Mark: Hi, it’s Mark Bossert. We’re here with Dr. Harold Meinzer, a chiropractor in Vancouver from Evolution Wellness, which has locations in Vancouver and North Langley and we’re here to talk about Achilles tendinitis and how lasers help a lot with this. How are you doing this morning, Dr. Harold?

Dr. Harold: Great. Great, great, great. Thanks, Mark. Yeah, I thought we’d talk about Achilles today just because of the Raptors basketball the other night and Kevin Durant went out with an injury to his Achilles. So I thought, yeah, let’s talk about Achilles injuries, but more specifically to us would probably be like a tendinitis, which is just an inflamed tendon, and I think most people know the Achilles tendon, it’s that big one running from your heel up into your calf. It’s a really big, massive, massive tendon so it can get injured through all sorts of different ways that we like to use and abuse our bodies. Typically like overuse type injuries, like you’re repetitively doing something over and over and over again, over training that’s a really big one, right? So if you’re running and then all of a sudden you want to ramp up your schedule, so you increase intensity, you increase duration, you start adding heal work and other things and your body’s not adapted or ready yet.

That’s always a really big one, and then the one that I see probably most in the office is the deconditioned tissue and that just means vacation tissue. That’s the typical office worker who’s at their desk from 9:00 to 5:00 for the past five or 10 years, does minimal exercise and then softball season starts and their mind thinks, “Man, I can run between first and second,” and as you start to do that, your Achilles goes, “No, I haven’t done this in five years,” and it just blows up on you. So that’s a very common one.

Mark: So when you mentioned blow up, we’re talking about tendinitis, which is essentially, it’s inflammation within the tendon sheath I guess. Is that right?

Dr. Harold: Yeah, that’s right. So it’s inflamed. When I’m talking about blowing up, that would be more of like micro tears into that tissue at worst that can actually rupture and tear and that’s like a surgical procedure and that can take months and months and months to a year to resolve. Sort of the smallest injury would be the tendinitis, the overuse. It’s just irritated, inflamed, and then it’s painful, right? It’s constantly pain as you walk and move and the average person takes 5,000 steps a day, so think of something being irritated and you’re irritating it another 5,000 times per day. So it gets into a real cycle of chronicity.

Mark: Chronicity.

Dr. Harold: Not synchronicity like Sting, but chronicity.

Mark: Yeah, chronically hurting.

Dr. Harold: Yes, exactly.

Mark: So how does the laser help?

Dr. Harold: Like we’ve been talking about in this whole series is that anti inflammatory effect of the laser. The Achilles tendon is like white tissue. I always think of it as white, like it’s a tendon. Muscle, like your glute or your hamstring is big and beefy is red, red tissue, so it’s got good blood supply. And so the white tissue doesn’t have a lot of blood supply so we really want to increase or maximize the amount of blood that we can get into that tissue for healing. Right? Blood brings those building products for healing, and so we want to get fresh stuff in and we want to take out all the byproducts of that inflammatory condition. So by using that, that works as an anti inflammatory and then also stimulating those cells to repair and the faster we can repair that tissue, then the faster the symptoms will abate.

Mark: So what would an Achilles’ treatment kind of look like when you’re doing that?

Dr. Harold: Typically the Achilles treatment, I always will look into the calf muscle as well. So the calf muscle will start high and then the Achilles turns into that, it goes to the heel. So we use this really awesome applicator. It’s a quartz ball, fibre optic cable, the laser light goes through and that way we can make really great contact with the skin and tissue and then I can roll over top of it and this is the application. So generally I’ll start higher up from where the injury site is and then we’ll work our way down. We’re opening up blood flow high to low and so we’re not just going to just sort of look at that one specific spot that’s injured, but we’ll look a little more globally as how the whole foot and ankle works.

So this is I find a really comfortable treatment because I can put a little bit of pressure into the tissue as well and then any little knot or adhesion, then we work that out as we go through that treatment. So most of my patients always joke it’s like the most comfortable treatment that I offer. They don’t fall asleep, but if it was long enough they probably would.

Mark: Yeah. I can attest. It’s quite comfortable and warm and it feels good actually. So the Achilles is pretty close to the surface, so I imagine that you probably get some pretty good results with this.

