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Trigger Point Injections (w/ Micro-Dissection)

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Dr. Hanson now has several locations in the Vancouver, BC area where he routinely provides trigger point injections.


Physical pain can often be caused by a mechanical source, which is why pills don’t always work.  Trigger points are painful sites inside our muscles or connective tissues. They behave like a burr caught in the moving parts of our body. Trigger points are defined as having the following characteristics:

  • Pain related to a specific point inside a muscle (like a knot in a wooden plank) or in the tight fascial layer covering the muscle. These are not caused by an obvious local injury or infection.
  • Palpable nature: these can feel firm, like a small walnut embedded in muscle, or they can be palpated as a thin sheet of tenderness in the overlying fascial layer. 
  • Reproduction of symptoms: Direct pressure over the correct trigger point will reproduce the symptoms, often not in the same place.
  • Invisible on images such as x-ray, ultrasound or MRI.  As such, they are often missed. 


Commonly, pains present in one or more parts of the body, while the root cause comes from a distinct trigger point. For example, pains in the arm could be coming from a trigger point in the neck. Or a tender trigger point in the sacro–iliac joint (low back) can cause a person to “walk funny”.  This can shift the burden of weight- bearing, thus setting up myriad muscle pains in the back or limbs. We usually do not need to treat each of these extra sore spots, just the one or two that are the root cause.

For decades, doctors have used cortisone shots into trigger points, with some good effects. However, the cortisone itself carried considerable risk of side effects in the local tissues, such that it could be only used three times a year in the same site. Happily, it turns out that the shape of the needle was more important than its contents.  Researchers found the same results injecting plain saline, or using a dry needle, as long as it passed through the trigger point.


The trigger point needle is hollow and has a beveled edge, which makes it possible to mechanically break down these painful spots.  We only treat one or two spots at a time, to maximize benefits.   The needle tip is used to gently explore around the area of pain through a single point of entry, using a drop of local freezing if needed.  Through touch, the needle will detect areas of inflammation, scar tissue, or calcification. Once discovered, these targets are then microdissected with the tip of the needle.  This allows restoration of normal blood supply and function.


The procedure takes only a few minutes and, with a few drops of local anesthetic, is basically painless.  Results are usually quick, although a few patients may experience a temporary soreness for several hours before improving.  It is helpful to drink lots of water following the treatment, and to be moving rather than resting or sitting for the next while. One can go straight to the gym or yoga class or back to regular activities.

Examples of acute and chronic cases we treat: back pains, from upper to lower, rotator cuff and frozen shoulders, tennis elbows, and tendon pains in wrist and hand.  In the lower limbs we treat hip pains and stiffness, sciatica, sacro-iliac strain, knee, calf and iliotibial (lateral thigh) pains, ankle and foot issues including plantar fasciitis.



This depends on the root cause. If the injury is recent and unique, a few visits may be all we need.  If the root cause is a recurring one, such as bad posture or poor ergonomics, then the complaint is likely going to come back.

Side Effects:

The technique is done with the usual sterile protocols. Because there is no cortisone, there are no drug interactions, nor any problems interfering with current medications. If you are on blood thinners – please consult your doctor first. We do use a few drops of local anesthetic, Xylocaine 1% (Lidocaine). This is only injected if the patient feels discomfort. In case of allergy to local anesthetics, treatment can be done with nothing in the needle.

Other treatments: Trigger Point Injections work well in conjunction with other disciplines such as physio, acupuncture, IMS, therapeutic massage, yoga and chiropractic treatments.  Indeed, by restoring blood supply to trigger points, simple medications like Advil will work better, and stretching and exercises will be easier to do. 

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Caring for Sore Throats

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One of the most common reasons for patients to visit their doctor is the common sore throat.  For many years after the age of antibiotics began over a half-century ago, most doctors reached for Penicillin or Sulfa drugs, and most patients expected this prescription to be the “miracle” cure.  Which it might well be, if the underlying organism is a strep bacteria, and not a virus. 

However, times are changing, and so are bacteria.  

No longer will the common antibiotics guarantee complete recovery, even if the infection is purely bacterial.   In fact, the overuse of antibiotics has been not only in doctors offices, but in the food industry.  Mass-produced  livestock, such as  cattle, pork, chickens,  and even fish are kept in unnaturally close quarters, where they are basically bumping into each other, or the perimeters of their cages/fences. If they show superficial infections, they will not pass inspection.  So rather than have more space around each animal, it turns out to be a lot cheaper to dump antibiotics in with the feed.   This even shows up in eggs and milk in areas where this practice is not regulated. 

