(uplifting jazz music)
- Hi, I'm Bob Schrupp, physical therapist.
- I'm Brad Heineck, physical therapist.
- And together we are the most famous physical therapists
on the internet.
- In our opinion.
All right, Brad, this is the Bible.
- Right. - Yep.
- Yeah. For physical therapist or one of 'em anyway.
- So, who wrote this?
This is James Cyriax. He was considered
the Father of Orthopedic Medicine.
He was from Great Britain and he's come up
with a lot of techniques that are still used today.
He's been dead for, I bet you 25 years, but yet his
memory still lives on in all the work that he's done.
But today I thought we talked about something
that afflicts many people as they get older.
- Right.
- Sometimes people when they're younger too,
but I have seen a lot of people who try to remain active
as they get older and they end up with this problem
because they end up running or something like that, or
or doing some activities they hadn't done in a while.
And it, it, it ends up causing injury
to their Achilles tendon.
- Right. The weekend warrior thing.
- The weekend warrior.
I see it all the time.
They're very, very common.
And it's something that they never had as a kid, of course;
but when, as you get age 40, 50 and over.
Which by the way, we wanna remind you
if you haven't subscribed to our videos already,
you want to do this on YouTube.
The physical therapy video.
Because we're gonna cover these topics that are
gonna help you as you get older.
- Right.
- How to stay healthy and fit.
- And active. - And active. Yep.
- So the Achilles tendon, what the,
for people they hear but they're really not sure
the anatomy.
Where is it located and what does it do?
- Sure. First, I gotta tell you though.
You know where Achilles's the old,
the old story about Achilles don't you?
- Yeah, go on.
- You remember?
- Yeah. Achilles.
- Greek. - Greekology.
- Yes. - Yes.
He was uh... his mother took him when he was a child,
a baby. She wanted to protect him so, she grabbed him
by the heels and she took the baby.
She dipped him in the river,
which was gonna protect him from harm.
All the way up to the heels, but she didn't cover the heels.
So they, they were, they're no longer protect.
They weren't protected enough.
- Ah!
- So then later on when he got older, he was in battle,
somebody shot him with a poison arrow
into his Achilles heel.
- Yep.
- And that's why that's always used as that reference.
- Right. [Indistinct]
- Achilles.
- Yep.
- There's a movie on that too and
they actually shown 'em getting ah...
- Oh, shot in the heel. - Yeah.
- Yep. Good movie.
- So. Anyway, ah the anatomical term
is actually Tendon calcaneus.
- And um, let's just take a brief look here.
We don't have to go crazy on this,
but here are the muscles that come down of your calf.
We're looking at it.
If I, if I were standing this way.
Okay. So we're looking at this leg and your
this is the back part of it.
- Here's your calf.
Here's your heel.
Here's your ankle standing around the floor.
So we're looking that direction.
- So three muscles actually come together and they, they
they form, they narrow and become a tendon. Okay?
And this is actually the thickest tendon in the body.
Do you know that Brad?
- No, I believe it.
- Yeah. It's a, it's a heavy duty tendon.
So it, it takes a lot to, to injure it
but you're putting a lot of forces through it.
So it narrows up and it becomes a tendon
and attaches to your, your heel,
which is the calcaneus here.
- Let's, let's just get a real body and show this.
- Sure. Let's let's show 'em, right.
We gonna have to do this anyway.
- Yeah. Okay.
- So. - Oh my God. (laugh)
- Yeah. Okay.
- So yeah. Here's the muscle Bob.
- You got this Nancy?
- [Nancy] Yep.
- Muscle narrows down becomes the thick tendon.
Look how thick that tendon is here?
Then it attaches to this calcaneus bone here.
And it actually kind of displays out a little bit
as it attaches there.
Now the injury tends to occur and we'll
we'll discuss this more, but it tends to occur
on the sides of the tendon here.
On the sides, or sometimes on the front.
Never the back. It's always on the sides,
so that's where we're gonna be doing the treatment.
Is on the sides.
And one of the ways to tell whether or not what you have is,
is if you stand on your toes like this
and you feel the pain.
That cause the pain.
Course other activities like running and
and probably even walking, you're gonna feel it.
