♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
(Bob clapping)
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous
physical therapists on the internet.
- In our opinion, of course, Bob.
- Today we're going to show you
how to fix Achilles tendinitis,
absolute two best self treatments.
This is updated one, right?
- It is, Bob.
- It's science-based.
- That's right.
- Brad did his research.
- My homework. You better believe it, Bob.
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Go to the giveaway section.
This week we're giving away our exercise bands
and the wall anchor.
- Oh, the whole works, huh?
- [Bob] Yeah, the whole kit and caboodle.
- Sure enough.
- [Bob] See how it attaches to the wall?
We send you four of those, right?
Yeah, I believe that.
- Four. Not just two, not just three, but four.
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if you want a 60 second version of our program.
- And we're at podcasts now, right?
- Oh yeah, we got podcasts.
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- All right, so the Achilles tendonitis.
Bob, I was looking at our comments as I normally do,
and someone commented,
"You cannot do eccentric exercises to fix the Achilles.
It's now found that that's causing damage."
And I thought, "Wow."
- Yeah, because this is...
- We can't give information that's going to cause damage.
- In the therapy world, we've been hearing this for years,
"Eccentric strengthening is better for an injury."
And it's basically you're strengthening the muscle
while it lengthens.
- Right. So anyways, I went to the research
and I was looking through things.
I found out a lot of articles supporting it,
and actually recent ones.
And I found one that said eccentric was questionable.
It was one of those things where
it needs more research, which...
- They always say that.
So I did not find anything
to say it was damaging, and a lot worse...
- It's hard to believe that it would be damaging.
- I mean, there could be if...
there's always circumstances,
but you do it properly and follow the guidelines,
you'll be fine.
- I think when you do plyometrics sometimes...
- Oh, right.
And that's a lot of eccentric strengthening,
but you can really tear a muscle pretty easily.
- But the way we're going to show them, it's very safe.
And then I found this Bob, this article,
2019 in Orthopaedic Journal of Sports Medicine.
They actually compared eccentric strengthening.
They went to the two of the best treatments that...
good treatments, and they thought they'd compare them
versus pressure massage.
So that caught my attention,
because we promote that as well.
- We promote massage, yeah.
- And they concluded that both the pressure massage
and the eccentrics were very beneficial,
and actually the pressure massage slightly more.
And I found some other evidence saying
that pressure massage is good for reducing pain,
realigning the scar tissue, et cetera.
But it doesn't have anything to do for strength.
You can't just... you got to strengthen it.
And so, the eccentric, we're going to go through that, too.
- So basically the two best treatments
are what was in that study.
- Yeah, exactly.
That's the way we're looking at it.
And from our personal opinions, we concur...
- Yeah, we've treated many cases of this, so...
- So, it's three minutes into the video.
We better get to the exercises.
- All right, do you want to start with massage?
- The massage, yeah, let's do that first.
- So this is... was founded by James Cyriax,
orthopedic surgeon.
It's called cross-fiber massage.
So here's the tendon right here.
I don't know if you can see it.
And what you're going to want to do is...
It's called cross-fibers, so you're going across the fibers.
The fibers run this way.
My finger's running across it.
Now what Cyriax says is that with Achilles tendinitis,
most often the problem is on the sides of the tendon.
Occasionally it can be underneath the tendon.
Which makes it harder...
- [Brad] More difficult to get to, yeah.
- [Bob] But it's not on the back of the tendon.
So you're going to take your hands,
take a pincher grip, and you can just go back
and saw back and forth on that area.
You'll find the tender spot,
and what you would like to feel
is that as you start doing that,
it actually numbs, or it maintains the same.
If you do this and it just keeps getting worse,
you're probably going to have to ice for a while
or rest for a while.
- [Brad] So you start the massage. Oh, it hurts.
But after 20 to 30 seconds,
if it's calming down or starts that numbish feeling,
that's good.
But like Bob said, after 30 seconds,
if it continues getting worse, you got to stop.
It's not the proper treatment. It's not ready.
