resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Poor Choice for Pain Relief
Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it's also the most likely to be taken inappropriately.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 2)
As we noted in our previous article, with a positive Derifield (+D), the doctor observes the reactive (shorter) leg in the prone position that becomes longer or "crosses over" in the flexed position.
ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
Professional Credentialing and Board Certification: An Ethical Faux Pas
Because of the Affordable Care Act, health care systems are coordinating care through accountable care organizations (ACOs) in order to reduce the cost of care and improve quality of care.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
First Do No Harm?
There's no questioning the frightening nature of breast cancer, which strikes one in eight women in the U.S. – eclipsed only by skin cancer in terms of prevalence.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
Rethinking Musculoskeletal Pain – A Public Health Perspective
The American Public Health Association (APHA) is the world's oldest and largest association of its kind, founded more than 140 years ago and boasting over 25,000 members.
September, 2007, Vol. 07, Issue 09
Achilles Tendon Disorder
By Whitney Lowe, LMT
Massage therapists see many clients with active lifestyles. Running, jumping, dancing, climbing, or any number of other activities can put serious stress on the Achilles tendon (AT). AT disorders also can contribute to biomechanical disorders in the foot and lower extremity.That is why it is important for the massage practitioner to understand more about the structure, function and pathology of this very important tendon.
The AT is the strongest tendon in the body and needs this strength because of the high force loads required during motions such as walking, running or landing from a jump. AT disorders can occur at any age, but there is an increased frequency in older populations. The increased age of the active baby boomer generation in this country suggests we likely are to see more of this condition in years to come. The tendon is susceptible to a variety of pathologies, such as paratendinitis (also spelled paratendonitis), tendinosis and tendinitis. Some of these different terms can be confusing, so I'll distinguish them below.
Structure, Function and Pathology
The AT connects the gastrocnemius and soleus muscles to the calcaneus. The tendon is surrounded by a thin membrane called the paratenon, which helps facilitate blood supply throughout the tendon. There is a region of the AT near the distal insertion, called the avascular zone that has a very poor blood supply (Figure 1). This region frequently is the site of inflammation and degenerative changes within the tendon.
The term tendinitis is used for overuse tendon pathologies throughout the body. Yet, most of these conditions do not involve inflammation so they truly aren't tendinitis (the suffix -itis indicates inflammation). Yet the AT is one tendon that commonly does have inflammatory activity in the tendon and the paratenon. Consequently, the terms tendinitis and paratendinitis usually are accurate when referring to the AT.
Achilles tendinitis is classified as insertional or non-insertional. Insertional tendinitis involves pathology at the insertion of the AT into the calcaneus. It is prevalent in older individuals and those who engage in activities without proper conditioning. Poor healing of minor tendon damage occurs at the calcaneal tendon insertion due to the lack of blood supply in the avascular region.1
The second category of overuse AT disorders is non-insertional tendonitis - those that don't affect the insertion of the tendon into the calcaneus, but cause problems in other areas of the tendon. Non-insertional tendinitis typically affects athletes and those engaged in vigorous physical activity. The pathologies under the umbrella of non-insertional tendinitis include paratendonitis (inflammation of the paratenon), tendinosis (collagen degeneration within the tendon) and tendinitis (inflammation of the tendon).
Tendinosis is degeneration of the collagen matrix within the tendon, which leads to pain and loss of function. It commonly is categorized as non-insertional tendinitis, even though it is not an inflammatory disorder. The degenerative changes of tendinosis are caused by age, repetitive microtrauma or other factors that lead to collagen breakdown. The collagen degeneration frequently precedes inflammatory conditions such as tendinitis.
Non-insertional tendinitis can be acute or chronic and primarily affects the avascular zone near the base of the tendon. There is tenderness throughout the tendon and fibrous thickening near the distal end, which is apparent when the tendon is compared to the unaffected side (assuming the other side is not affected). In many cases, tendinitis and paratendinitis occur together and both the tendon and paratenon are inflamed. If not treated properly, tendinitis can lead to either partial or complete tendon ruptures.2
Recent studies show a link between certain medications and the onset of AT degeneration and ruptures. Especially implicated are medications in the fluoroquinolone family of antibiotics, such as ciprofloxacin (brand named Cipro).3-5 These medications cause tendon pathology in large tendons of the body, even in the absence of vigorous repeated activity. In addition, systemic disorders such as hyperthyroidism, renal insufficiency, gout or rheumatoid arthritis also can contribute to tendinitis in the AT.6,7
AT disorders are best controlled through rest and activity modification. Rest means stopping offending activities, not immobilization. Lack of movement might lead to the development of fibrous adhesions. Cold applications and anti-inflammatory medication may be used to address inflammatory activity if present. As soon as stretching is tolerable, it is helpful to stretch the AT several times per day.
Massage applications to the calf muscles reduce tension and decrease tensile forces on the tendon. Deep friction, as tolerated in the problem area, is beneficial in stimulating fibroblast proliferation in the tendon to repair the damaged collagen matrix. Cold applications prior to the deep friction reduce the intensity of the discomfort, and reapplying cold after treatment reduces the accelerated metabolic response to the friction. Heel lifts inside the shoe may be recommended to help reduce tension on the tendon. Corticosteroid injections formerly were used with greater frequency and are not recommended now because of long-term detrimental effects on the tendon, such as tendon rupture.8 Massage therapists applying these concepts of evaluation and treatment will be much more effective in helping their clients address this frequent cause of foot and lower leg pain.
Click here for more information about Whitney Lowe, LMT.
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