Tendinopathy, Plantar Fasciitis, and Chronic Adhesions

Conditions & context

Tendons and fascial tissues can be remarkably slow to recover. Once a problem has persisted for months, it is often no longer useful to think of it simply as an acute injury that has failed to heal. The tissue may have become less tolerant of load, movement patterns may have changed, and surrounding muscles may have been compensating for a long time.

Many people who come to us with these conditions have already been through a long sequence of treatment: physical therapy, orthotics, anti-inflammatory medication, cortisone injections, periods of rest, changes in footwear or activity, and months or years of waiting for the problem to resolve. Sometimes those measures have helped considerably; sometimes the pain returns as soon as normal activity resumes.

Our approach is to treat both the painful tissue and the mechanical pattern that has developed around it. Acupuncture, manual treatment, cupping, moxibustion, and appropriately graded movement may all be used depending on the condition and its stage.

This is particularly important with tendinopathy. Persistent tendon pain is more complex than simple inflammation, and prolonged rest is not generally enough to restore a tendon’s capacity. Tendons need appropriately managed loading in order to regain strength and tolerate activity. Treatment is therefore used alongside that process, addressing pain and muscular guarding while the tendon gradually adapts to increasing load.

What we treat

• Plantar fasciitis and persistent heel pain — including the characteristic pain with the first few steps in the morning
• Achilles tendinopathy
• Tennis and golfer’s elbow
• Rotator cuff-related tendon pain
• Patellar tendinopathy and other load-related knee pain
• De Quervain’s tenosynovitis and other wrist and thumb tendon pain, including repetitive strain
• Persistent restriction following injury or immobilization
• Healed scars and areas of tissue restriction following surgery or injury
• IT band and hip-related fascial restriction
• Longstanding areas of restricted or painful tissue following an old injury

How we treat it

Treatment is adapted to the tissue involved rather than using the same technique for every painful area.

Plum blossom needling, a traditional form of microneedling, is one technique we use for some longstanding tendon and fascial problems. Rather than inserting a single acupuncture needle at one point, a small cluster of very fine needles is tapped lightly across the surface of a broader area. This allows us to work across the plantar fascia, along a tendon, around a healed scar, or through an area of persistent tissue restriction.

Moxibustion may be added when warmth is appropriate to the presentation, particularly when an area feels chronically stiff or is noticeably more comfortable with heat. Moxa provides sustained warmth without requiring vigorous mechanical treatment of an already sensitive area.

Acupuncture is used more broadly, treating not only the painful structure but also the muscles and movement patterns that have developed around it. A persistent plantar-fascia problem, for example, may coexist with calf tension, altered gait, or changes higher in the kinetic chain. Similarly, elbow tendinopathy may need treatment of the forearm, upper arm, shoulder, and neck rather than repeated treatment of one painful point.

Cupping may also be incorporated where muscular or fascial restriction is prominent. Manual therapy may also be recommended when more extensive hands-on work would be useful.

In some cases, when regular warmth between appointments is appropriate, we may teach patients how to use moxibustion safely at home.

The aim is to treat the local problem without losing sight of the way the rest of the body has adapted around it.

Tendinopathy and rehabilitation

Tendons recover slowly, and treatment has to respect that biology. Symptoms may begin to improve before the tendon has regained the capacity required for running, lifting, racquet sports, or other demanding activity.

For that reason, pain relief alone is not our measure of recovery. The tendon also needs to tolerate progressively greater load.

Treatment can work alongside a progressive loading program from a physical therapist or other rehabilitation professional. Acupuncture and manual techniques address pain, muscular guarding, and associated restriction, while appropriately graded exercise progressively restores strength and load tolerance.

How long treatment takes depends on the tendon involved, how long the problem has been present, its severity, and what you need the tendon to be able to do. We look for practical changes along the way: easier first steps in the morning, less pain during ordinary activity, less reactivity after exercise, and gradually increasing tolerance for load.