As a consequence, the bacteria are so used to antibiotics that they frankly are not impressed; and the infections are mutating with such speed that we cannot make new families of antibiotics fast enough. 

So with this as background, you will not be surprised when your doctor today is much less likely to dole out these medications.   Even if you have green or yellow discharge from your nose or in the back of your throat, and even if you have bright red tonsils the size of golf balls.

Instead of reaching for the prescription pad, doctors now will suggest a throat swab to test for strep, before prescribing any antibiotics.  This can be done as an instant test (which may be an extra charge, depending on your insurance), or as the kind that takes two days for the lab to report.  Over 80% of the time (in my practice) these are negative for any treatable bacteria, meaning the infection is caused by an untreatable virus.

So how do we deal with these painful viral episodes?  Here are a few tips that may help:

  1. Consider holding back on dairy products for a few days.  Milk products in many people will have an effect (not an actual allergy) to thicken mucus.   That’s why singers never drink warm milk between songs.  As soon as the mucus clears, you can happily resume your favourite milk, cheeses, or ice creams.  If milk does no such thing to you, don’t worry about this step.
  2. Grandmother’s Chicken Soup: turns out to be an excellent choice to help thin mucous discharge from the nose, throat, and airways.  Keep a few boxes of chicken stock handy, or use boullion cubes to fill your mug with a nice hot drink.  Remember to rehydrate your body with water.  Lemon and honey can prove soothing in a mug of hot water, as can herbal teas or ice water. 
  3. Saline gargles: Do NOT use commercial mouthwashes more than a few times a day, or you can change the pH, as well as the  ecosystem in the mouth, and end up with a fungal infection, with a  blue or white tongue.  If you have a really sore throat, including swollen tonsils, you need to gargle a lot, even hourly.  The best way is to use saline, stirring a few spoonful’s into a half-glass of warm water, until no more will dissolve.   Gargle as long as you can with the first mouthful, then spit it out, and repeat a couple more times.  You can immediately take a swig of something tastier, so you don’t need to endure the salt for long. 
  4. Treat symptoms with off-the-shelf medicines.  For fever, sinusitis, and pains, something like an ibuprofen or aspirin based cold/sinus pill will help. 

If the above is not working, go back and see your doctor.  Even if it turns out that your case is caused by a bacteria that will respond to an antibiotic, the above steps are still very useful.

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Hip Pain? Hip Tips...

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One of the common complaints I see in my office is that of hip pains, which come in two varieties:  

ACUTE hip pains:   We see these cases a lot as injuries to the groin muscles on the inside aspect of the hip.  These are usually pretty obvious in their origin, for example when a hockey player collides with legs straddling the ice, or when a football player is tackled with one leg extended out to the side.  (Hip fractures are the subject for a separate blog).  These cases often respond quickly, as long as there is no serious tear in the muscle/tendon structure as it inserts from the inner thigh.  Other cases involve the outside of the hip joint, seen with cases of bursitis or capsulitis from extended exercises like rowing, biking, or running.  Treatments include rest, physical therapies like ultrasonic vibrations, electro-stimulation, and medical acupuncture are often all that is required. An anti-inflammatory medication can also help settle things down.  If this is not working, then further investigation with images can prove helpful, and more aggressive treatments like cortisone shots could be considered.  Gentle movements are encouraged, along with a graduated program of stretching and toning of the inner thigh muscles to rehab the area. Assuming the root cause was a one-time injury, recovery is usually excellent.  If continued trauma occurs, then the problems become more chronic.    

CHRONIC hip pains: These occur if the root cause is repetitive, such as the constant pounding felt by rodeo riders, snowmobilers, or moto-cross cylclists. This can lead to the destruction of the cartilage and the build-up of extra bony growth causing osteo-arthritis.   l More commonly, the root cause is just the repetitive effects of gravity as seen in the daily movements of an obese patient.  Especially with the morbidly obese ( 100 pounds or 45 kilograms over their ideal weight) this means the simple acts of standing up, walking, and stair climbing all cause daily damage to the hip joint.  Other conditions such as systemic forms of arthritis can certainly also affect the hip joint itself, leading to “bone-on-bone” instead of smooth surfaces where the hip joint is supposed to move.  Again, we look for any correctable root causes.  This would entail routine blood-work and images, to assess underlying diseases.  It would also involve corrective action for the obese patient, with proper diet and exercise regimens.  In severe cases, that are beyond any such help, replacement of the hip joint may be needed. 

