I am a patient of Dr. S (chiropractor) and have had chronic
achilles tendonitis for at least 10 yrs. Recently icing and stretching
has not been effective to decrease inflamation in the L foot in
particular. I have been going to PT for the past month receiving
iontophoresis with dexamethasone treatments. I do get some burning on the skin and it has taken about 6 treatments to see and feel about a 60% improvement. However , as soon as I do even mild use of the left foot with weight bearing, it flares up to previous levels.
I am curious as to whether hot or cold laser therapy would help this
condition. Do you think laser therapy would help and what type…hot
or cold? Any advise, information, opinions are welcome from you.
THANK YOU very much for your time.
RESPONSE FROM DR. TUCKER
It is a challenge managing chronic Achilles tendon injuries. The warm laser can help heal the in-growth of new nerves and blood vessels which are known to be sensitive to pain chemicals. As part of my rehab protocol for Achilles problems I use the following:
•Alfredson’s heel-drop exercise
In 1998 a Swedish orthopaedic surgeon published excellent results for a group of patients with Achilles tendinosis who undertook a specific 12-week eccentric calf loading rehabilitation program. The subjects all experienced a dramatic reduction in pain, a significant increase in calf strength and returned to full running.
The client stands on the bottom step of a staircase, facing inwards, hands lightly supporting at either side. The forefoot of the affected leg is placed on the edge of the step. The client lowers their body down by dropping the heel of the affected leg over the edge, with control; then places the foot of the non-affected leg on the step to raise the body back up to the starting point. If this proves too difficult, or if both Achilles are affected, it is possible to raise back up on two legs (thereby sharing the concentric load) and coming down on a single leg (this is the “2 up, 1 down” concept).
•Perform 3 x 15 eccentric heel drops with the knee straight and 3 x 15 repetitions with the knee bent, repeated twice daily.
More recent studies have found that eccentric loading increases collagen deposition in tendinotic tendons, suggesting a healing response. Perhaps of greater significance is the apparent disappearance of the vascular in-growth in people who respond favourably to loading and it is possible that the effectiveness of the program is due to the direct effect on pain rather than tendon healing or an increase in calf muscle strength.
Balance training programs are essential as part of the rehab for Achilles.
Regarding the warm laser, I think it would be very helpful & effective.