- [Bob] Now what Cyriax...
The thing is, you can do these,
he can often recommend doing these massages
for long periods of time, 10, 15 minutes,
which is difficult on your hands.
And that's why if you want to go an option
of a mechanical massager, we'll show you that, too.
- [Brad] One thing I do want to mention is often times
you're going to find a lump in there
where that scar tissue is forming
and it's getting on top of each other.
So don't get excited if you feel that.
- Yeah, you may actually visually see a lump.
I actually... treating a neighbor kid
who was a great runner, a fantastic runner,
and it sidelined him, Achilles tendinitis.
He had a big lump there.
He kept rubbing it, it actually went down.
- Broke up that scar tissue.
- It broke up the scar tissue
and he was back to running again.
- So the other thing we don't want to forget
is the muscle above.
If you got that Achilles tendon flared up,
oftentimes the muscle above gets tight.
When you have a tight calf muscle,
the soleus and the gastroc,
that just puts undue stress on that.
So we want to show you some quick options.
- If the calf is tight,
then it's going to put more stress on the Achilles tendon.
- You can do manual massage.
- Same thing.
- On here, and find that tight spot and work it.
I'm not going to get into too many details on that
because I really think
your thumbs are already tired
from doing your Achilles tendon massage,
but you want to keep those muscles loose.
If you happen to have a foam roller,
it's the easy way to do it.
And it's not that expensive.
- [Bob] What's nice is you can hit both at the same time
if you wanted.
It's a quick way to...
especially as a maintenance thing
or a preventative thing, I think, Brad,
I think you're going to have to do the...
get in there and do the cross fiber for it to get better.
- Yeah, on the tendon itself.
This is just an adjunct to it.
You can see I've got my weight, my butt in the air,
I've got my leg crossed,
and that's probably as most aggressive you can do
with a foam roller.
It may be too much.
- [Bob] Right. To start.
- Yeah, you may want to...
I got a cramp in my tricep.
Can you imagine that?
Aging process sucks, Bob.
And go like this, and then progress to one foot on there.
And then you can go over to one side and rotate.
You'll get a feel for it.
It's a good way to get to learn your body and anatomy
in that part of the body.
Now, the easy way to do the massage on the Achilles tendon,
as well as the muscle belly, is using a massage gun,
they're very popular.
Prices are coming down.
Quality is going up.
They're wonderful devices.
So I'm going to get this one going.
This one has the round head.
They give you...
- [Bob] They come with five heads.
- Five different heads, typically.
Now for this treatment, what we've discovered...
Now this field goal head, what we call it,
we found no good use for it.
Except for this.
But there may be some other ones.
- [Bob] Maybe go along the side.
- I read that on a comment, too.
- [Bob] Sure. They liked it for that.
- [Brad] Yeah. But I got my shorty socks on.
You're not going to go straight in on that.
It's going to be pretty aggressive.
We're probably going to start at an angle.
- [Bob] You're still hitting the side of the tendon,
but you're not going directly on, like a drill.
- [Brad] Yeah, you're probably not going to go
directly on it like this and hammer away on it.
- [Bob] You wouldn't want to do that anyway,
because that's the back of it.
We want the side.
- [Brad] So working the side.
Start out, again, the same rule with the gun
as with the manual.
It may hurt at first, but after 20 to 30 seconds,
should just start to feel good,
or that numbish feeling, but not worse.
If it's worse, you got the gun working too hard.
You're working it too hard.
You may want to just avoid it,
and then come up on the muscle and get the muscle.
Now the muscle belly here, you can get in square with it.
- [Bob] Yeah, you can go at it.
- [Brad] I know with mine,
there's always a spot right in here that, even my...
I'm healthy, it's a tender spot,
it's like a trigger point. Oh.
- [Bob] Probably a little strain there.
- [Brad] There could be.
- [Bob] Now these are two different massage guns,
by the way.
This one's a little more portable. The little mini one.
Isn't that cute?
- [Brad] It is. It's amazing the strength that it does have.