In the meantime, here are some hip tips:

  • Watch your posture: Sitting is hip-hostile.  Try to stand up a few times per hour if you can.  We have already written about the benefits of sitting on a pilates ball for back pains, 
  • it also helps hip pains by introducing some movements into an otherwise frozen posture.  If you can, try to rig your work station for standing up all the time. 
  • Select non-impact exercises, like the bike or elliptical machines in the gym.  Also try yoga and pilates to help with toning and flexibility.
  • Watch your weight.  One of the rules of medicine is that pain is fattening.  If you are in pain, you can’t move much to burn off your daily calories.  This becomes a viscous circle, where any excess calories are simply added to one’s fat stores, adding to the pains of simple movements.  To compound this, junk foods such as white sugar, white flour, etc are all known to cause more inflammation, further adding to the damage to the hips and other joints.
  • See your doctor to seek out underlying diagnoses, from systemic diseases to simple things like one leg being significantly longer than the other.  Depending on the underlying causes, you may also benefit from massage, physical therapy, or chiropractic treatments. Follow their exercise tips to stretch and tone the surrounding hip structures.

For more info,

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Knee pains: How to prevent and recover

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Knee pains are becoming very common.  Most of the orthopedic surgeons in professional football and hockey are specialists in the knee, leaving others to look after the rest of the bones in question.  In looking after sports injuries in my clinic, I can attest to the high rate of knee injuries among part-time athletes as well. 

Some logical questions follow:

1. Why is the knee so vulnerable to sports injuries?  The main reason is its range of movement is only in one plane.  Other joints can swivel, but the knee is just like a single hinge that straightens or flexes the leg, and is integral in our ability to walk, run, and jump.  However the knee has virtually no protection to a side impact.  Nor does the knee do well with twisting or rotational forces.  With the popularity of contact sports, especially ones with  helmets and hard pads, we are seeing more collisions resulting in serious knee injuries.  

2. Even in non-contact sports, such as running, we are seeing more gradual erosion of the knee structures.  While running is one thing the human body was well designed to do, the knee is not a great shock-absorber when one runs on pavement.  

3. Paradoxically, the inactivity of the modern work place also contributes to the rise of knee injuries.  With movement, the synovial membrane around the knee produces fluid, which not only lubricates the joint, but provides trace quantities of oxygen and food to the cartilege cells.  But today, we don't move our knees at work, we fold them under us like a deck chair.  At the end of day, it gets ugly, watching people trying to force their stiff legs into the standing position.


If you have injured your knee, here are some important action items:

1. Apply ice to ease swelling and pain, for about 10 minutes every half hour.  Make sure you have a layer of cloth between your skin and the ice, to protect from freezer-burn

2. See your doctor if you are not improving.  Images of Xray, Ultrasound, and MRI can help identify pathology.

3. When bending the knee, there is never any need to go beyond 90 degrees, unless you are just stretching. 

 For example, when you are doing a squat in the gym, just bend as far as if you were about to sit in a chair, then back up.  

Never bend the knees so far you can sit on your haunches if you are loading the joint with weights, or even your body weight.  If bending to pick something off the ground, bend just one knee to touch the ground, so both knees are at 90 degrees.  Its much easier to stand up, and much less likely to hurt the knee.


4. Watch your leg posture at the desk.  If your knees are hyper-flexed all day under your chair, they you will have a host of issues from dry knees, including stiffness of the surrounding muscles.  Try to set a timer to remind you to bend and flex the knee every fifteen minutes, even if you have to cradle it in your hands to get it started.  

5. Consider a soft knee brace when standing or doing activities.  

Not great for sitting with bended knee, as they tend to cut off the return blood flow if they crinkle behind the knee.  But when the knee is more straight, it can provide support, and may help reduce some of the swelling.  At the very least it will remind you which one is the sore knee, so you won't accidentally land on the wrong foot when running down the stairs for a train!

6. For rehabilitation, seek exercises that don't hurt, and that don't create impact.  Eliptical machines, bikes, swimming, skating etc are all good suggestions, along with controlled weight lifting and stretching exercises.  Make sure you seek professional guidance to make sure your ergonomics are good.  