Dr. Harold: Yeah, we get really good results with the Achilles. It’s a tough condition to treat just because, like I said before, we’re always on our feet and a lot of people think like, “Oh, I’m resting. I’ve stopped playing softball, I stopped running,” but you’re still on your feet 5000 times, so that really can irritate it. So you know, we will also include some rest, obviously ice. Stretching we have to be careful with. Proper warm ups always for weekend warriors. After the acute condition is done then strengthening into that area and sometimes cross training is effective as well because we’re doing one sport and we’re not doing enough of other things to kind of balance it out, so different types of movements can be effective for that as well.

Mark: What about some of the training kind of protocols and stuff? How soon can someone go back to training? Is it like completely without any kind of pain at all before there’s all the pains gone, like what would you prescribe?

Dr. Harold: Generally if it’s a really acute tendinitis, then we’re going to stop activity depending on the athlete, because some athletes need to train a little bit or be ready for competition. So then we might stop altogether because training at that point is not going to make any difference but we just need them to be able to function at that end result or for that tournament or that race.

So a lot of times we’ll sort of cut everything back, scale it back for like a two to three week period where we’re going to treat them and then we’ll slowly start to try to integrate. So you got to test the water at some point, and then we’ll test the water, see where they’re at and then it’s kind of a case by case basis to see how soon we can integrate that activity back again. But generally we get some great results. Like I say, it’s a very kind of chronic and difficult condition to treat without a laser. That really speeds up that healing process and gets people back on the field, and that’s why the Seattle Seahawks, Toronto Blue Jays all use the same laser in their dressing rooms.

Mark: And are there any other pieces of information that are important to this? Like what about footwear and that sort of stuff?

Dr. Harold: Yeah, I think footwear can make a big difference, that you have a base of support and stability, that you’re wearing the proper footwear for the proper sport, all those things. And also that you’re not using footwear that’s aged or dated. There’s lots of people that are running and they’re doing a lot of kilometres and their shoes should have been thrown out, you know, six months ago. So you really want to look at your feet a little bit differently because they do carry you for your lifetime and treat them well. You want to treat those feet well.

Mark: And the treatment protocol, just to reiterate, I imagine it’s probably similar to some of the other treatments we’ve talked. About every other day, sort of.

Dr. Harold: Yeah. Yeah. Every other day. I’ll try to get them in every other day. Sometimes they’ll do some soft tissue work into that calf muscle as well if I find adhesions that I want to break up and loosen up. That’s not as quite as pleasant as-

Mark: No, it’s not.

Dr. Harold: Lasers, but it needs to be done and so we can break up those adhesions and we’ll treat every other day. Usually I say to patients six treatments and then we’ll reevaluate at that point. I’m not here to sort of waste time or money for people. If it’s not an effective modality at the time for the patient, then we’re going to refer them out to someone else, but generally that six treatment point is that reevaluation point and we’ll say, well are you 50%, are you 80% better? And then we’ll make another determination for the next protocol.

Mark: And do you work with other like athletic trainers or any other experts in this realm as well?

Dr. Harold: I used to treat the BC Ballet with my brother and I’m working with the Langley Rivermen right now. It’s a local junior hockey team, so I like sports and sports injuries. That’s sort of my background with soccer and other sports. I like the sports aspect because I think I understand the mentality of the athlete wanting to get back on the pitch or the field or the ice surface as fast as possible, and sometimes you really need somebody to say like, okay slow it down. We’re going to have to take a little bit of time now so that you’re actually not going to be… so you’ll be back on the ice in a shorter period of time. Sometimes it’s a difficult negotiation with an athlete.

Mark: Absolutely. So there you go. If you have some problems with Achilles tendinitis or any kind of twitches in your Achilles, the guys to see… the guy to see is Dr. Harold Meinzer at Evolution Wellness. You can reach them at (604) 881-2404 to book your appointment. They’re located both in Vancouver and North Langley. You have to call and book because he’s busy. He’s got lots going on, lots of clients who need some pain help and this will definitely help. I’ve had Achilles treatment myself and it worked really well. Thanks a lot, doctor.

Dr. Harold: Thanks a lot, Mark. Have a great afternoon.