- Achilles tendinitis, tendinopathy,
we've made a number of videos on this already.
- Uncommon. - Yep.
And we're gonna do a little update here.
There's been a little bit of debunking going on
in the world of cross- - Controversy.
- Yeah, with our treatment,
and so, we're gonna address that as well-
- We gonna defend it.
- Yeah, we're gonna tell you what we really think,
and what really works.
So- - Our opinion.
- Good luck.
Oh, stay around to watch us though.
♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ on the internet ♪
- Okay, Achilles tendonitis, tendinosis, tendinopathy,
we've got the Achilles tendon, there it is.
One of the largest tendons in the body.
It gets irritated from overuse, maybe from weekend warrior,
getting that tendon to actually become painful, swollen,
and oftentimes when that happens,
the tendon will actually get a buildup
or a mass on it.
- Right?
- I've seen that. - Associated with that.
It can be very painful,
it can keep you from walking,
it can be painful when you get out of bed in the morning,
when you first put weight on it,
and you need to get it under control.
- So, what should you in bed, Brad, when you first wake up?
- That's very good.
If you are one of those people
that when you get up and you stand on it,
and you take that first step and it you're limping,
you're gonna actually-
- Do we a little stretch. - Yep.
Actually you can you just start out with some-
- Range. - Ankle pumps.
- Right? - There you go.
If you want to give it a little more of a stretch.
- You should actually grab onto it.
- There you go.
Yep, just sit down out,
I normally wouldn't be sleeping with my shoes on,
so, yeah.
- This is a little more realistic.
- Yep, stretch it, and then you can actually give it
a little gentle massage, okay?
Now, this isn't the massage,
we we're gonna treat later with it,
but just to get the blood flow moving.
Okay, number two, this one's pretty basic, Bob.
Avoid activities that irritate it.
So, if walking is pretty painful on it,
I'm gonna suggest you actually get a crutch,
or a cane out, and take some stress off it.
- Some people will put a little heel wedge,
just in the shoe on that side.
- Right, yep, so just a little spacer,
like a piece of carpet.
- Yeah, kinda carpet heel.
- Yeah, I've used cardboard,
layered up cardboard, that fit just under the heel,
and that- - It's temporary, so...
- Yep, raises it up, puts a little slack on the tendon,
and it's temporary until it feels better only a few days.
'Cause otherwise you got a leg length difference problem.
- Good, the next one, address the calf muscle.
- If that's tight, it's gonna put more stress on the tendon.
So, you wanna make sure this is loose.
- And that may be the reason, why you got the tendonitis,
is because your calf muscles were tight.
So, we're gonna show you a couple different options
to do it.
You can massage that calf muscle by hand,
and that can work good, you may find a tender spot.
I know on mine, it's outside,
it's gonna vary on different people,
but you're gonna spend some deep tissue massage
with your hands until your fingers get sore.
- They fall off. (brad laughs)
- Yeah, you wear your fingers out.
We're gonna show you a couple other options,
if you have a massage gun, or a six-inch roller.
Go ahead, Bob.
Okay, if you happen to have one of these six-inch rollers,
you can start with that one.
And it doesn't matter what density, it's usually a medium,
or a hard one.
And if this is my muscle and I go across,
and I can find...
Sometimes it toes up, you turn to the side,
you'll find the tender or knotted area.
Once you find it, then you're gonna work on that.
And if you need more pressure,
'cause this is a little painful,
but you'll know what's the right thing,
is after about 30 seconds, it starts to feel better.
You're actually releasing the tension in that muscle.
You may go more aggressive by doing this,
putting the good leg over the top,
and continuing to work it.
You may do this two to three minutes or even more.
If you have a massage gun, Bob's gonna talk about that.
- A lot more effective, I think, Brad.
So, I have found the massage gun is by far,
the most effective way to do this, Brad.
I mean, it's really easy to do,
easy on hands and effortless.
So, this is the EM19, by the way,
which you could find in Walmart.
- There you go.
But this is something you've been doing for quite a while.
- Right. - Yeah.
'Cause you got a tight calf thing going on.
- [Bob] So I do before exercise,
and also at night before I go to bed.
- [Brad] Right, yep.
- [Bob] And it's got five different heads.
- Yep, well five heads, they look all similar like this.
And the nice thing about this is,
you can use it for every part of your body,
except for your neck.
You're not gonna use it and-
- Back, shoulder, chest. - Yeah, it works well.
There you go. - Don't you all?
- All right, next one.
Okay, Bob, this next treatment, one that we've been very...
We promoted it quite a bit over the years.
Lot of success.
