♪ Bob and Brad, ♪
♪ The two most famous, physical therapists ♪
♪ On the internet. ♪
- Hi folks I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together, we have the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- I just had a good friend that call me up,
he's having some trouble with Achilles tendonitis,
so I went and saw him.
I thought, this is a good time to review,
what you should do, in the instance when you have this,
and this is the absolute best treatment you can do for
Achilles tendonitis.
- Right, we've had a number of comments coming back, people,
cause we have this video before we're just gonna update it,
make it a little better.
- Yeah. A little more comprehensive.
- Right.
- So, alright.
Achilles tendonitis obviously happens
in the Achilles tendon, which is right here.
It tends to happen about,
2 to 6 centimeters above
the attachment, which is right in the heel right here.
- We draw a line there and we're gonna work right up there.
- Yep.
So it tends to happen right about here,
in the case of my friend now, he had the typical example
of what happens when you could sometimes,
when you get the tendonitis.
It would get better, cause he'd rested,
and then as soon as he'd start exerting again,
it'd come right back again.
- Sure. Yeah.
- He's been fighting this for a year and a half, Brad.
- Oh wow.
- So I mean he's been trying to stretch it
and doing all his things.
He saw a therapist who is working on the calf muscle
but you gotta get down here and work this area
in order for this to get better.
- Sure. You bet.
- This is a cyriax technique,
what you're gonna do is, cross fiber, friction massage.
- Okay? Mouthful, right Brad?
- Yeah, it is.
- All right, and what you're gonna do,
the lesion as they call it,
tends to be on the side of the tendon, not on the back.
Here's the back,
you're not gonna rub there.
You're gonna rub on the side of the tendon, on both sides.
It's like, you're gonna pinch and you're gonna pinch
and you're gonna rub back and forth like this.
Oh, I'm a little bit tender there, Brad.
- Yeah.
- I'm probably pre-injury.
- Maybe you were working out too hard this morning.
- That's right.
So, I don't know if you can see what I'm doing,
but I'm rubbing like this back and forth and
initially it's gonna be very sore, when you do this.
- Right.
- And, and after a few minutes, a minute or so,
- Right.
- you'd like to see that it's, it's stabilized,
it's not getting worse or,
at the very good sign
is it that actually starts to get a little bit numb.
- Right.
- It starts to feel better even.
- So to,
reiterate that Bob's working on that, he's actually
you're putting a fair amount of pressure on, right Bob?
- I start off light, Brad.
- Okay.
- And then I go really, by the end I'm really rubbing hard.
- The big thing, after 30 a seconds to a minute,
if it continues to just hurt more and more,
it's not ready for it.
- Yeah, then you may have to go back to what,
initially when you injure it, by the way,
I want you to ice it for a day or two.
Brad, do you wanna show a easy way to ice?
- Right, you can take a paper cup or styrofoam cup like this
fill it up, almost to the top,
maybe a half inch below and then,
- With water.
- Yeah, with water.
- We better not forget that part.
- Right, put it in the freezer overnight
or whatever it takes to be solid ice.
And then, you can peel off
the cup like that and then it's gonna end up, you know
it's gonna be a shorter cup, like this, broke off.
- The ice sticking out a little bit.
- Yep.
- And I take my palm even and,
smooth it out a little bit.
- Yep.
- And then you can just go like this and just, you can
you can numb this up very quickly this way.
You don't have to sit there with an ice pack,
by the way as another reminder, Brad,
right now let's use this time to remind people,
if you're new to our channel,
make sure you hit the subscribe button.
It's right down there, Brad.
- Yep. Right there.
- Because we do lots of videos on
how to stay healthy and fit.
And we, upload a video everyday, in the evening.
So, look for that.
- Let's get back to the treatment.
- All right, back to the treatment.
All right.
The reason we're doing this is what happens with this,
when it's healing, it heals in a erratic fashion,
you know, it's scar tissue,
so it forms like a web.
- Right. You got that injury
and the scar tissue starts laying down across but
it doesn't lay in a uniform manner,
which it really needs to, to be strong.
- Right.
It's in an erratic fashion
and therefore it easily breaks open
and that's what was happening to my friend.
It heals,
and then he goes,
and does something and it breaks open right away.
- Sure.
- So, it's just very frustrating.
He's like, "I can't do anything."
He says, "You know, I go out to the basketball court and
and it broke right open."
This helps it realign those fibers
and it helps
make them strong.
So when you're doing this,
so how long are you gonna do this Brad?
That's the big question here.
- Well,
- I got a time,
cyriax wants you to do this for 15 minutes.
There's nobody I know that's gonna do this for 15 minutes.
- Your fingers wear out.
- Yeah. So what I recommend instead is, you know
you do a couple minutes at a time.
- Yep.
- And you can do this, you know, three times a day.
He had him doing it every other day.
- Yep.
- And that's probably not a bad idea.
- Sure.
- But on the day you're doing it,
I'd like to see if you can get 15 minutes total.
- Sure. Yep.
I've done that,
I had the exact same problem about three years ago;
worked great.
- Yeah.
- It's just, it's a good technique.
- The only time this doesn't work, Brad,
is if you actually have a tear,
I mean if you have an outright tear,
- A rupture,
- a rupture, it's not gonna
- It's not gonna put that together.
- So this is the key part of the treatment.
You're gonna do, like we said, up to 15 minutes,
really, I can't emphasize enough that, you know
you start off kind of,
you know not too deep or not too hard, but by the end
I'm rubbing as hard as I can.
