Chiropractor in Laurel

Achilles, Plantar Pain Resolved in NFL Official Season Started Successfully after GT Intervention

On Aug. 18, 2008, just a couple of weeks beforethe start of the NFL season, a 45-year-old NFL official was referred to us with a diagnosis of right Achilles tendinosis with specific orders from our medical director to check his orthotics and to startthe Graston Technique® as part of his treatment.

History

Three years before this bout of right Achilles pain/tendinosis, this patient had a diagnosis of bilateral achilles tendinitis and right plantar fasciitis. At that time,the patient presented with tight gastroc/soleus and had pain with running on his tread mill, which is what heused to get into shape for the upcoming season. He had been trying to stretch, was strengthening, and was taping his ankles for the support he thought he needed. As this was prior to use of Graston Technique,® his treatment consisted of: iontophoresis; XFM to each Achilles tendon and the right plantar fascia; stretched the gastroc andsoleus; strengthened the lower legs, and ordered orthotics. The patient had nine treatments, was discharged with only mild stiffness in the morningsfor 15 minutes until warmed up and had instructions to continue home exercises.

This history was noted when he presented in August of 2008 with mainly right Achilles pain at the medial M-Tjunction, stiffness in the calf with running that progressed to bothering him when walking, and tingling inthe plantar aspect of both feet during running. The patient said he thought he had been stretching correctly,was taping his gastroc and ankles with no relief of the pain and stiffness, and that he also felt his orthotics rocking in his shoes. The physician had given him Don Joy Air heels and they did afford some relief. This patient was fairly active in his off-season playing golf and tennis. I was asked to assist with this case because I was the clinician on our staff who was certified in GT and because I had the most experience doing gait evaluations and orthotics.

Exam Findings

Tenderness and tissue restriction at the right med MT junction, hypertonicity of the gastroc, soleus, hamstrings, and plantar fascia bil, decreased flexibility of the great toes in flexion bilaterally with excessive “grit”felt in the extensor tendon of the right > left great toes as well as in all of theafore mentioned areas bilaterally,decreased dorsiflexion with knee flexed on the right only, weakness in inversion and eversion > plantar flexion, decreased balance on the right LE, good hip/pelvis alignment, over pronation in gait with moderate RF varus deformity, moderate FF varus deformity,slight tibial varum bil, the metatarsal arches had collapsed bil, typical over pronation calluses noted on themedial aspect of the great toes and over the second and third met heads, and the posting on the orthotics he had from 2005 had compressed in the rear foot.

Treatment

Because of the bilateral findings, the physician sent aprescription to treat both lower extremities. We rushed his orthotics in for refurbishing asking for RF postingof 6 degrees, FF posting of 2 degrees, an extension of ¾ length to full length with 1/8” PPT padding and CASE REPORT
Achilles, Plantar Pain Resolved in NFL Official Season Started Successfully after GT Intervention By Terri Angelo, MA, ATC, Summa Health System, Akron, OHT his article was published in the Fall 2010 issue of THE EDGE, a quarterly publication by Graston Technique® 2 leather covers added along with PPT teardrop metpads added that I made and sent with the order. The patient warmed up with walking before each treatment; on day 1, GT2 was used first, brushing over the hamstrings, the calf and plantar fascia, and the knobs were used on the sides of the Achilles. GT4 was used more aggressively over the hams and calf during active knee flex and plantar flexion, followed by GT3 used in multi-direction over the med gastro-Achilles MT junction, the Achilles tendons, and the insertion and middle portion of the plantar fascia. The single beveled edge of GT6 was used on the great toe extensor tendons and over the Achilles tendons,working with the single beveled tip on the under side of the Achilles during active PF. This was followed by stretching of the gastrocs and soleus, hams and hip flexors, light strengthening using the Pilates Reformer doing a leg press with heel dip motion, BAPS work,seated calf raises, and eccentric gastroc ex with Pre-Mod e-stim on sub-acute, sweep to light contraction with ice after the session on each calf. GT was progressed aggressively over the next four treatments to using GT4 over the calves and Achilles while thepatient was doing resistive toe raises and while doing the BAPS rotations on each leg. The Achilles tendonswere taped with elastoplast for running.

Outcome

The patient felt some pain relief after the first GT treatment, and by the fifth and final treatment over 18 days, he had no more plantar fascial pain; he could run with no pain in either Achilles; there was minimal to moderate ecchymosis fading, and he felt good with the new orthotics, which also relieved the tingling inthe feet. At the patient’s request, his ankles were taped prior to each game. The patient was so impressed with how GT saved his season that he has referred family members to us and has sent colleagues to other cities to receive it.

By Terri Angelo, MA, ATC, Summa Health System, Akron, OH