But the way we're gonna treat this, two ways.
One, you're gonna want to keep it stretched out.
- Sure.
So we're gonna show stretches for it.
But more importantly, we're gonna
show crossfire friction massage.
And this is something you can do your own.
Um, and it's very simple to try and there's not,
you know, there's no harm in trying it.
So if it doesn't help, you can always, you know
go to your doctor or physical therapist afterwards.
- Right. And this is from James Cyriax.
- James Cyriax. Very highly recommended.
So we'll cut away here and get ready
to show you the treatment.
Okay. This is something that I'm gonna show, first
gonna demonstrate me, you know, doing it
to Brad or doing the treatment to Brad.
And then I'm gonna show how Brad could do
the treatment himself.
But what, what we're trying to do here is actually
we're assuming that there are um... they used to
think this was kind of a tendonitis, Achilles tendonitis.
They actually now call it tendinopathy and meaning
that, that either there's some minor tears
or the fibers are disrupted and they're disorganized.
And it's like a, if, if you were to cut yourself
and you got a scar tissue there.
And, let's say, let's say I cut my elbow
and there's a, you know, a cut going across here and
and the, and the scar begins to form, begins to heal.
And then all of a sudden I bend my elbow
and the scar breaks open again.
That's what we're trying to prevent.
We're trying to have those, it heal strong.
So that's what we're gonna do is rubbing here.
It's gonna help the fibers line up right
and heal strong, so they don't break it open
every time that you try to use it again.
So what, what happens quite often is people,
they injure it. It begins to heal.
They go walk, and it breaks open again.
By doing this treatment, it won't break open again.
It'll just stay healed and it'll get
more blood flowing to the area.
So we're trying to align the fibers.
So again, you're gonna usually generally have pain
in one of two spots when you're having trouble
with your Achilles tendon.
One is usually either on either side of the tendon.
So here's the tendon, that big thick thing here.
So you're gonna either on this side or both sides
or right where the tendon attaches to the heel.
Can you pick that up, Nancy?
Can you see kind of where we're at here?
And you'll be able to tell just by rubbing, where
where does it hurt you.
So let's, let's first start with the sides
of the, the tendon.
You just can take your fingers.
You can take, you could actually just do kind
of a pinchy thing here like this and go like this
and rub back and forth like this.
And I'm rubbing hard.
I'm rubbing as hard as I can.
And I'm kind of pinching it together.
Pinching my fingers together and catching the sides.
Did you catch much of that, Nancy?
Okay. So that's one you can do if, if
if it's on the sides.
And if it's not on the sides,
if it's more down where the heel attaches here,
there you can actually take your thumb
and rub back and forth like this.
In each case, you want to go across the fibers.
So I'm gonna rub across like this.
Now the key here and the reason I'm doing
one thumb on top of another
your fingers are to get tired and exhausted here.
And it's actually hard on the joints
of the fingers to do this.
But what the recommend is that you
you wanna do a total time of 15 minutes, every other day.
And you need to do this for a week or two.
And you'll know if it's helping.
It'll help fairly rapidly.
I many times I've done this to myself on any area,
I, I can tell within a couple days that it's helping
and, and and then usually within like a week or two,
it is gone.
So, you know, you could start by doing five minutes
and if that's too much for you, then, then, you know
spread it out through the day.
So you maybe do three, three sessions
of five minutes or five sessions of three minutes.
However you wanna break it, break down.
Brad, do you wanna sit up
and maybe show how we can maybe do this on your own?
- Sure.
All right.
I'm thinking I want to just go like this and this works
out while on here, you can do it on some furniture at home
were you got nice soft edge.
And then you're just gonna get in there.
- Yeah, that's good position.
- Good. And, and again, again we're gonna keep this loose.
The ankle loose.
You're not gonna pull back to keep it tight or
or anything like that.
You just keep it relaxed and work that in like this.
And you can use both hands, like Bob said, for some support.
And that works good. Now...
- [Bob] Push it down very deep, very hard.
- What if it hurts Bob?
- That's a good, that's a very good question Brad.
Actually if... our rule of thumb is if you start rubbing
and the pain gets, just gets worse, worse, worse, worse;
we generally do, we have you back off
and maybe ice it for a while.
