Achilles Tendinitis

The Achilles tendon — a strong fibrous cord that connects the muscles in the back of your lower leg (gastrocnemius and soleus) to the back of your heel (calcaneus).This large tendon helps you point your foot downward, elevate on your toes and push off your foot as you ambulate. Every time you move your foot, chances are you are utilizing your Achilles tendon. Under too much stress, the tendon can become overworked. This generally leads to inflammation or tendonitis. If not addressed this inflammation can produce scar tissue thus decreasing the range of motion in the tendon. This can lead to more problems. If you overstretch your Achilles tendon, it can tear (rupture). A rupture can be partial or complete. Usually the rupture occurs just above your heel bone, but it can happen anywhere along the tendon. A couple other common problems that can occur at the Achilles Tendon include Bursitis . The bursa is a fluid filled sac that secretes lubricant to make movements at the joint smooth and frictionless. Think of it as WD–40 for the body. Inflammation can occur in the bursa between your heel bone and your Achilles tendon. This type of bursitis is called retrocalcaneal bursitis.

Achilles tendinitis is inflammation of your Achilles tendon. 

Symptoms include:

* Pain along the back of the tendon, frequently closest to the heel

* Decreased R.O.M. at the ankle

* Heat or redness over the painful area

* Bump or build up of scar tissue that can be palpated at the tendon

* Snapping noise from scar tissue when movement at the ankle occurs 

Common Causes

* Tight, weak or fatigued gastroc muscles

* Too much, too soon with hill runs or speed workouts

* Worn out or inflexible running shoes

* Individuals who overpronate

* Flat feet

*In addition, injuries can often result from taking part in an activity involving quick directional changes for which you're not conditioned or for which you haven't stretched properly. Playing tennis, racquetball or basketball for the middle–aged weekend warrior is very common for this particular injury. 

Treatment

* Stop running (if you are a runner)

* Apply cold therapy 15 minutes several times a day until inflammation subsides with compression and rest.

* Continue use of cold after exercise to prevent re–occurring injury

* Consider short term usage of aspirin or ibuprofen for inflammation and pain only if approved by M.D.

* Massage the knotted area several times a day

* Stretch the gastroc /soleus area

Work your way back slowly. Do not begin running until strength and flexibility have returned to the area. This is the hardest part for the avid runner and most athletes to swallow. The good news is that the cardiovascular or aerobic component of exercise can still be addressed, only in a more protected temporary environment. Consider swimming or aquatic running /exercise in deep H20 progressing to shallow water along with calf stretching and raises in the pool. Balance training, and directional hops can be added with increased weight bearing as tolerated.Consult your local physical therapist for a complete exercise program. Last but not least, a gait analysis is a vital piece of the rehabilitation puzzle with foot injuries. Along with the initial pain treatment listed above, the use of custom orthotics and/or motion controlling shoes should be evaluated. This can prevent your injury from returning to haunt you in the future.

*2001 Article by Shawn J Hickling B.S. P.T.A*   This article may not be re-printed without proper permission.

Ankle Sprains

Immediate Care The immediate care of this injury encompasses the first 24 hours post–injury. The goals of this first stage are to limit the amount and severity of any swelling, limit any pain, and, by immobilizing the joint and having the athlete use crutches, prevent any further injury. Immediately after the evaluation of the injury, treatment consists of ice (cold), compression, and elevation (I.C.E.). This consists of repetitive bouts of cold for 15 to 20 minutes, with 30 or so minutes without ice between applications. Compression should be applied and the leg elevated. When the player is sent home for the day or night, he should continue this routine. At this time, it is also important that the joint be immobilized and the player is weight bearing to tolerance on crutches. Immobilization can be accomplished with a bandage, brace posterior splint, or tape. Open–gibney ankle taping in particular provides compression and allows the damaged tissue to begin healing in an approximated or shortened position. The tape can then be removed during icing to better facilitate the transfer of cold to the injured area, but after the ankle has been iced, it should be rewrapped or taped.