Plantar fasciitis and heel pain

Plantar fasciitis is one of the most common persistent foot problems we treat. The classic presentation is pain underneath or toward the inside of the heel, often particularly noticeable with the first steps after getting out of bed or after sitting for a period of time.

Although the pain is felt in the foot, we do not necessarily treat the foot in isolation. Calf tension, ankle mobility, training load, footwear, gait, and the way the leg is being used can all be relevant.

Treatment may include acupuncture, plum blossom needling, moxibustion, and manual work depending on the presentation. We also look at what repeatedly loads or aggravates the area, particularly for runners and people who spend much of the day on their feet.

Chronic adhesions, scars, and restricted tissue

After an injury, prolonged immobilization, or surgery, an area can remain uncomfortable or restricted long after the initial healing has taken place. Scar tissue may also be sensitive, tight, numb, or associated with altered movement in the surrounding tissues.

Once healing is complete, we may work directly with the scar and surrounding tissue using acupuncture, plum blossom needling, manual techniques, or other approaches depending on the location and presentation.

Not every persistent restriction is literally an “adhesion,” and we do not assume that pain means scar tissue needs to be mechanically broken down. The clinical question is whether the healed area remains painful, sensitive, restricted, or appears to be contributing to altered movement — and whether treatment changes it.

When further evaluation is important

A persistent tendon problem is very different from an acute rupture.

If pain began suddenly with a snap or tearing sensation, substantial swelling or bruising, marked weakness, or an inability to bear weight or use the affected limb normally, it should be medically assessed before treatment. A suspected Achilles tendon rupture in particular requires prompt evaluation.

Let us also know about previous imaging, injections, surgery, or rehabilitation. If you recently received a corticosteroid injection, tell us where and when it was performed so that we can take that into account when planning treatment.

Common questions

I was told I have tendinitis. Does that mean the tendon is inflamed?

Not necessarily. “Tendinitis” was historically used for many painful tendon conditions, but persistent tendon pain is now more commonly described as tendinopathy. Chronic tendinopathy involves changes in the tendon and its ability to tolerate load and is more complex than simply ongoing acute inflammation.

I’ve already done physical therapy. Why would acupuncture be different?

It serves a different role. If rehabilitation was limited because the tendon remained too painful or surrounding muscles were persistently tight and guarded, acupuncture and manual treatment may make that process more manageable. We may also recommend returning to progressive strengthening or loading rather than replacing it.

How long will it take?

That varies considerably. Tendons generally recover more slowly than uncomplicated muscular injuries, particularly when symptoms have been present for months or years. We look for progressive changes in pain and function while gradually increasing what the tissue can tolerate rather than promising a particular number of treatments.

Does moxibustion burn?

No. The moxa is used to provide controlled warmth and is not intended to burn the skin. We adjust the treatment according to your comfort and sensitivity.

What is plum blossom needling?

Plum blossom needling is a traditional Chinese medicine form of microneedling. A small cluster of fine needles is tapped lightly across the surface of the skin rather than inserted individually at acupuncture points. We use it selectively over broader areas of persistent tendon, fascial, or scar-related restriction. It is different in technique and purpose from the cosmetic microneedling commonly used in facial treatments.

I had a cortisone injection. Does that change anything?

Tell us when and where you had the injection and how the area responded. We take recent procedures into account when deciding when and how to treat locally.

My pain started suddenly with a snap, or I can’t put weight on it. Should I come in?

Have it medically assessed first. Those symptoms can indicate a significant tear, fracture, or tendon rupture rather than a chronic tendon problem. A suspected Achilles rupture needs prompt evaluation.

Can I keep running or training?

Often some activity can continue, but it depends on the injury and how the tissue responds to load. Complete rest is not automatically the answer for tendinopathy, but neither is repeatedly training through escalating pain. We can work alongside your physical therapist, sports medicine physician, or rehabilitation program to help determine appropriate modifications while you recover.