Iontophoresis with dexamethasone for achilles tendonitis?

I've no experience with Achilles tendonitis, but all those modalities are bullshit. They treat symptoms, not causes. I would find someone who can evaluate you for restrictions in the foot and lower leg, and offer correections that ignore the short-term inflammation and address the range of motion restrictions that are over-stressing your AT. You might get some success with massage if the person is lucky enough to hit an area that is restricted, but to get it right you need someone who will be able to feel it with his/her hands, not just rub the whole lower leg. Where do you live? I might be able to recommend someone.

Thanks for your response Haddock. Those are the exact reasons I have not tried this treatment up until this point. I just feel like this may be the last resort.

Unfortunately, I live way up in Potsdam, NY...right near the Canadian border. I have relatives near Albany, however, so I am hoping to find someone who has treated serious runners with similar problems before.

My therapist actually claims that he can feel it when he does the friction massage. There is no doubt in my mind that he has found the spot because I am in a lot of pain when he pinpoints it.

Anymore suggestions/ideas are appreciated.

do what joan benoit seems to do: keep racing and running on it. even Joe McViegh seems to think this is the way to go.

Had it on my knee a few years back. Actually felt a heck of a lot better, than I went and did a blow out workout instead of easing back into it.

My experience was pain resided, but should've taken time getting back into it.

I had it on my achilles two years ago. It worked really well for getting rid of the pain and inflammation, but more helpful was the physical therapist showing me how to do stretches and stuff to prevent it from getting inflamed again.

Hey NY guy,

Sorry to hear about your bum achilles. I have been struggling through my own for the same amount of time and progress has been minimal. I have had the same types of treatment as you and they have helped a little in my case. I stopped wearing my heel lift months ago so I could start to solve the problem which is really range of motion for me.

Have you had an MRI? You may want to consider that to see what's going on in there. I know you probably don't want to stop running...but are you resting?

Best wishes

Bobs, I tried resting for a few months, and then started running 2 miles every other day for the last month, but I think it's time to rest again. I'm going to ask my doc for an MRI next time I see him.

Good luck with your injury.

NY Guy,

Thanks, buddy. I\'ve been out since January. I too tried the rest for a couple weeks run for a couple days thing but it still lingered. I finally stopped for good. It\'s been boring and hard to be patient...but it\'s the one thing that has helped the most, I believe. I can\'t imagine you having to deal with both of them. I\'m sorry to hear that. I hope you recover soon.

Peace.

I had that on my tendonitis last year...worked wonders on the swelling. I did that, ultrasound, and heat treatment (warm whirlpool before) and cold treatment ( cold whirlpool after). The modalities combined with the treatment for inflexible calf, hamstring, and back muscles worked really well. I did a total of 30-40 minutes of running and then did a lot of streching, almost 40 minutes total of streching before and after. Combind with pool work, I was able to come off my injury in better shape than I had left....I went from 16:28 (pr-before) to 16:15 (pr-after). I was in the pool 2X a day for about 3 hours total....

Kinda funny....looking back I think I spend more time working out injured than when I was healthy!!!

i had iontophoresis, dosing 2cl's of dexamethazone 3x/wk over a 4 week period ( after a 6 week period with zero healing) when dealing with my tendonitis sept of 04. I was on heavy anti-inflamms, ultrasound, friction massage, in a boot, etc... and it was the ionto that finally started to triggor the healing process. I had a lot of crepedis (sp?) afterwards which was normal. (tendon feels like its sliding up and down). I noticed improvement after only a few treatments.... this is just my experience. I really do think it works, but while and after its healing get to the root of the tendonitis ( strength imbalances, etc.)

ionto queen wrote:

i had iontophoresis, dosing 2cl's of dexamethazone 3x/wk over a 4 week period ( after a 6 week period with zero healing) when dealing with my tendonitis sept of 04. I was on heavy anti-inflamms, ultrasound, friction massage, in a boot, etc... and it was the ionto that finally started to triggor the healing process. I had a lot of crepedis (sp?) afterwards which was normal. (tendon feels like its sliding up and down). I noticed improvement after only a few treatments.... this is just my experience. I really do think it works, but while and after its healing get to the root of the tendonitis ( strength imbalances, etc.)

Amazing! Do you mean to say that you had this procedure done in the future? Please don't spoil the Olympics or the presidential election for us - I want it all to be a surprise.

BDG

Here's a link to a damn good exercise system. The first page is some general boasting bullshit, but the second page will get you into the exercises and they are good.

The tendonitis is caused by tissue that isn't strong enough for the load it is taking on. Hence the need to strengthen the tissue. Relieve the pain and swelling with the medication, but treat the cause while doing so.

By the way, I'm not a doctor but I did stay in a Holiday Inn Express last night.

Bubba is right.

Most of the mentioned treatments ie massage, ultrasound etc are a waste of time but will cost you $80 three times per week for a month often before this becomes clear.

Mostly people are directed to massage then pills then surgery - these are out dated treatments for this disorder.

The first interesting studies in the late 70's found a very close link between calf weakness and achilles tendon problems. Then later in the 80's an even closer link was described between eccentric calf strength and tendinitis. Then in the 90's a couple of Scandinavian Physiotherapists found that patients undergoing a progressive eccentric strengthening programme returned to running much more quickly and consistanly than those recieving surgical treatment. (this illustrates the insurance/ surgically led medical system in the states - surgery generates more money so - it is performed way way too much.) In fact some studies stated pain is not a contra indication to strengthen thes tissues eccentrically but an indication.

The PPonline article did illustrate the importance to look at the knee and hip stablisers such as glute med, min, max, Tensor Fascia Latae, the Quadriceps and Hamstrings.

Be careful to eliminate training errors as able ie shoes rubbing on AT, cambered running, inadequate recovery, poor technique etc, etc (pretty basic)

Stretching will not help this condition - though those afflicted with this condition swear by it and at the injury that doesn't improve. The evidence behind stretching and massage for AT is weak and contradicting - ie do it if it feels nice but you are wasting your time. (Strengthen the claf and AT)

A few notes on achilles tendinitis - very rarely is inflammation a big issue (orthopaedic surgeons have reported to me that often a very painful tendon looks quite nice in surgery), surgery basically consists of a few cuts into the tendon with a knife then limited mobilisation.

So in short - sort out your training and biomechanical errors then strengthen the calf eccentrically. ]

Nb eccentric training will take weeks (please don't give up after one session)

NY runner,

Glad your PT is digging into your calves. If your PT is feeling the lump in the medial belly of your calf, then he is feeling the "runner's knot", which is a red herring, and not a factor in your injury. If you're already doing calf stretches the problem is more likely to be scar tissue in the tendon area, and general foot immobility, than the muscle. Bubba wrote that A-Tendonitis is caused by the AT not being able to take the load, but I think that runners have plenty strong calves, and the load that can't be withstood is too much because imbalances cause it to increase from normal.

My PTs were in Boston, but worth the trip from where I am (just as far away). One is Dan Dyrek at 781-431-6161. Gary Geissler is there too and is also good. Might want to ask Montreal runners, too.

Wow, thanks for all the advice everyone. I started doing the eccentric exercises (from the website mentioned above) and I am going to start the iontophoresis today. If you have any other thoughts or if anyone else has any recommendations, please post them. I am greatly appreciative of any and all advice.

- NY runner