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Eye Infections - Be Sure to Treat Correctly

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Eye infections are very common, and very important to treat correctly.

When an infection starts on the outer surface of the eye, the conjunctiva, or thin membrane that covers it, becomes inflamed.  As with any inflammation in medicine, we append the suffix “itis”  to make it into conjunctivitis, otherwise known as “Pink-Eye”. 

Considering the thousands of particles of dust laden with bacteria we have bombarding our bodies every day, one might wonder how the eye avoids constant infections.  The answer lies in its brilliant design:

  • Lids to close out sudden gusts of particles, form sand storms to sneezes, and lightning fast reflexes to operate them
  • tears to flush water under these lids to drain through the lacrimal ducts into the nasal passages
  • enzymes in the tears to destroy any invading organisms (which is why contact lens wearers can pop out a lens in an emergency, flush it under tap water or even lick it, then reinsert  without  getting infected). 

However, these defense mechanisms can still be overcome, and the result will be crust or pus forming between the lids, and a characteristic redness of what is supposed to be the “whites” of the eyes.

Parents know that this condition is an absolute reason to quarantine their child away from classmates or day care peers.  But it can also occur in adults just as easily. 


Once this yellowish material forms in your eye, it is very important to see a doctor.  While the diagnosis is pretty obvious from the history and findings, there are some important steps for follow-up to consider:

  • Pink-eye is extremely contagious.  Simply by rubbing the infected eye, one transfers the germs onto the hand.  
  • When that same hand later touches the other eye, the infection can now start there.  If that hand touches a door knob, then the next person touching that surface can get it too.  Schools and day care centers are quite right to keep pink-eye cases out of contact with the rest of the kids.  If you do catch yourself rubbing an infected eye, wash your hands immediately.
  • Try to flush it away.  In the old days, people were told to use an egg-cup full of water, which was a real mess. The simplest way is under the shower; turn the eyes into the direct spray, and open them even a little. 
  • Use disposable wipes, or tissues.  Do NOT use your towel to dry your eyes, as this will leave infection on the fabric, which will then reinfect you the next time you use it.
  • Sterilize or discard any cosmetics, sponges,brushes, that touch the eye lids or lashes.  
  • Your doctor will give you some prescription eye drops with anti-bacterial ingredients.  Use these as directed, and make sure you insert them correctly.  For directions, see Eye Drops Made Easy  
  • After the second day, improvements should be noted, and the infection should be all gone by the fourth day.  If not, then go back to see your doctor.  At this point a more thorough exam by an eye specialist might be needed.
  • I always suggest patients use the drops for an extra day after the last of the symptoms, for good measure.

If you follow the above steps, and take your prescribed eye drops as directed, you should be quickly back to normal. 

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Adhesives Instead of Stitches Reduces Scarring With Less Pain

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If you have a facial cut in the future, you may not need to see a doctor for sewing.  Instead, you may see the nurse for gluing. 

During my years as an emergency room doctor, I saw a lot of facial lacerations, especially in children.  In fact, during the winter months, in the days before face shields were attached to helmets, it seemed that I did nothing but sew up kids hockey teams.  If I sewed up three six year olds in yellow uniforms, and then three in red uniforms, it was a safe bet that the game had ended in a tie.  Well, now, children's lacerations may not end in a tie at all, but rather in a gluing.  Dr. David Watson, a specialist in accident and emergency medicine in Mayday Hospital London, reported his findings in the British Medical Journal (Oct.21, 1989).  He studied fifty children under the age of forteen years, who had superficial lacerations.  These were treated with cyano-acrylate tissue glue, known as Histoacryl, and then they were followed up with photographs and repeat visits.  The glue was essentially painless to apply, although some noted a sting less than a second in duration.  The results showed fantastic healing, with none of the cross-hatching or pigmented dots that can accompany sutures.  Besides faster heasling and less pain, another major benefit iis the time saved for all concerned.  Instead of waiting for the doctor, kids with minor cuts can be glued by the nurse.  Instead of returning to have the sutures removed, they just carry on. 

Natural Goo

The search for adhesives that can perform better than sutures and surgical staples has recently been taking researchers into some unexpected places. There are a number of organisms that produce natural adhesives that could make stitches a thing of the past. Take slugs, for instance.

