Achilles Tendinosis in Elite Runners

Meet today’s guest blogger:

Stephanie Penny, PT, DPT

Stephanie practices at Lakeshore Sports Physical Therapy in Chicago, Illinois. She earned her Doctor of Physical Therapy degree from Central Michigan University in 2008. She has a special interest in sports medicine and vestibular rehabilitation, has completed coursework in manual therapy, and is a certified Astym® provider. Stephanie is an active member of the American Physical Therapy Association.

Elite runners alternate between intensive physical training and recovery to improve performance.  However, many runners fail to maintain a balance between intensity of training and appropriate recovery, resulting in a breakdown of tissue reparative mechanisms which eventually leads to overuse injuries.  Historically, these injuries have been referred to as “tendinitis” or “tendonitis”, words that point to inflammation as the cause of the problem.  Continue reading Achilles Tendinosis in Elite Runners

Rib pain: The buck can stop here.

Meet today’s guest blogger:

Gus Gutierrez, PT, OCS, FAAOMPT
Gus is an owner of and serves as clinical director of BRPT-Lake, a multi-clinic private practice that specializes in the treatment of orthopedic patients and sports-related injuries. He received his Orthopedic Certified Specialization distinction in 1994 and then again in 2004. He is certified as a Level 2 Manual Therapist and is Fellow of the American Academy of Orthopedic Manual Physical Therapists. He has over 23 years of clinical experience and working with athletes on all levels. Gus has been certified in Astym since 2001.  He is also certified in Kinesiology Taping and as an Active Release Technique practitioner for the upper extremity, lower extremity and spine.

Often times patients who develop rib pain with no known etiology (cause) are processed through the medical system undergoing countless medical diagnostic tests and consultations.  Physical therapy needs to be part of the assessment team to determine whether treatment for soft tissue and joint restrictions can be helpful.  Often time these patients respond very quickly to manual therapy techniques including joint manipulation, mobilizations and Astym for the intercostal soft tissues.

A patient with a 3 month history of mid costal (rib) pain was referred to me by an Orthopedist that believed Astym could be helpful and asked us to assess her.  Clinically she presented with all the signs and symptoms of costochondritis as he indicated.  After 6 treatments including Astym, rib mobilizations and thoracic manipulation she was 100% better.  She is instructed in postural exercises for home and given foam roller exercises.  This is an example of how physical therapy can be an important part of the consultation algorithm and Astym can be an effective adjunct to your manual joint mobilization techniques.


What is De Quervain’s Tenosynovitis?

Meet today’s guest blogger:

Kristy Uddin, OTR/L, Astym Provider
Integrated Rehabilitation Group, Inc.
Locations throughout the greater Puget Sound, Washington area
Pacific Avenue Hand Therapy – (425)374-2846
Snohomish Physical Therapy – (360)568-7774

Two of the main tendons to the thumb pass through a tunnel (or series of pulleys) located on the thumb side of the wrist. Tendons are rope-like structures that attach muscle to bone. Tendons are covered by a slippery thin soft-tissue layer, called synovium. This layer allows the tendons to slide easily through the tunnel. Any swelling of the tendons located near these nerves can put pressure on the nerves. This can cause wrist pain or numbness in the fingers.


How does this condition develop?  De Quervain’s tendinitis is caused when tendons on the thumb side of the wrist are swollen or irritated. The irritation causes the lining (synovium) around the tendon to swell, which changes the shape of the compartment. This makes it difficult for the tendons to move as they should. Activities such as opening jars, wringing out washclothes or sponges, cutting with scissors, any activity that involves ulnar deviation and weight on the wrists (lifting a frying pain or heavy objects out of the oven that put resistance on your wrists.

What are the symptoms?
• Pain may be felt over the thumb side of the wrist. This is the main symptom. The pain may appear either gradually or suddenly. Pain is felt in the wrist and can travel up the forearm. The pain is usually worse when the hand and thumb are in use. This is especially true when forcefully grasping objects or twisting the wrist.
• Swelling may be seen over the thumb side of the wrist. This swelling may occur together with a fluid-filled cyst in this region.
• A “catching” or “snapping” sensation may be felt when moving the thumb.
• Pain and swelling may make it difficult to move the thumb and wrist.
• Numbness may be experienced on the back of the thumb and index finger. This is caused as the nerve lying on top of the tendon sheath is irritated.