- Right. Your thumb and fingers get tired.
- Yeah. So, all right.
After, you know, a few days
of doing this and hopefully it's starting to improve,
you're gonna wanna start the stretches, Brad.
- Sure.
- Do you wanna show maybe just a stretch with
a belt first, Brad?
- Yeah.
- Cause that that would not be as, as aggressive.
This helps align the fibers too.
You know, Brad, this helps,
you know put the fibers in the, in the right direction.
- Don't start stretching, too early or too aggressively.
- Yeah.
- It's gonna be a, just a general stretch.
Remember you had some tissues that were,
tore, you know in a small manner,
you don't wanna re-tear 'em,
but you do wanna, not let 'em get tightened up either.
You wanna stretch 'em gently.
- Do you wanna go ahead and show a wall stretch too, Brad?
- Sure.
- And that's one we definitely
wanna do with the knee band to be straight.
- You can do this on off stretch, pressure on, pressure off.
- Pressure on,
pressure off.
- If you wanna do a static stretch,
it's really feeling good,
you may wanna hold it,
but probably not more than 30 seconds.
I usually do the, pressure on, pressure off, myself.
- You wanna do the wall stretch, I'll put my shoe on.
- Can you catch me over here, Lonnie?
Very common stretch.
Most people are familiar with this,
if you have had any activity
in the past with any athletics or sports.
The wall stretch, the heel down here is, glued to the floor.
I always tell my patients,
keep the toe pointed straight ahead
and set it off to the side and just lean forward.
You can do it with your knees straight,
or with the knee bent,
stretches two different muscles.
You might as well be complete and get both of them.
- And if you wanna really
be fancy, you can get a slant board.
- Yes.
- They sell these at OPTP,
we did a view on that.
They have those foam ones, don't they?
- Yep. If you're handy
you can go make one in your garage.
We got a video on that as well,
out of some wood, make sure you do it well.
This feels good, I really enjoy an incline board
and you can bend that knee as well.
- Cause one thing you wanna really keep in mind Brad, is
after this is all said and done,
it's better and it's no longer giving you trouble,
you're definitely gonna wanna stretch and keep stretching,
as you, you know, continue your life
and go into athletics and stuff like that.
- You wanna keep the tissues elastic
and not let 'em tighten up, so they'll be strong.
- All right. The other thing is, again,
once the pain is really diminished,
you're gonna wanna do some strengthening.
- Yep.
- And the simple stretching uh strengthening
you're gonna start is first, just toe raises, Brad.
So you're gonna go ahead.
Are you down, Lonnie?
Okay. She's bringing it down.
- Okay. On the floor.
- Toe raises, you're gonna just go up.
It's just what they say, up on your toes,
and you're gonna do both at the same time to start off with.
- Sure.
Show 'em a profile once, Bob,
so they can see how far the heel's getting off.
There you go.
You're gonna go up as far as you can
or as far as what's comfortable, if you're starting out.
- Okay.
Now, then eventually you could go to,
maybe, you know
single toe raises, like this, but honestly the
best one to do for this, Brad,
is the eccentric strengthening.
- Sure. Yep.
If you're doing toe raises,
you know, a set of 10,
2 sets of 10, as you get stronger,
you can go to 3 sets of 10.
- So what you gonna do is, you wanna do these Brad?
You wanna hold onto something?
- Yep, grab me that PVC pipe.
- This is a good one to do on the stairs.
- All right.
- So, what you're gonna do is,
you're actually gonna, actually, Brad,
just start in the raised up position like that.
Yep, and you're gonna lower it down.
And then, you just go ahead and put it up like this again.
Nope. You don't raise up.
You actually go like this, Brad,
you start like this,
and then lower it down.
Start like this and lower it down.
You wanna show that way?
- Yep.
So up like this
and then you're gonna put weight through it
and go down like this.
Yeah. I'm actually, I actually need more balance to
do this properly, Bob. I would need two things.
That's why I'm having problems.
- Okay.
Cause yeah, you wanna go off the edge if you can.
- Right and then you go all way all the way down.
- So again, show this, show this.
- Here, should I try it?
- Yeah. You're gonna lose your balance too, Bob, I bet .
We're too old for this.
- Yeah.
Now I gotta show 'em.
Okay, so you're gonna start like this,
and lower it down,
then start like this;
it is hard.
- Yeah.
- Lower it down.
So, all the strength in you occurs eccentrically,
is basically what's happening.
- If you're doing this in a stairway
and you have two handrails,
it's much, much easier than us trying to be a gymnast.
- Now, they did a study on this, Brad, and
there was people that had Achilles tendonitis,
that's the only thing they did.
They did that,
twice a day, I believe.
Yeah. Twice a day.
10 times.
- Okay.
- And they did it for uh,
12 weeks.
- Okay.
- Twice a day, for 12 weeks,
10 times,
and their,
and the vast majority of people,
it took away their tendonitis, that alone.
- Without any...
- Without any of the other stuff.
So that's how important this is.
My son had tendonitis.
He's a runner,
and they had him doing this too.
To be honest, I mean,
because he puts in such high mileage,
the thing that did take it away with him was the rubbing.
- Sure.
- And it took it away really quite well,
despite the fact he was putting in, you know,
50, 60 miles a week.
- Sure.
- So, all right.
If you haven't already, like we said,
subscribe to us and remember we can fix just about anything.
- Except for that broken heart, Bob.
- Yep.
- No, it's up there, yeah, that's right.
- That's right.
Thanks.