|
|
ACHILLES INFLAMMATION AND PAIN
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
ACHILLES INFLAMMATION AND PAIN - April 4, 2006 2:27:00 PM
|
|
|
lesain
Posts: 24
Joined: November 21, 2003
From: MERCEDES, BUENOS AIRES, ARGENTINA
Status: offline
|
Hello friends,
I have a patient with Achilles´s tendon inflammation in the avascular zone, swelling, and pain when he wants to begin to walk and in the night during sleep.
2 months with this problem, what I must do?
PLEASE!!!!!
_____________________________
LEANDRO ESAIN, PT.
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 5, 2006 4:17:00 AM
|
|
|
JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
Status: offline
|
Eccentric training and gentle stretching.
Consider ice, taping and heel lift for pain.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 5, 2006 5:12:00 AM
|
|
|
PTupdate.com
Posts: 1477
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
|
As Jason notes, and perhaps also pulsed US (sorry Jason, I know you hate plug-in things) and iontophoresis with acetic acid (hey, it's battery operated and not plug in...plus I have had more success with the acetic acid than dexamethasone for this problem). Also TFM.
He's entering that "tendinosis" time zone, and if not careful, could rupture with one simple sudden movement.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 5, 2006 5:30:00 AM
|
|
|
ehanso
Posts: 355
Joined: September 14, 2004
From: Minnesota
Status: offline
|
May try Ionto with Ketoprofen. Orthpods I work with are a little hesitant to use Dex over weight bearhing tendons.
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 5, 2006 7:19:00 AM
|
|
|
JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
Status: offline
|
John - no worries, I am getting my second wind about pulsed ultrasound. After getting around your site, I better understand your "take no prisoners, everything at once" approach, what with limited visits and all.
In my practice, i have the luxury of taking the time the patient needs, so I rarely go to ultrasound right away. I can always see them back in a few weeks (if acute) or 4-6 wks (if chronic) and go to the "next level" if needed.
In recalcitrant cases or those in acute pain, I would definitely try the U/S.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 5, 2006 8:03:00 AM
|
|
|
VagusX
Posts: 215
Joined: March 26, 2003
From: Savannah, GA, USA
Status: offline
|
In addition to the above try some pre-fabricated pronation control orthotics.
-Daniel
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 5, 2006 8:11:00 AM
|
|
|
jma
Posts: 2414
Joined: August 24, 2000
From: NY
Status: offline
|
I agree, A heel lift may help as well.
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 5, 2006 5:02:00 PM
|
|
|
ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
Status: offline
|
Continuous mobilisation of L5S1 till relief of pain associated with the joint mobilised will bring about a swift and essentially permanent normalisation to "achilles tendinosis", which I have found to be almost always , a referred event .
LOcal treatments may relieve tenderness for various periods of time, as do most local treatments to referred events.
Strong pressures are usually required , with mobs for about five to ten minutes common to restore normal pain free L5S1 mobility. You will find the ankle swelling will dissappear after around 24 hours, with pain relief at the ankle immediately.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 5, 2006 5:55:00 PM
|
|
|
PTupdate.com
Posts: 1477
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
|
Ginger...explain that to the guy who just ruptured his Achilles dropping back to complete a slant pattern...that it was all in his back?!?!
Jason...I am now using more your bosses' term "shock and awe"
Dan..yes, I forgot the pronation control, to remove the "wringing" effect on the tendon.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 5, 2006 6:01:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
I am puzzled by the heel lift idea, which means even more stretching to overcome the risk of further shortening. Don't see how that achieves healing...?
Ginger, I'm with you on this one, having had a couple of patients with some LBP (moderate) and complaining of 24/7 pain in the Achilles with some swelling. They both asked for a review of the LBP; after that was treated...no more Achilles pain.
nari
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 5, 2006 6:39:00 PM
|
|
|
ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
Status: offline
|
Not sure what your problem is Mr Duffy, I never said all achilles pain was referred, I will say again however that most is. There will be no sleep lost here if you wish to continue to treat referred events locally. Just a little puzzled as to why you would be so critical when I suspect you have invested a lot of time and energy into becoming a PT, yet refuse to meet me even half way on a method that would revolutionise your practice. Imagine, you wouldn't have to wait for exercise to yield its slow but useful result. Your hand alone could treat and eliminate most achilles pain and sweeling problems. All you would have to do would be to follow my directions, be skillfull and persistant, and see for yourself the benefits of this approach. You really won't believe your eyes. This is the method that has seen many many cases in these rooms and others here under my supervision, come good with no other attention other than L5S1 mobs.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 5, 2006 8:51:00 PM
|
|
|
ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
Status: offline
|
All structures with neural innervations have the capacity to provide messages to the brain that are interpreted as sensation , equally a field of innervation provides the means for structures to behave in the normal way.
Were those nerves to be irritated ( by compression ,by damage, by inflammation ) altered sensation would occur , in the brain , interpreted from dodgy info arriving there. Referred pain is one of the ways that the brain percives a structure as being painfull , when in fact , the nerve itself is irritated. Ok not so unusual, a common occurrence.
