Pilates For Achilles Tendinitis

Heel pain can occur at either of two places: the bottom of the heel or the back of the heel. The heel bone, the calcaneus, is the largest bone of the foot and bears our full weight during part of each stride. The painful heel, in almost all instances, is caused by excessive strain on one of the two major ligaments, and the pain occurs where these ligaments attach to the bone.

First, the Achilles tendon attaches at the back of the heel. This is the strongest tendon in the body and connects the muscles on the back of the calf to the heel. The force of contraction of the calf muscles enables us to stand on tiptoe and gives an extra thrust as we walk. Damage to this tendon attachment is called Achilles tendinitis. Frequently, there will also be tears in the tendon itself or in the lower part of the muscle.

Second, the heel spur syndrome affects the bottom of the heel. This is where the ligaments that make up the arch of the foot attach to the heel bone. These ligaments function like a bowstring to arch the foot, so they are under pressure every time we stand or step. If a problem at the bottom of the heel persists, calcium may develop in the inflamed area where the ligaments attach. The presence of the calcium spur may or may not cause additional pain. Many people have pain without visible spurs on X-ray, while others have spurs but no pain.

Usually heel pain is a simple result of a minor and forgotten injury. Unfortunately, since we strain the injured part every time we walk or stand, these problems can become a vicious cycle in which there is more injury, more inflammation, more injury, and so forth.

Rest, avoidance of further injury, and gradual resumption of activity as the pain subsides are indicated. Non-weight-bearing activities like swimming can be continued full tilt.

For Achilles tendinitis, rest the foot or feet. Use a shoe with a high heel wedge and a lot of padding, since this limits the stretch on the tendon. Warm up and stretch carefully for 10 to 15 minutes before exercise. Exercises such as tennis or walking uphill are not good; these stress the tendon. Remember that tight muscles on the back of the leg put extra strain on this tendon, so warm up with gentle toe touching or other stretching exercises for the calf muscles.

For the heel spur syndrome the activities to avoid are ones that cause pounding on the bottom of the heel. Heel padding will help, but support for the arch is even more important since this takes tension off the ligaments whose job it is to hold the arch. A strap around the foot at the level of the top eyelets on a shoe, secured firmly but not tightly by Velcro, can give good relief. Commercially made running shoes are sometimes very helpful. In most of these shoes the cushioning air cells break down after a few months, so you should change shoes even before they appear worn out. Don’t worry about wearing a silly-looking shoe; forget fashion and concentrate on getting well. This kind of problem can take a year or more to resolve, or it may go away quickly. Keep trying.

Achilles Tendonitis:  Tampa Dr. Nelson Mane provides treatment with High Power Laser

Achilles Tendonitis is generally a condition which affects weekend warriors and athletes over 30.  These individuals are participating in sports which typically include running and jumping.  A tendon connects muscle to a bone.  The Achilles tendon is located in the lower leg and connects the gastrocnemius and soleus to the heel.  These are very powerful muscles in the calf.   “Itis” is a suffix which means inflammation of.  So in Achilles tendonitis we have an inflammation of the tendon which attaches the major calf muscles (gastrocnemius and soleus) to the heel.  The Achilles tendon is located posteriorly or on the back side of the lower leg. 

In my practice the most difficult aspect associated with treating a patient suffering from Achilles tendonitis is that the patient (runner, soccer player, basketball player) doesn’t want to stop playing his particular sport or activity and wants to return to his chosen form of exercise and recreation immediately.  Standard treatments for tendonitis include rest (to reduce inflammation), anti-inflammatory, Motrin, Aleve, (to reduce inflammation), ice, (to reduce inflammation) custom made orthotics may be used in order to reduce biomechanical stress on the Achilles tendon.

Physical therapies such as ultra sound and electric muscle stimulation may be used.  Rehabilitation may include strengthening and stretching exercises.

High Power Laser Therapy is a little used but highly effective treatment in the treatment of Achilles tendonitis.  Laser Therapy has been shown to increase bone and cartilage repair, accelerated healing, increase circulation, reduce inflammation and scar tissue as well as reduce pain.  High Power Laser Therapy as a tool in the treatment of Achilles tendonitis that allows a properly trained physician with experience and training regarding treatment of biomechanical injuries to the lower extremity (leg) and High Power Laser Therapy can accelerate the athletes repair and return to their chosen activity.  High Power Laser Therapy can also reduce the possibility of further injury by reducing the formation of scar tissue (a weaker grade of tissue) and repairing the Achilles tendon injury.   Most doctors are not aware that High Power Laser Therapy exist and therefore cannot use this to help treat these patients.  Below are a couple of articles from the scientific literature specifically dealing with Achilles tendonitis with laser therapy.