Andrew Smith, a professor from New York's Ithaca College, worked with undergraduate students to capture slugs and "milk" them to collect a defensive goo that the animals use to protect themselves in the wild. Upon analyzing the secretions, Smith and his helpers found that it was formed out of a combination of metal ions and a network of polymers that was neither completely solid nor completely fluid. 
"Gel like this would make an ideal medical adhesive," Smith said. "It would stick to wet surfaces, and no matter how much the tissue flexed and bent, the gel would flex and bend with it. There would be no leakage or scarring."

Smith isn't the only scientist looking for a new glue in nature: German researchers are investigating the Asparagus beetle that uses a biological adhesive to attach its eggs onto asparagus spears, while a University of Utah professor is looking at the natural glue produced by caddisflies.

Medical glues are not new. They have been used for decades in Canada, Europe, Israel and the Far East. But doctors in the US paid little attention to them until the last year or so because the older glues had many limitations.

For one thing, they were too weak for all but small, shallow wounds. In addition, some caused toxic reactions on the skin. Perhaps the biggest strike against them was a finding published a decade ago that one adhesive induced cancer in laboratory rats.

More recent research has not borne out the cancer link, and newer medical glues are stronger and, when used properly, not toxic, said Dr. James Quinn, an assistant professor at the University of Michigan Medical School in Ann Arbor who was the lead author of the new study. His success in using medical glues in Canada as an emergency room doctor touched off his interest in doing research on them.

His new study included 130 adults with 136 lacerations on the face, torso, arms and legs that were treated in the emergency room of Ottawa General Hospital in Canada. Half the wounds were closed with a medical glue, the other half with stitches. Deep wounds that normally require two layers of stitches were given stitches beneath the skin and then randomly assigned to be closed with either glue or stitches on the surface.

Certain wounds were excluded from the study because of the high risk of infection and other complications, including animal bites and scratches and puncture wounds.

The study found that the wounds in each group healed equally well when evaluated within the first few days or weeks and again after three months. But the glue had two big advantages over stitches. First of all, it closed the wounds in a quarter of the time: about 3.6 minutes compared with 12.4 minutes. And patients reported significantly less pain.

Further studies are still going on, but it seems that children with facial cuts will be spared the needles, and instead be treated painlessly with glue.  I wish they had it when I was a kid.

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Osteoarthritis and the Cherry: The latest Joint Venture

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Joint inflammation,  or “arthritis”, is very common with today’s active public.  As opposed to a disease that travels through various joints in the body, osteo-arthritis is one condition that is physical in nature.  In other words, “osteo” form of arthritis is a “wear and tear” or “rusty hinge” phenomenon, usually caused by repetitive trauma in any joint, which can vary depending on the activity in question. 

For example, runners often get this in their great toe joint, where the toe meets its metacarpal.  This form of repetitive motion is certainly aggravated by poorly fitted shoes, or by running on concrete (instead of grass or soft ground).   When this joint is inflamed by gout (a systemic condition where millions of crystals of uric acid deposit in joints and kidneys), we call it “podagara”.  Coincidentally, Sports Medicine researchers are now finding that an old-fashioned natural remedy for gout can also work wonders for any “osteo” joints in the body. 

Tart cherries have long been suggested as an anti-inflammatory aid to gout patients, as part of their treatment protocol.  But recently researchers at the Oregon Health and Science University studied twenty women between the ages of 40-70, all of whom had osteoarthritis.  Each was asked to drink tart cherry juice twice a day for three weeks.  They were tested for markers of inflammation in the blood stream.  It turns out that excellent results were seen, especially with those who had the worst inflammation to begin the study. 

Principal investigator Kerry Kuehl  M.D. of the Oregon Health and Science Universtiy, was delighted to confirm that a natural food could offer such anti-inflammatory help without any of the side effects associated with drugs.  Since most people who exercise are also health conscious, this is particularly good news for athletes, including the weekend “warriors”. 

Leslie Bonci, Director of Sports Nutrition athe University of Pennsylvania Medical Center for Sports Medicine, has incorporated tart cherries into the training menu for all of her athletes. 

The active ingredient in the cherry is the antocyanins; antioxidant compounds that reduce pain and inflammation at levels comparable to many well-known pain pills.   Available in dried, frozen and juice forms, tart cherries are versatile, and easy to find.

So if you are aching in any joint, don’t be intimidated by all the pills at the drug store.   Sometimes the best treatment can be “cherry-picked” right from your local grocery store. 