Equally common , yet not equally recognised , is that neural mechanisms for normal behaviours, of skin , of vessels, of muscle , of any combination of living tissues, is able to be altered by the same irritating neural events. Such that tissues and structures in limbs are able to be observed to behave differently when , in particular , inflammatory occasions arise in nerve roots.
It is the irritations then to nerve structures , at the root , though not limited to the nerve root, that , as a result of inflammatory events to Facet joints may contribute to altered activity of those innervated structures.
Restoration of normal pain and inflammation free movements to those facet joints neurally related to the structure percieved as painfull , will then provide a normalisation to sensation and to neural input. This then relieves the unusual activity giving rise to swelling, puffiness, palpable tenderness and pain. ie problem solved.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 6, 2006 2:38:00 AM
|
|
|
PTupdate.com
Posts: 1477
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
|
nari..the lift won't cause any major adaptive shortening..just reduces the strain with every step taken and permits more controlled lengthening via self stretching.
Ginger...I am actually quite open minded with regards to this material, and would certainly look at the back of a person with certain symptoms.
I see this patient population quite often, and rarely have problem resolving by treating locally, especially when I have tendon thickening and nodule formation, crepitus in the sheath, areas of hypoechoic return on diagnostic US, or even partial tearing on MRI to back up the fact that this problem is indeed in their ankle.
Before I EVER put my paws on the lumbar spine of some ankle patient here in litigious-happy-Pennsylvania, I'd make sure I had both clearance from the physician and some evidence behind what I was doing. Is there any written evidence behind mobilization of L5-S1 to resolve Achilles tendinosos/tendinitis pain in the literature?
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 6, 2006 8:02:00 AM
|
|
|
drbuddy
Posts: 429
Joined: July 30, 2005
From: Pennsylvania
Status: offline
|
FWIW, I had a professor in school that works with mostly athletes. He claims that he gets his best results with achilles tendonosis using eccentric training. He explained to us to have the patient peform a calf raise on both feet, then remove the good one (support all the weight on the bad side) and very very slowly lower the ankle. He said it hurts like hell, but they seem to do much better after a week or two of performing the exercises.
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 6, 2006 9:24:00 AM
|
|
|
lesain
Posts: 24
Joined: November 21, 2003
From: MERCEDES, BUENOS AIRES, ARGENTINA
Status: offline
|
I have tried with US, iontophoresis and eccentric training. And I was not lucky. Now I will try with LB mobs because the patient also feel LBP.
_____________________________
LEANDRO ESAIN, PT.
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 6, 2006 9:43:00 AM
|
|
|
physiosteve
Posts: 18
Joined: December 4, 2004
From: Canada
Status: offline
|
Ginger,
Would you please outline patient positioning and direction of mobs. Do you mob in prone and do a straight PA, or do you try to mob in the direction of the facet joints (hard as that may be). Or perhaps you use a side-lying method and use a side-flexion/opening technique? I'm curious, and interested to try this on a current patient.
Thanks.
Steve.
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 6, 2006 1:30:00 PM
|
|
|
Synergy
Posts: 592
Joined: March 11, 2004
From: Texas
Status: offline
|
Buddy,
I second your latest post. I have most if not all of my ankle folks perform what you described and it tends to work very well.
_____________________________
Chris Adams, PT, MPT
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 6, 2006 2:01:00 PM
|
|
|
ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
Status: offline
|
"but they seem to do much better after a week or two of performing the exercises."
"I have most if not all of my ankle folks perform what you described and it tends to work very well"
Compare that to,
Perform mobs to L5S1 and the pain and palpable tenderness will be felt to improve as facet joint mobility is improved . Noted by therapist as reductions to the resistance to passive movements of mobilisation and by patient as reductions (and ultimately cessation ) of pain associated with mobs.
During testing by stretch to achilles and by palpation during the course of a typical 30 to forty minute treatment, pain will be considerably reduced and possibly eliminated.
What this demonstarates is a temporal relationship between pain and facet joint mobility, a little bit like the temporal relationship that can be demonstrated when a person is watched while eating a hamburger.
The hamburger is put up to the oral cavity, movements of the persons jaw is seen to relate to the decreased size and ultimate dissapearance of the hamburger.
We could conclude that it is possible that the hamburger went down the throat of the eater, or rather that there is a strong temporal relationship between jaw movements and the apparent loss of the hamburger. Duhhh.
or maybe, heres a leap forward in logic
he ate the burger!
And maybe,,,, achilles tendinosis really is a referred event.!!
wonders never cease .
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
|
|
|
|
|
Re: ACHILLES INFLAMMATION AND PAIN - April 6, 2006 2:30:00 PM
|
|
|
ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
Status: offline
|
Steve j.
method.
Manipulations will not bring about a sufficient reduction in paravertebral tone and subsequent loss of inflammation to joint and nerve at L5S1. Mobs work very well however, the effect is far more long term than for just pulling joints apart.
patient prone, thumb positioned between sacrum, spinous process and ilium, oriented with tip pointed at a 45 degree angle. considerable pressure of the thumb will be required to produce pain at L5S1. continuous mobs for a period from one minute to ten will see reductions in tone and loss of joint pain as previously described.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.125
|
Printable Version
