GETTING THE ARROW OUT OF YOUR HEEL
Physical Therapy Treatment of Achilles Tendonitis
Tom started having pain in the back of his left heel after working out at the gym. He had no pain while exercising, running, or water skiing, but symptoms would occur later in the day. By the end of the summer, he was unable to walk a round of golf secondary to heel and lower leg pain. Tom was treated by his family physician with medications and rest, but the pain did not go away. He received two injections in the Achilles tendon that temporarily relieved his pain, but symptoms returned in two or three weeks. Tom was referred by his podiatrist to Fenton Physical Therapy for treatment of his Achilles tendonitis.
The left Achilles tendon was sensitive to pressure, and Tom had a build up of scar tissue in the middle of the tendon. His left ankle dorsiflexion range of motion (ROM) was half that of his right ankle. He had pain in his heel and the back of his left lower leg with attempting to rise up on his toes and with squatting. His physical therapy treatment consisted of ASTYM and a program of home stretching drills he performed three times a day. After six sessions, the pain was gone and left ankle active ROM was full range. Four months after discharge, Tom reports that he has been pain free and continues with his daily stretching exercises.
Inflammation and scarring in the Achilles tendon can be a debilitating and difficult problem to deal with. Over the last few years, aggressive conditioning programs involving repeated box jumps and obstacle course type races have brought more Achilles tendonitis cases to our physical therapy clinics. Achilles tendon problems often flare up and then go away with rest and icing. The repeated cycle of trauma and recovery results in a non-flexible scarring of the Achilles tendon. This is believed to be the precursor to a more traumatic Achilles tendon rupture. At our physical therapy clinics, we have found great success with the Augmented Soft Tissue Mobilization (ASTYM) method. ASTYM treatment consists of twice weekly treatment with specialized tools to aggressively mobilize the scar tissue that develops on the Achilles tendon and “kick start” the healing process. This approach encourages the patient to be active and engage in a functional stretching program instead of immobilizing and resting the lower leg. The ASTYM tools allow greater intensity and accuracy with manual therapy treatment of the lower extremity. The patient generally participates in eight sessions of therapy and is instructed on a home regimen of mobility exercises.
Fenton, Linden, and Milford Physical Therapy all utilize the ASTYM treatment technique. Fenton Physical Therapy was the first clinic in Michigan to offer the ASTYM method. We continue to bring our patients the most innovative and up to date Physical Therapy care.
Michael S. O’Hara, P.T., OCS, CSCS
CORE-TEX TRAINING PLATFORM
The New Tool In Our Training And Rehabilitation Toolbox
The latest addition to our rehabilitation and training toolbox is the Core-Tex. This thirty inch round platform floats on three roller bearings that permit it to tilt, translate, and rotate. The tri planar motion of the Core-Tex creates an ideal environment for us to work on retraining our patients’ balance, coordination, and proprioception. It can also be used to create challenging core and shoulder girdle stability activities.
One Stop Shopping For Better Proprioception, Balance, and Coordination
You can improve all three of these critical components of function with one or two Core-Tex activities. Beginners can use the handrail to create a more supportive environment, and as they improve, progress to reducing the assist from the arms. Integrating head movement, arm reaches, and weight shifts into the drills enables the clinician to design activities specific to the patient’s needs.
Keeping The Loads Level
The Core-Tex reveals any deficits in weight distribution. If the patient is unconsciously avoiding loading one side the body, the movement of the Core-Tex platform quickly reveals the flaw. The therapist can then prescribe training to increase tolerance of loading on the affected side and return for re-evaluation on the Core-Tex.
Tuning Up Your Righting Reflexes
Many of the sensors that keep our body in an upright position are located above the neck. I don’t care how strong or flexible you are, if these neural feedback systems do not work properly, you will not move well. Evaluating and improving the function of righting reflexes centers in the inner ear and the neck is a frequently neglected area of rehabilitation and fitness. Incorporating activities that involve moving the head and neck while standing on the unstable Core-Tex platform has proven to be very beneficial in patients with slow reflex response times.
Rotation In The Right Places
Being able to rotate through the thoracic spine and hips is an important aspect of optimal function and pain free existence. Many physical therapy patients have neck and shoulder pain driven by a lack of thoracic spine range of motion in rotation. Deficits in hip rotation produce undue wear and tear and eventually pain in the knees and lower back. The Core-Tex turns 360 degrees and allows us to teach transverse plane motions at the hips and thoracic spine in a fully functional upright, weight bearing position.
Michael S. O’Hara, P.T., OCS, CSCS
“SO WHAT ABOUT CRUNCHES?”
Personal Training Question Number One
I get this question from many of my fitness clients at the end of their personal training or group coaching sessions. Somehow crunches are viewed as an essential part of fitness. Instructional DVDs are sold with an hour of abdominal exercises—I counted 12 different types of crunches and sit ups in one very popular infomercial product. In physical therapy, I get to treat the patients who in a valiant, but misguided effort to regain fitness launch into a series of crunch / sit up exercises only to wake the next day with searing lower back or neck pain. I was recently asked to e-mail my no crunches answer–so here we go.
Most fitness clients are already have earned a black belt in spinal flexion. Their thoracic and lumbar vertebrae are bent forward for many hours a day– sitting too much, driving too much, television too much. Most are proud at how easily they can fold the thoracic and lumbar spine over and “palm the floor”. The last thing they need is to pull the ligaments, discs, and joints of their spine into further flexion with crunches and sit ups.
Your Mother’s Eyes and Your Grandma’s Spine
As we age, our thoracic and lumbar spines tend to fall into a flexed over “crunched” position. Why would you want to accelerate the pace of this degeneration by performing activities that accentuate the slumped over forward flexed spinal posture of old age.
The Other Spot Reducing Exercise
Your abdominal muscles or “six pack” will not become more visible with lots of crunches, sit ups, rip twists, belly blasters, or any other targeted training. There is no such thing as spot reducing. The table push away is the best exercise to improve the visibility of any muscle. Unfortunately, it is the least utilized exercise in America.
A Little Kinesiology
The function of your abdominal muscles is not to create movement but rather prevent movement. They work with a team of other muscles to act as anti extensors, anti rotators, and anti flexor muscles. The six pack muscle or rectus abdominus makes up a portion of the cylinder of muscle that serves to support your spine in tall and stable position–not bend it forward. Think “movement preventers” and not “movement producers”. Crunches and sit ups train your abdominal muscles to do the wrong thing.
The Pros Don’t Use Them
I cannot think of any athletic activity that emulates the motion of a crunch or sit up. It will not improve your ability to run, jump, throw, or compete. The strength and conditioning coaches that get paid big money to make athletes more successful and keep them injury free do not use crunches or other repeated trunk flexion exercises in their programming.
Maybe Not Now, But Soon And For The Rest Of Your Life
Your lumbar spine hates combined flexion and rotation, and it really hates it if you throw in some compression from an exterior load like a medicine ball, weight plate, or kettlebell. Lumbar spine injuries are cumulative. The stresses build up until one day you bend over to pick up a pencil and your back “goes out”. Crunches and sit ups serve to accelerate the rate of accumulated spinal stress. I know you have a friend who does one hundred twisting, medicine ball crunches a day and has never had a problem. I have a friend who has smoked for twenty years and says he feels fine.
Michael S. O’Hara, P.T., OCS, CSCS