BACKGROUND: Eccentric exercises (EEs) are recommended for the treatment of Achilles tendinopathy, but the clinical effect from EE has a slow onset. HYPOTHESIS: The addition of low-level laser therapy (LLLT) to EE may cause more rapid clinical improvement. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 52 recreational athletes with chronic Achilles tendinopathy symptoms were randomized to groups receiving either EE + LLLT or EE + placebo LLLT over 8 weeks in a blinded manner. Low-level laser therapy (lambda = 820 nm) was administered in 12 sessions by irradiating 6 points along the Achilles tendon with a power density of 60 mW/cm(2) and a total dose of 5.4 J per session. RESULTS: The results of the intention-to-treat analysis for the primary outcome, pain intensity during physical activity on the 100-mm visual analog scale, were significantly lower in the LLLT group than in the placebo LLLT group, with 53.6 mm versus 71.5 mm (P = .0003) at 4 weeks, 37.3 mm versus 62.8 mm (P = .0002) at 8 weeks, and 33.0 mm versus 53.0 mm (P = .007) at 12 weeks after randomization. Secondary outcomes of morning stiffness, active dorsiflexion, palpation tenderness, and crepitation showed the same pattern in favor of the LLLT group. CONCLUSION: Low-level laser therapy, with the parameters used in this study, accelerates clinical recovery from chronic Achilles tendinopathy when added to an EE regimen. For the LLLT group, the results at 4 weeks were similar to the placebo LLLT group results after 12 weeks.

PMID: 18272794 [PubMed - indexed for MEDLINE]

Physiotherapy Science, University of Bergen, Bergen, Norway. jmbjor@broadpark.no

BACKGROUND: Low level laser therapy (LLLT) has gained increasing popularity in the management of tendinopathy and arthritis. Results from in vitro and in vivo studies have suggested that inflammatory modulation is one of several possible biological mechanisms of LLLT action. OBJECTIVE: To investigate in situ if LLLT has an anti-inflammatory effect on activated tendinitis of the human Achilles tendon. SUBJECTS: Seven patients with bilateral Achilles tendinitis (14 tendons) who had aggravated symptoms produced by pain inducing activity immediately before the study. METHOD: Infrared (904 nm wavelength) LLLT (5.4 J per point, power density 20 mW/cm2) and placebo LLLT (0 J) were administered to both Achilles tendons in random blinded order. RESULTS: Ultrasonography Doppler measurements at baseline showed minor inflammation through increased intratendinous blood flow in all 14 tendons and measurable resistive index in eight tendons of 0.91 (95% confidence interval 0.87 to 0.95). Prostaglandin E2 concentrations were significantly reduced 75, 90, and 105 minutes after active LLLT compared with concentrations before treatment (p = 0.026) and after placebo LLLT (p = 0.009). Pressure pain threshold had increased significantly (p = 0.012) after active LLLT compared with placebo LLLT: the mean difference in the change between the groups was 0.40 kg/cm2 (95% confidence interval 0.10 to 0.70). CONCLUSION: LLLT at a dose of 5.4 J per point can reduce inflammation and pain in activated Achilles tendinitis. LLLT may therefore have potential in the management of diseases with an inflammatory component.

PMID: 16371497 [PubMed - indexed for MEDLINE]

PMCID: PMC2491942

The advantage of High Power Laser Therapy over low level or cold laser is its power.  In laser physics power equals penetration.  The increase power allows the treating doctor to reach and   saturate the deeper target tissues with the light energy which creates the healing effect.

Dr. Mane is a board certified chiropractic orthopedist and neurologist.

For more information about the treatment of Achilles tendonitis with High Power Laser Therapy or about Dr. Nelson Mane D.C. please visit our website at http://www.manecenter.com/neuropathy.htm. 

Dr. Mane offers one on one consultation for Achilles tendonitis Sufferers.  If you are interested in scheduling a consultation please call 813-935-4744.