What tests are done to determine what it is?
The Finkelstein test is conducted by making a fist with the fingers closed over the thumb and the wrist is bent toward the little finger. The Finkelstein test can be quite painful for the person with De Quervain’s tendinitis.
Tenderness directly over the tendons on the thumb side of the wrist is a common finding with this test.

How can you make the pain go away?  (Conservative care & surgery)
• Conservatively – Splints. Splints may be used to rest the thumb and wrist
• Astym treatment
• Anti-inflammatory medication (NSAIDs). These medications can be taken by mouth or injected into that tendon compartment. They may help reduce the swelling and relieve the pain.
• Avoiding activities that cause pain and swelling. This may allow the symptoms to go away on their own.
• Corticosteroids. Injection of corticosteroids into the tendon sheath may help reduce swelling and pain.

If you elect surgery what is the goal?
Surgery may be recommended if symptoms are severe or do not improve. The goal of surgery is to open the compartment (covering) to make more room for the irritated tendons.

Tendonitis: Why Won’t It Go Away?

Because it’s probably tendinosis.  Often, chronic tendonitis (also spelled tendinitis), which lasts more than 6 weeks is really tendinosis (also spelled tendonosis).  The difference is that acute, short-term tendinitis is thought to be caused by inflammation, which is an active immune response of the body to a perceived threat.  The acute, inflammatory tendonitis can be treated and usually resolved within several weeks by icing the area 3 to 4 times daily for 20-30 minutes, resting, and taking over-the-counter or prescription strength anti-inflammatory medication, such as ibuprofen.

Chronic tendonitis is usually defined by the tendon pain lasting more than 6 weeks, and the condition is more accurately referred to as tendinosis.  Tendinosis is mainly caused by degeneration of the tendon.  In order to effectively treat and resolve tendinosis, you must stimulate regeneration of the affected tendon.  There are very few approaches that do this.  Astym treatment has been used successfully for years and is the most established treatment to stimulate regeneration of a tendon and other soft tissues.  To view the resolution rates (outcomes) of Astym on particular types of tendonitis/tendinosis, click here:

What is Astym treatment?: Astym Definition, Part III

Scientific studies have shown an increase in fibroblast recruitment and fibroblast activation with Astym treatment, which reveal the body’s underlying physiological response to Astym.  These studies highlight the regenerative mechanism of Astym treatment and help us understand how Astym treatment results in the regeneration of soft tissues. There also appears to be a neurological component to the Astym treatment process as evidenced by immediate changes in pain perception (often pain is immediately reduced) and strength measures (strength often immediately increases) following treatment.

At its core, Astym treatment was developed from basic science research to stimulate a regenerative response at a cellular level.  Following that, there were a number of case studies published and then a randomized clinical trial on patellar tendinopathy.  A large randomized clinical trial on lateral epicondylosis was then awarded a platform presentation at the American Society for Surgery of the Hand’s national meeting.

In addition to ongoing clinical and scientific research, the Astym program also emphasizes the collection of practical information.  Astym treatment has put major effort into developing a reliable national outcomes collection system and database, where clinicians from all across the country independently enter data to create a national bank of dependable outcomes data.  These outcomes (treatment results) show the percentage of people with each condition that resolve (get better).  Not only does this provide a good real-world evidence base for Astym treatment, it also allows patients and health care providers to know how many treatments it should take to resolve a certain condition, and what percentage of those cases should resolve.  For instance, for a patient with plantar fasciitis, you can predict that in 10 therapy visits, 91.8% of patients will be improved or much improved.  To see a full listing of diagnoses and outcomes, click here:

What is Astym treatment?: Astym Definition, Part II

Astym treatment is effective in resolving many soft tissue problems, including chronic tendinopathies, tendon pain, tendon injury, stiffness, restricted movement, limited function and other conditions associated with adhesions or scar tissue that can occur after trauma or surgical intervention. It is also quite effective on sprains, strains, and other acute and sub-acute soft tissue injuries.  Continue reading What is Astym treatment?: Astym Definition, Part II

