Thursday, July 23, 2009

Part 4

This is the last of the article I am deciphering, link.

"Top Treatment Tips For Tendinitis

Although tendinitis can be an acute condition, the frequency of recurrence and the nature of dance tend to make chronic tendinitis a common occurrence in dancers.

You will frequently see Achilles tendon problems that are associated with muscle weakness of the feet, lower leg and thigh musculature. Tight-fitting pointe shoes or shoe ribbons that cut into the tendon may also cause Achilles tendon problems. When the gastrocnemius and soleus muscles are tight, dancers have difficulty with pliƩ and often have poor weight distribution, resulting in faulty technique.
Treatment includes contrast baths and NSAID medication. During the initial acute phase, employing a small heel lift in street shoes can be effective. However, the cornerstone of rehabilitation and prevention of re-injury is a structured stretching program the dancer or patient performs in conjunction with eccentric and concentric progressive resistant exercises.
Flexor hallucis longus (FHL) tendinitis may manifest as posterior medial ankle pain, arch pain or great toe discomfort. The dancer typically experiences posteromedial ankle pain with a “clicking” or locking sensation of the great toe when he or she points the foot or when going from the fully pointed position to a more dorsiflexed position. Sometimes, an audible pop occurs with this maneuver.
During the physical examination, you will note tenderness over the posteromedial aspect of the ankle in the zone between the retomalleolar region and the sustentaculum. Passive motion of the great toe and ankle may induce symptoms of tendinitis when palpating along the FHL. Be advised, however, that this does not often induce the popping unless the patient actively contracts the FHL tendon with the foot pointed and the toes plantarflexed.
Distinguishing between a posterior impingement and the FHL tendinitis is challenging because the two structures are in close proximity and these conditions may co-exist (see “Detecting Posterior Pain Syndromes Of The Ankle In Dancers” above).
When conservative treatment is indicated for these patients, emphasize relative rest and avoidance of the offending positions. A course of NSAIDs and physical therapy with phonophoresis or iontophoresis is warranted.
For resistant cases, you may employ a boot brace or a steroid injection. On some occasions, FHL tendinitis may be recurrent and disabling. In these cases, operative tenolysis may be indicated, but one should only consider this option after at least a year of conservative therapy in the young dancer or six months in a professional."

This is typical tendinitis meaning tendons are damaged due to various factors; muscle inbalance or excessive wear with restrictive or tight fitting shoes not allowing full movements and blood circulations. Like most tendinitis, use RICE, Rest-Ice-Compression-Elevate. Perhaps not Elevate. The rehap is the key to recovery. Whatever exercise you do, you need to do both sides not just the side with problems.

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