However, there's a little turmoil in the therapy world,
with some studies that have been out in the recently,
is that, this cross-friction massage technique
on the Achilles tendon is a big no.
- Right. - However the...
I found a study in 2019,
our previous video that actually promoted the massage,
as well as the eccentric strengthening,
we'll get into that.
But, Bob, you wanna talk about your feelings on this?
- Well, I mean, I have used this on 100s of people.
I mean really literally 100s of people,
and it's always,
almost always been effective if they do it right.
- So, I didn't read the study that debunked.
But we just know from our clinical experience,
and anecdotal experience.
Now, let's show how we do it.
- Well, one thing
you don't want to go across the back of the tendon.
You actually want to go on the sides of the tendon,
like you do a pincher grip.
- Yep. - So you go back and forth,
like you're a saw, back and forth.
And if it's really tender, you keep doing it.
It gets worse and worse, you stop.
It's too early for it.
- And we usually use that 20 or 30 seconds.
After that time, if it still hurts and it's painful,
you need to stop, it's not ready for it.
- But if it starts to feel a little bit numb,
or better or decrease the pain, then you keep going.
You can do 15 minutes a day.
- Sure.
- And if you can tolerate that much-
- I just wanna emphasize for those people like me,
if you've little bits good,
you're not gonna jump into 15 minutes.
Take your time, progress day to day.
And so, you're...
Let's just look at that again, Bob, there we go.
- Pinch, back and forth saw. - Yeah.
- And you're really pinching in there,
really grip it down on the tendon,
and doing cross-fiber massage.
- Yep, okay well.
And we've had success with them.
We would not promote it, if we didn't.
- It's one of my favorite treatments.
- Yeah, so, just be careful with it.
Make sure you don't overdo it the first day, or two.
Build up. - Yeah.
- Okay, what's the next one, Bob?
Walking. - Yep.
- Hopefully you've got the muscle loosened up,
you've got the circulation and the tendon less pain,
and all of a sudden, you don't need your cane anymore,
you're walking pretty good.
Do not jump into running.
- Right. - Or high intensity yet.
You need to progressively build up.
You can do your walking,
when it starts to get painful, you stop.
And then we're gonna get into strengthening next.
Strengthening, Bob.
What's the word for starting out strengthening?
Starts with an "E"!
- Eccentric. - There you go.
Yeah, so, a nice set of steps works really well for this.
Just like we have here,
if you got handrails, you're in a...
What do we call it? - Heaven.
- Heaven, there you go.
- Or Kevin. (Brad laughs)
- There you exercise heaven now.
We wanna do eccentric to get this muscle,
and tendon strengthened again.
'Cause we're actually strengthening that tendon as well,
and getting the fibers lined up, doing this.
Start up here.
Now, I'm gonna take my healthy leg,
and go down, and slowly go down.
That's the eccentric.
Go down as far as comfortable.
You may not be able to go down all the way.
Other foot goes on, lift up, the way up.
There's little-
- So you strengthen as you lengthen.
- Strengthen as you lengthen.
There you go. - Right.
- There's two, am I gonna go up?
So, you get the idea,
and you need to have a pair of shoes on,
so you grip to the steps.
And by the way, I need to point out, Brad made these steps.
Isn't he handy?
- [Brad] Well, Bob, it's just one of those things,
that's kind of a curse. - [Bob] Amazing, Brad, yeah.
- [Brad] Yeah, well, it was a nice project.
- [Bob] I curse, right?
- So, when you can do 10 of those,
and it's not painful, things are going good,
then you can progress to both feet.
Up and down. - Sure.
- Concentric and eccentric - Right.
The goal is that you get full range of motion
down without pain.
You may start out in the neutral position,
again same with the eccentric concept and work that.
And as you do this,
you're gonna find walking's getting better.
If you're runner, you're gonna start out jogging,
maybe jogging, walking, jogging, walking.
And for those people who are high-end athletes,
maybe doing some jumping,
anything that is more aggressive, tennis, soccer, et cetera.
We're not gonna get into the advanced strengthening,
which we do have videos on.
- That would be another video.
- Yep. - Right.
- We have some videos, Bob and Brad,
on ankle strengthening for the athlete,
I believe is what the name of it is.
You'll see it, google it,
and many alternatives will come up.
And once again, Bob, I think this does fall into the-
- We can fix about anything-
- Except for a... - Except for a broken heart.
- Yeah. - It's on this side, right?
- Is that far over?
Yeah, that's good now.
- That's close enough close center.
- Yeah, we just had a nice video on heart attack.
So, but that's another story.
- I'll pass it, Brad.
(both laughs)