Right Achilles Pain: Initiate BRISS

I just saw a patient with Right Achilles pain for 6 months. She had no increase activity or change in medications. I initiated BRISS treatment for tendinitis and advised her to email me in one month about her progress. I found swelling, but no tightness in the achilles (to see if Occam's Law applied). BRISS is a simple acronym to remember to think about all the categories of tendon injury treatment. The acronym stands for:

• B for biomechanical treatment
• R for Rest or Activity Modification treatment
• I for Inflammation Treatment
• S for Stretching or Flexibility Treatment
• S for Strengthening Treatment

How did it help start the treatment on our first visit?

B for 1/4 heel lifts in all her shoes, no barefoot next 6 weeks, heeled shoes as much as possible

R for day to day activities only, will consider cross training with bike, elliptical, swimming

I for ice twice daily and contrast bathing for swelling reduction each night

S for gastrocnemius stretching and no negative heel stretching now

S for two positional heel raises with the heels only on one inch book and no shoes each evening

https://www.drblakeshealingsole.com/2010/06/briss-principle-of-tendinitis-treatment.html

This patient was given an RX for 8 PT visits and will email me in one month. We did talk about posterior sleeping splints, but since she is a poor sleeper, she was worried that it would bother her. So, the splint was not in our initial treatment.