Post Immediate Care This stage of treatment usually includes the time period of 24 to 96 hours post injury. During this stage, there is still bleeding and swelling occurring within the joint, and the chance of re–injury is still high. The goals for this phase are to decrease any pain the athlete is having, decrease or hold steady the severity of swelling, and begin to restore range of motion. All of these can be accomplished simultaneously. It is important to continue the repetitive bouts of I.C.E. for 15–20minute periods. Gentle active R.O.M. in combination with the cold treatment may also be used along with the start of gentle calf stretching. Positive galvanic stimulation (bouts of 10–30 minutes at a tolerable setting), interferential current (20–60 minutes high pulses/second {pps}) and microcurrent (30–60 minutes high pps) have been shown to be successful in limiting pain and swelling post–injury. In addition a portable TENS unit can be used to help with the athlete's discomfort while away from the treatment room. A splint and crutches should be continued for ambulating with continued weight bearing to tolerance.

Early Care The early care phase usually runs from 96 hours post–injury to roughly 7–10 days. During this phase, the goals continue to be to control and reduce swelling, regain ROM, and facilitate healing, with the added goal of beginning to strengthen the area. Because the active bleeding in the joint has decreased, you can now introduce heat into your treatment regime. This can be in the form of a “contrast bath” or “contrast treatment," where the athlete will alternate between heat and cold exposures. The contrast will act to pump the swelling out of the joint. Alternating bouts of hot and cold in a 1:3 or 2:5 manner, sandwiched between 10 minutes of cold, are the most common (that is, start with 10 minutes cold, then 1 to 2 minutes warm followed by 3 to 5 minutes cold. This cycle should be repeated 6–8 times, finishing with 10 minutes cold. The athlete should perform passive stretching and active ROM while treating to help pump the swelling from the joint. Use of negative galvanic stimulation, microcurrent and interferential, can also be used to facilitate swelling reduction, pain control and tissue healing. Since there is still a chance of injury outside the treatment setting, it is important that the athlete continue using the splint and crutches with weight bearing as tolerated.

Reprinted with permission from Training and Conditioning Magazine, April, 2001. By Rick Guter, ATC, PT, Head Trainer with the MLS's D.C. United.

Common questions about your wrap?

SHOULDER SIZING : ActiveWrap's Sm-MD shoulder ice wrap is the popular choice for youth, women and small frame individuals. The main difference is in the arm sleeve opening and the shorter adjustable chest strap with this model. If you happen to be a smaller frame bodybuilder with large arms please opt for our LG-XL size to accomodate your build.  For most adults the best choice is the Lg-XL size for versatility.

  FOOT AND ELBOW SIZING: - ActiveWrap Foot-Ankle-Elbow models can hold 2 packs comfortably in a wrap however  smaller feet can fit 3 packs with one on top of the foot. Often times only one pack is needed during treatments (such as Tennis Elbow, Achilles or Sever's injuries) allowing you more size flexibility and the freedom to cycle the other two packs in and out of the wrap for additional treatments. This allows for ice that is always ready without the wait for re–freezing. Support can be worn to increase warmth and circulation to the joint without thermal inserts.

Sizing Measurements

• Xs Childs 3 and under; Childs elbow under 60 lbs SPECIAL ORDER

• Small/Md Mens 3 to 10; Elbow use under 165lbs Wmns 3-11

• Large/XL Mens 10 and up;Wmns 11 and up; Elbow use over 165lbs

KNEE SIZING: In general, most kids, women and men under 140 lbs will fall under our Sm/Md size. To make certain, simply measure 3 inches above the knee and if you are under 17 inches around you will take a Sm/Md.