What is Astym treatment?: Astym Definition, Part I

Astym treatment is a regenerative therapy provided by specially trained (and certified) physical and occupational therapists.  Instruments are applied topically (on top of the skin) to locate dysfunctional (unhealthy) soft tissue, and to transfer pressure and shear forces to the underlying soft tissue structures.  The protocols, the force, and direction of the treatment induce a healing/regenerative response in tendons, muscles, and other soft tissue structures.  Astym treatment stimulates tissue turnover, scar tissue resorption, and the regeneration of tendons, muscles and other soft tissue structures. Therapy is typically provided twice weekly for three to four weeks and is done in conjunction with eccentric loading, stretching, and functional exercises. Continue reading What is Astym treatment?: Astym Definition, Part I

Heel Pain: Most Common Cause is Plantar Fasciitis

The tough band of tissue that connects your heel bone to your toes is called the plantar fascia.  It supports the arch of your foot, and when it becomes irritated or degenerated, then you have what is called plantar fasciitis (other names include: plantar fasciosis, which indicates degeneration, and plantar fasciopathy, which includes both degeneration and the inflammation indicated by plantar fasciitis).  This condition affects up to 2 million Americans each year.

Runners or people who are on their feet for long periods of time often get plantar fasciitis.  Also, people who are middle-aged, overweight or pregnant are susceptible to getting plantar fasciitis.  One of the most common symptoms of plantar fasciitis is foot pain in the morning getting out of bed or foot pain after getting up following prolonged sitting.  Once the foot loosens up it usually gets better unless you spend a lot of time on your feet or go running.

How can you get better?

Drugs to reduce inflammation are commonly prescribed and should help if the cause of the pain from plantar fasciitis is inflammation.  However, most long term plantar fasciitis is likely caused by degeneration of your plantar fascia, and in that case, medication to reduce inflammation will be ineffective to resolve the condition, although it may give some temporary pain relief. Rest, splints, stretches and modified shoes are also commonly recommended. Again, these treatments may also be effective if the condition is caused by inflammation, however, they will not be effective if the plantar fasciitis is caused by degeneration.

Plantar fasciitis caused by degeneration will often recur when resting is over, splints are removed, stretching is stopped or different shoes are worn.   Modifiying your lifestyle can help in certain cases, but the downside is that you have to keep it up.  To me, that is an indication that you haven’t cured the underlying problem, but rather you are constantly treating the symptoms and you are learning to live with the inconvenience.

Although it is not fully understood, researchers and a growing number of health care professionals recognize that almost all cases of chronic plantar fasciitis are due to degeneration of the plantar fascia, and treatment should involve stimulating regeneration of the affected tissue.  This link will show you some of the scientific evidence – histologic findings – that confirm this view:  Right now, there are very few approaches that focus on regenerating healthy tissue.  However, a good treatment option that focuses on stimulating regeneration and has a high rate of success for plantar fasciitis is Astym treatment.   You can see what Astym treatment is like by clicking here:

Internal Scar Tissue/Adhesions Limit Movement and Cause Pain

Over time, internal scar tissue or adhesions can build up in your joints, muscles, tendons, and soft tissues.  It can be caused by working your body too much, injury (such as sprains, strains and trauma), surgery, disease, or just by moving and not being in absolute perfect physical condition or having perfect “form” when you move.  Stiffness and many of the aches and pains that we have after reaching a “certain age” are due to the build up of internal scar tissue and adhesions.  Astym treatment is effective at reducing or eliminating internal scar tissue or adhesions.

Once the scar tissue and adhesions are reduced or removed, stiffness, and aches and pains often go away.  Astym’s resolution rates (outcomes) for scar tissue and adhesions related pain are impressive.  Click on this link to see how many people resolve their conditions after Astym treatment:  These outcomes were submitted by independent clinicians from all across the country.

About Thomas L. Sevier of Astym

Thomas L. Sevier, MD, FACSM is a double board certified physician, consultant, author and medical researcher. As a team physician and event physician, he has provided medical coverage for many high-profile sporting events. Dr. Sevier established the first ACGME accredited Sports Medicine Fellowship in the United States, and has served as a faculty member at two universities. He has helped pioneer important advances in rehab and sports medicine, and writes extensively for peer-reviewed journals, scientific publications and books. Dr. Sevier regularly speaks on medical and rehabilitation matters, and serves as an expert resource for medical and popular media outlets. Dr. Sevier is one of the few physicians who has been granted fellowship status in both the American College of Sports Medicine and in the American College of Physicians. 

Restore – Revitalize – Recover