For more reading: Reduce Chronic Inflammation in People with Osteoarthritis 

And for another good way to treat pain without drugs: Acupuncture: An old treatment gets to the point!




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Achilles Tendon Injuries: how to fix

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One of the more common complaints among patients is a pain above the heel, in the Achilles tendon.

This debilitating injury is seen commonly in athletes, where explosive forces are

channeled into the pencil-thin tendon that joins the calf muscles to the heel bond.  For example, when running backward in soccer, then suddenly changing direction and sprinting forward.  The acceleration/deceleration physics contrives to put hundreds of pounds per square inch into the Achilles tendon, causing it to stretch, strain, partially tear, or completely rupture.  The history is defining: it feels like someone "struck my heel with a board", followed by a sudden crippling pain, and inability to even bear weight on the limb.

For the weekend athlete, the injury is even more common.  In large part this is because we tend to sit all week at a desk, with our legs folded under us, and our feet pointing behind.  This shortens the Achilles and calf muscle, in much the same way that we see happening with wearers of  high heeled shoes (including cowboy boots).  When these contracted muscles are taken for a run, they are stretched with every push-off into the next step.  Especially in cases where pre-run stretches or warm-ups are skipped, the results are quite predictable: strains, partial tears, or, ultimately the complete rupture.

For minor strains, conservative measures such as ice and rest can suffice. Some will benefit from a temporary heel-lift in their shoe, to prevent stretching the tendon back out to its full length until it is ready. For more significant tears, often one needs physiotherapy, and possibly rest in a "boot" or cast.

When the Achilles tendon is completely severed, surgery is really the only solution.  Often this is done a few days after the injury, in order to wait until the bleeding has stopped.  Once sutured, the tendon heals slowly, due to its inherent poor blood supply.  (Think of a chicken leg, where the tendons are like clear plastic rope).  For virtually all such ruptures, the standard recovery time is over a year, often 18 months.  For a professional athlete, this can mean a career ending injury.

 One such patient that I treated was Wes Hart, of the Colorado Rapids in the MLS.  He had a classic injury on the field during the opening game of the 2001 season.   His surgery was done by team doctor Wayne Gersoff, who also followed with MRI images at intervals.  He was monitored and treated daily by Theron Enns, the team trainer, and encouraged to progress to more weight bearing and movement each week.  As an additional therapy, I treated him twice weekly with acupuncture needles placed deep into the tissues above and below the tear.  His speed of recovery was beyond expectations: he advanced so quickly that he was able to play for the final game of the same season, a mere sixteen weeks after his surgery. 

To recap, here are some tips to prevent Achilles tendon injuries:

1. At work: Try to keep your feet flat on the floor when you are at your desk, don't fold your legs and point your toes behind you.  This will train the calf muscles to shorten, meaning more pressure will come to the Achilles tendon when you stress it in athletics

2. Under your desk: Periodically straighten your leg, pull your foot up at the ankle until you feel your calf muscles engage.  Hold this for several seconds. 

3. Before sleep, stretch your calf muscles and your Achilles tendon. 

4. In the shoe store: make sure you have proper shoes, professionally fitted.  Step into the sizer, and make sure the shoe is comfortable all over, including over the Achilles tendon.  Don't keep your shoes too long, as they will lose their supportive function with regular use.  Most runners will need fresh shoes every six months, which is long before the shoes are looking worn.

5. Before exercise: Stretch after your initial warm up, as we discussed in another blog.  No bouncing, just smooth regular stretching.

Calf stretch/ exercise : 

Your Achilles tendon connects the muscles in the back of your leg to your heel bone. The calf stretch exercise can help prevent an Achilles tendon rupture. To do the stretch, follow these steps:

1. Stand at arm's length from a wall or a sturdy piece of exercise equipment. Put your palms flat against the wall or hold on to the piece of equipment.

2. Keep one leg back with your knee straight and your heel flat on the floor.

3. Slowly bend your elbows and front knee and move your hips forward until you feel a stretch in your calf.

4. Hold this position for 30 to 60 seconds. 5. Switch leg positions and repeat with your other leg.  

6. After exercise: More stretching, and an ice pack if you feel any pains over the calf or achilles mechanism. Also consider this stretch:

7. In the doctor's office: once you do present with an injury to your Achilles tendon, your doctor can take images to get a better sense of your severity.  At that point, one can prescribe from a list of options, from orthotics to physiotherapies, and from anti-inflamatory medicines  to medical acupuncture.

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