatrist about a week and a half ago, and she took pictures. Foot is fine, structurally, and the Achilles is intact. So, I ask her to give me a prescription anti-inflammatory because Advil, which she recommended, wasn't working. She wouldn't answer any questions I had about whether or not I should stretch it, insisting that I go to a PT. Wrote me a script for two sessions, more if needed. First anti-inflamm didn't work (feldene) and upset my iron stomach, so she switched me to Dicolofenac, which is slowly decreasing the inflammation. Getting into see a PT is a nightmare---all booked up thru July. Today, I'm going to take another stab at trying to beg one to give me an appt. Resting it has no affect. Icing helps too, but it's difficult to keep up with the icing when I'm at work. I definitely have cut back on my activity--just cycling, no running, no walking, etc. Until (if) I can get into a PT for an eval and a home exercise regime, what can I be doing to help this along and heal faster?

[KnottedYet]

I'd write more, but I gotta go catch my bus for work.

1st thing I'd do is get some Superfeet insoles so you can support those irritated tissues properly. If the problem was kicked off by unsupportive shoes, you gotta correct that pdq.

Gotta run!

[Veronica]

Sounds like they could use more PTs in Virginia!

Hope you heal quickly VB!

V.

[Velobambina]

Thanks for the good wishes.

I usually use Superfeet insoles, so call me a knucklehead. LOL. Knott, I'll anxiously await any advice. Every day, it's a little better, but I need guidance on what I should not/should be doing on my own to get it better faster. I'm inclined to stretch it gently but I'm afraid that will make it worse. My doc OK'ed cycling, so long as I wear my Sidis.

I'm 44 years old, so that's probably a factor. Not a spring chicken anymore, so it's going to take longer to get back to 100%. This is my first achilles injury ever, and I never ever want to go through this again. After I recover, I'm going to start wearing Earth shoes for work (they make some cute shoes that will look nice w/longer skirts and slacks).

[Wahine]

What Knott said plus...

Ice for 10 to 15 min twice per day or more often if you've further irritated it with activity.

You can also try to apply some arnica gel, it's a homeopathic anti-inflammatory.

Stretch it gently in a non-weight bearing position, hold stretch for 20 seconds, repeat 4 times twice per day:

[Teddy]

Sorry to hear about your tendonitis. I know how frustrating that can be. I am not a PT, but do have lots of experience with injuries from both my past profession (stuntwoman) and past and present sports activities and hobbies. I had chronic tendonitis in my left foot, and to a lesser degree, my right foot for years. I used to be a fighter (kickboxer) in my younger days. Because I started competing so late in life - I was in my late 20's and everyone else was a good six to nine years younger than me - I trained longer and harder than anyone else. As a result, I developed tendonitis in both my feet and one of my shoulders. Some things I learned from my PT, my doctor, but mostly from trial and error:

1. ICE IMMEDIATELY after you realize you're injured. This constricts blood flow in the local blood vessels, lessens swelling, decreases cell metabolism which can lessen hemorrhaging and cell death, and also helps with pain.

2. After the initial 24 - 48 hour period of icing, you can alternate ice with heat. Go for 20 minutes each alternating. Do this as often as possible and as long as possible. What you're doing is dilating and constricting the blood vessels which helps flush blood through the injury site as well as force pooling waste products out. All of which will help with healing.

3. I'm sure you already know this, but never ice for longer than 20 -30 minutes at a time. And when you ice, go for the numbness phase. Most people don't ice this aggressively since you have to go through the painful stage to get to the numbness stage. The stages go something like this:

Stage 1 - Cold
Stage 2 - Burning/Pricking
Stage 3 - Aching/Pain
Stage 4 - Numbness
Stage 5 - Reactive Vasodilation

This last stage is the stage at which your blood vessels start to reopen and flush the area with warm blood again. In essence, your body perceives it to be freezing and is trying to warm up the freezing tissue. This stage happens at about 20 - 30 minutes and is why you shouldn't ice longer than that since you will cease to gain the benefits of ice therapy at this point.

4. Don't stretch unless the doctor or PT tells you to. Stretching too early in the healing process will only tear up the fibers that are trying to build up to heal the injury. In the beginning the fibers will lay down a willy nilly patchwork of threads to shore up the site. After a time, the body will then start to lay down those fibers in a more structured pattern. Until then, it is my feeling that you should not stretch, but only your doctor or PT will be able to judge that properly.

5. Rest is best for new tendon injuries. Resist the urge to do more just because it doesn't hurt. It takes FOREVER for tendon injuries to heal. Depending on the severity, you're looking at months of recovery time. Tendons have poor blood supply and thus heal slowly. It all depends on the severity of damage too. I continued to fight on very injured tendons - to the point I could barely walk. That stupidity earned me about nine months of recovery - which was initially estimated at one year (!), but I fast-tracked it.

6. This is optional, but I always take large doses of Glucosamine, Chondroitins and MSM. I'm 44 and my body has had an incredible amount of hard use so for me, it's necessary to keep everything lubed up and flexible. Supplements may only give you 10%, but at my age and with my body, I'll take it.

And a word about Ibuprofen - it's extremely hard on your kidneys. And when I say extremely, I mean extremely. I used to use it instead of the more hardcore painkillers/anti-inflams, but learned from a pharmacist friend that it's incredibly hard on your kidneys - so much so that she won't take it. Also learned from another friend that her finacee - who'd just had open heart surgery - went into near renal failure from the large doses of (prescribed) Ibuprofen he was taking for pain. It is a personal choice and everyone has to make their own decision on what they are and aren't comfortable taking. I'm one of those people who won't even take aspirin unless I absolutely have to. So I am probably a little weird in that regard. However, after doing some research on the effects of Ibuprofen on your kidneys, I have made the choice to avoid using it.

Good luck with your recovery!

[Wahine]

I agree with most of what Teddy says but I feel it's necessary to address a few comments.

It is safe to stretch an achilles tendonitis, even in the acute stage if done so GENTLY and in a Non-Weight Bearing position as I posted above. What I should perhaps clarify is that gently means stretching to the point of tension but not pain. If done in this manner, it helps to prevent contracture and facilitates the organized laying down of new collagen fibres that Teddy alluded to above.

Second thing is that the inflammatory stage can last much longer than 24 to 48 hours, especially in a not completely rested body part. So I do not recommend the use of heat until after day 4 and only if the constant pain has resolved. If you still have constant pain at 4 days, keep with icing only until day 7. Also, it is not necessary to ice beyond 10 to 15 minutes. If you like ice and you want to keep it on for 20 to 30 go ahead, but as Teddy said, don't keep it on longer than 30 min.

Contrast thermal treatments (alternating ice and heat) are great for more chronic tendonitis conditions, but I don not recommend them before day 5. This is because the opening of the blood vessels with this technique, while it does bring an influx of new blood, can also cause an extravasation of fluid and various inflammatory and cellular components aggravating the inflammation and swelling instead of helping it.

[Zen]

Did the doc write a scrip for one particular PT?
Arlington and vicinity must be loaded with clinics.

[Velobambina]

Thanks, everyone, for the advice.

There are plenty to PTs and PT clinics in my area. They are ALL booked up and the earliest appt I can get is in two weeks. More evidence that the DC area is overcrowded...