- Yeah. My son came home for Thanksgiving
and I had one in the house, and he's got this one,
but he loved this one because it just...
He says he can get his hand on there so well, and...
- [Brad] You can put it in your suitcase better.
I had that happen once just a few weeks ago.
Now this again, the field goal is really nice.
It gets around that tendon, gets on the side.
- [Bob] But you can go right onto the side.
- [Brad] Yeah. Just be careful
when you get up by your ankle bones,
those malleoli bones, you don't want to push in there.
I mean, you're going to feel it.
It's going to be uncomfortable.
- [Bob] It'll let you know.
- [Brad] So you're going to have to be gentle around there.
Back in here, you can get a little more aggressive.
You worked that as needed.
I did see one continuing ed I had,
they talked about instead of going across the fiber,
that you can work with the muscle they called it...
- [Bob] I've noticed though, over time,
Brad in the therapy field,
there's always going to be a contrarian.
- [Brad] Yep. They called it stripping,
that you strip the muscle.
Actually, that was done manually.
I'm thinking do what your body tells you to do.
- [Bob] Right. You certainly aren't hurting anything
by doing the stripping too.
- And that may be the case.
If you don't have scar tissue up there,
you're just trying to loosen up the muscle.
- Yeah, it might be good for flexibility.
- Exactly.
- Pliability.
- Now let's go to the eccentric aspect of the game.
I'm going to show you on...
You got to have your shoe on,
it works best if you're going to do it non-weight bearing.
And I found these loop straps work really well,
with the exception of the skinny one.
If you've got a set of them,
they have one little baby one,
and it doesn't matter
because it's too weak anyways for most people.
I'll use the red one so it's easier to see.
And it's best with the shoe on.
So with eccentrics, I'm going to start with it down.
I'm going to pull resistance and slowly let it out.
- Yep. He's working it on the way back.
And then he lets go.
- Yep. And slowly let it back.
- Yeah. When he lets it go down again,
he's not giving any resistance to it.
- Now if you're doing this one
and you maybe have to go to the heavier resistance
or double this up,
it's probably time to go to the full weight bearing.
This is an early strengthening exercise.
Do a set of 10 to 15,
maybe a couple, three of them.
By then, you're going to need
to get your body weight into it,
which is going to be the primary treatment
for the most of your rehab.
- Now don't do it on a flimsy step like this, normally.
Go to your steps,
anywhere you have a railing you can hold onto to.
Brad's going to use the Booyah Stik.
Do I need to hold this, Brad? Or is it going to...
- Bob is like my wife, always worried I'm going to get hurt.
He cares.
- I wonder why.
- [Brad] I'm going to go like this,
and I'm going to let down slowly.
And the nice thing about going off the edge of a step
is you get the full range of motion to go past neutral,
where my ankle is now.
Then I'm going to take the weight off with the other foot.
Now I'm going to put weight on my right leg...
- [Bob] So again, there's stress on the way down
on the right.
On the way up he's putting stress on the left.
He's not working it on the way up too.
- [Brad] This really works best when you have a handrail
on both sides, on a stairway.
You can see I'm fumbling around with my Booyah Stik even.
And down we go.
Now, you do that and things are feeling stronger,
you're not having pain when you walk,
you're ready to start jogging.
Then you can progress to your full non-eccentric,
concentric with eccentric, three sets.
- Doing both ways.
- [Brad] Yeah, exactly.
- Strengthen on the way down, strengthen on the way up.
- [Brad] And then I would have a shoe on both feet.
And then I would go up to three sets of 10.
Once that's too easy,
then you can go to one foot only and work that
with a full eccentric/concentric.
So by that time, things are going quite well.
Everything is healed up well,
and you're just strengthening
for those high level activities.
- Well, there we go.
We got you the two best ones.
You think it wouldn't last 13 minutes, but it did.
- I know, Bob. I don't know.
I guess we got to take a babbling class.
- Loquacious.
- Yeah. What?
You've been studying again. Take care.
- Thanks for watching.