- Sure.
- Um, but if it, if it stays kind of neutral
and after about a minute, it becomes numb.
- Right. - That's perfect.
- Right.
That's, that's, that's exactly the time
you want to do this, then.
- And I've had that on myself, as well as patients.
You know, after you do this for about a minute
and they say it's feeling kind of numbish
or it's not really numb, but it has that sensation
or feels like, you know, you're right on.
You're doing the right thing.
And as far as, I don't know, 15 minutes, Bob
I think I'm gonna break that up because...
- Yeah.
- I'm gonna get sore fingers. So um...
- I actually was surprised to read that,
cause I, I've gotten less.
I've usually gotten less and, and gotten by.
But I, you know, if you want to go at it seriously,
you may wanna... and maybe I do end up
doing 15 minutes total in the end.
- Right. By throughout the day.
- Yeah. So, and then now he's showing it
on the heel itself, how he's going across.
- Right. I just switched over there.
Okay.
- Now there are a few instances where it's actually
on the front of the tendon, which you can't get
to and a therapist would have to do that.
So if you don't get better
and it seems like it's kind of deep in there
then you may have to have a therapist do, do
do the remaining treatment.
- Right.
- So great treatment.
Ah, we'll now show you the stretches.
We'll cut away and we'll,
we'll show you the stretches to do for this.
- Sure.
- There are a lot of ways to stretch the calf
and the, and the tendon, but this is one
of the more common ones you, ways you might see.
And that's, you know, a lot of times it looks
like people are trying to push over a wall
or something that a lot of runners.
And basically, I'm stretching the back leg here.
And I keep the foot flat.
And I keep it pointed straight back.
And what I'm gonna do is,
I'm gonna lean forward like this.
- And notice how the heel's trying to come up.
- And it's almost...
- Starting to come up.
So, we're gonna keep it down towards,
towards down because...
And then you also wanna stretch it with the leg
the knee bent like this.
You wanna stretch it both ways.
Now you can also stretch this, you know
you could stand on some steps and, you know
hold onto the railing or whatever.
And you could put just the fore foot
on the step and just let the heel hang off the edge.
(coughing)
- Oh, there you go, Brad.
This guy, he's a regular engineer here.
- And, if, if these would of represent the edge
of the step here. Or you could use books,
like use books like this.
[Indistinct]
...if two by four or a couple two by fours.
Or wooden block of some sort.
- So I'm putting my fore foot on the, on the step
and then I'm letting it come down like...
- Actually here, it's actually touching the ground
and I can lean forward a little bit here.
- Actually. That's a good stretch there.
- [Bob] On a step, you probably... it wouldn't even touch
the next step below it.
So it, it would really give a stretch.
And again, I do it with the leg straight
and also the knee bent, both ways.
- This is a nice stretch. You use gravity.
It doesn't take a lot of effort.
You just have to relax and let gravity do the work.
- Yeah, that's why I like it too.
Another one you can do, again,
I don't even have a towel here,
but you could wrap a towel
around your fore foot and pull the
the fore foot toward you.
And that would do the same thing.
- Yep. Stretch it.
So, very easy to do.
You want to do that stretch
probably every day.
- Sure.
For a couple minutes, um while you're
going through this healing process
cause you want it to heal lengthen.
- Right.
Because if it doesn't heal lengthen,
as soon as you step on it;
it'll stretch and it could, you know,
break open again. The scar tissue. So.
- And, and you can do that stretch lot
of times. I recommend do it throughout the day.
Even if you do a five minute stretch
and you just do it, you know, 10 to 15 times a day
just stop and give it a gentle stretch.
You're not getting aggressive with it but,
wanna keep it generally stretched for circulation.
Keep the, the length, the tension on
in the right...
- So yeah. In essence, you can be rubbing it
through the day.
You can be stretching through the day.
Throughout the day, you know
rather than trying to dedicate one big time for it.
- Right.
- You can just keep at it all day long.
- In most cases, this takes care of the,
takes care of the problem, unless you have a
a really serious tear.
- Tear or injury.
And if it's too sore, it gets swollen.
You know, ice packs are always helpful.
Yep. Sounds good.
- Have fun.