Everything over 17 inches we suggest a Lg/Xl wrap. All thermal inserts are the same 7 x 10 inch size regardless of wrap size. Our Lg/Xl wrap is equipped with extra long compression straps to handle larger size legs and increased wrapping for more support to the joint. For mild support: Sit in chair with knee in slight flexed position. Align centerline of support thru the knee cap. Wrap straps directly above and below the knee cap and directly over top each other. Fasten with hook to plush strap as desired. This will give you more knee flexion during activity. For reduced ROM and increased support, wrap straps around knee overlapping each strap by about a 1/4". Spiral straps (top and bottom) to cover patella snugly. Secure hook fastners to plush strap and position as desired for added compression and support. 

WRIST/HAND SIZING: Our wrist/hand wrap is a universal one size fits most wrap. The design is optimally applied with one therapy pack during a given treatment however you can utilize 2 with one pack on top and one on bottom if desired. The wrist support is an effective ergonomic aid for cpu activities when one pad is placed under the palmar surface of the hand. Use without thermal inserts for continuous heat retention to the joint.

BACK SIZING: Our back wraps come in 2 sizes. The XS- MD size fits small children all the way up to an adult waist of 34". The Lg -XXL is built for adult waists 35" up to 54". The product holds one large 7 x 10" hot/cold pack and can be worn for mild to moderate support around abdominal and low back areas. If there is NO freezer available….simply remove the gel inserts from the ‘black pouches” and fill with crushed ice following activity. Remember your ActiveWrap is completely washable.

Common questions

Can I walk with my ActiveWrap Foot Wrap? Answer: YES…around the house. Simply remove the pouch underneath the arch and you have full flexibility of movement during treatment for Ankle, Achilles or injuries to the top side of the foot. Our knee/leg wrap also allows freedom of basic movement without slipping but is not designed for use during a workout.

How long do the packs stay cold ? Answer: ActiveWrap packs are designed to keep the optimally desired cold at the foot (between 40 to 50 degrees) for over 20' mintues when applied. This is a built in safety component of our ice packs. The standard recommended treatment time is 15'. Ice packs claiming to stay cold for several hours at a time are generally chemical based and reach temperatures that can be harmful to the skin and underlying tissue. Remember a colder pack does not mean a quicker recovery.

How do I clean my wrap? Answer: A simple fresh water rinse and hang dry will keep your wrap clean for years to come.

I use ice cubes and an elastic wrap in the gym…why should we use ActiveWrap? Answer: Why did we switch from horse drawn carriages to automobiles? Modern materials and efficiency. Ice is often hard and sharp resulting in discomfort when compressed against the skin. This leads to an individual having to reduce the pressure of wrapping the joint to tolerate a typical treatment. The ActiveWrap allows for a snug–fit combining maximum compression and direct cold coverage to any painful area. ActiveWrap is easy to apply for any age athlete and will save your facility money in the long term with countless re-usable applications. Ice bags tear and cost money along with the elastic wraps or plastic that is used to secure the ice to the body. Gym facilities will further reduce the chance of dripping water on the floor reducing liability risks within the gym by using ActiveWrap. Tips for using hot and cold therapy Dont wait for an injury to incorporate ice into your training routine. Prevent overuse and typical inflammatory injuries by icing down after each workout for 15 minutes. Your cool down phase of training is just as important as a proper warm–up. Do not sleep with an ice pack on your body. Cold therapy and use of ActiveWrap should be no longer than 15' at a time. Do not lay directly as to apply your body weight on an ice pack. Ice during travel by keeping an ice pack or two at the gym and a couple at home. Most gymnastic facilities will provide freezer storage where you can place your handy “black ice packs” in your ActiveWrap drawstring carry pouch equipped with your name. This will save hours of time each week by allowing you or your child to ice down (without the mess in the car)when traveling. Best of all, it will help prevent lost hours in the gym by assisting in the prevention of many inflammatory injuries. If you use the ice and cold therapy alot, it is a good idea to give your skin a rest from time to time to prevent any chance of skin irritation. A thin paper towel is always good between cold and direct skin contact.