Unique solutions to two common, major maladies plaguing runners
Rationale for different self-treatment
Traditional treatments for Achilles Tendinitis (AT) and Plantar Fasciitis (PF) from the doctor do not workand Physical Therapy (PT) protocols can be hit or miss and take months or a year to fully resolve.1 The Lancet, in November 2010, reported that in 41 high quality studies involving 2672 patients with “tendinopathies” (diseased or damaged tendons), patients received only short-term relief with the traditional cortisone injection. The second traditional treatment (rest) only limits the injured tendon from getting worse. Jane Broody of the New York Times broke this news February 28th 2011. She added that tendinitis is a misnomer, as the tendon is often not inflamed and why the tendon does not respond to steroid injections. Also the tendon is often “gnarly” and mis-shapen. She noted that counterintuitive remedies may work better than the two traditional cures (cortisone injections and rest). One involves strengthening the muscles around the joint of the affected tendon, to stabilize it, then exercising the muscle more than you would think, which brings more blood and nutrients to the injury, promoting faster healing.
If experts have a hard time, why not try something else? My self-treatment method is similar to the counterintuitive remedy above but goes further in treatment, using specific soft tissue techniques, not widely known, that are easily learned with reproducible results. How many runners do you know with PF or Achilles Tendinitis and it plagues them for months or even a year?
So just what is and what causes plantar fasciitis (PR) and Achilles Tendinitis.
Tendonitis and Plantar Fasciitis are “tendinopathies” or diseases of the tendon. Often, but not always, the tendon is over taxed due to long term strain. At some point the tissue micro-tears (injury response with pain, swelling and weakness) and then the healing response begins. The healing response involves remodeling or “knitting” new tissue onto the damaged tendon. The athlete typically ices, stretches, and continues running. However, the strain is still there, and the tendon is constantly being micro-torn and re-knitted but in an unhealthy fashion, resulting in the gnarly tendon described above. What occurs now is a tendonosis or condition (bad), not an inflammatory response. Usually combinations of the following, not in any order of importance, are causing the development of the unsmooth tendon.
1. The wrong footwear creates muscle imbalances leading to strain on the tendon.
2. Knots in muscles, called Trigger Points, which are a normal occurrence if you are living and breathing, in shape or not. These knots are actually tiny spots of contracted muscle tissue harboring metabolic waste products that irritate pain receptors causing pain. These knots also cause improper muscle firing, discrepancies in muscle length, and muscle group imbalances.
Muscle imbalances, modern living (sitting in one position too long, performing the same movements all day, etc.), and poor posture are a few causes of Trigger points.
Trigger Points tax the tendon immensely, straining it perpetually, causing it to becoming tender and inflamed. Trigger Points are possibly the most over looked source of pain and muscle dysfunction as doctors focus on joints and nerves as chief sources of pain and dysfunction.2 In fact “tennis elbow” is nothing more than Trigger Points in the forearm muscles.3 New research shows that once the tension is released in key muscle bellies of the forearm by treating the Trigger Points, the tendon, which anchors the muscle to the bone, will relax.
Key Concept:
Trigger points, muscle imbalances, and improper foot wear alter the optimum “line of pull” in the muscle and tendon that is trying to heal. The new tissue is laid down in a messy manner.
One typical scenario: Your heavily into training and your heel starts to hurt. Months later it’s so bad you go to the doctor and get a diagnosis of “plantar fasciitis” and maybe a shot of cortisone, or maybe “the boot.” You also do your physical therapy as instructed. But, it’s still there, to some degree, months later.
Each time you irritate (run on) the injured tendon, it micro tears. Then the knitting process begins again. The problem arises when you have trigger points, muscle imbalances and / or bad footwear the body lays down more type III collagen and not enough type I collagen. Type I is smooth, looking similar to your three middle fingers held straight up in the air. Type III collagen looks like those three fingers intertwined. The solution is to break up the gnarled tissue, provide positive tension for healthy remodeling, and do all the other things you have been taught already.
Another Solution:
Remember traditional treatments do not remodel the tendon nor deactivate Trigger Points in the muscles around the tendon. Your coach or Physical therapists are experts at muscle imbalances and footwear but in order to heal the tendon and prevent future problems one must:
· Treat trigger points and massage the muscles going into tendon
· Remodel the tendon manually
· Place positive stress on the tendon
·
Key Point:
Why massage and muscle focus? Massage loosens the entire muscle, the fascia surrounding it, and releases strain on the tendon. To release the tension on the tendon, you must treat the entire soft-tissue unit of muscle, the fascia, and the muscle/fascia anchor, the tendon.
Self-treatment protocol for Plantar Fasciitis and Achilles Tendonitis .
Treatment of any tendinopathy uses the same protocol except in the case of a new injury. Brand new ones, as in it started hurting last week, does not have the gnarled tendon. In this case no remodeling is needed. This protocol is in addition to what your coach or physical therapist has given you. You still need to stretch and strengthen. Let’s treat AT and PF!
Massage and Trigger Point therapy. The method I use goes by different namesNMT, Trigger Point Therapy (TPT), deep stroking massage. Here is what to do.
Muscle massage: Using your thumbs, form a ‘V,” and apply mild to moderate pressure. Sink into the tissue half an inch from your heel and slowly glide up to the base of the big toe. Repeat from base to all four toes. Repeat this 5 more times. Do not forget to treat the flexor muscle of the big toe on the medial arch of the foot. You can substitute any massage tool that fits the into the muscle group, like the foam roller or a tennis ball instead of your thumbs.
What’s mild tomoderate pressure? On a pain scale of 1-10, mile to moderate pressure is a 2-4. If you wince or are not completely relaxed, it’s too much and the tissue tightens in response.
Treating Trigger Points: During the massage you probably found spots that hurt, felt hard, like little nodules, or just “weird.” These are trigger points. Next: In no particular order, do these two techniques, with pressure that elicits a pain of 4-5.
1. Rub the trigger point with your fingertips, thumb or with your tool of choice. Make tiny movements back and forth over the spot for 10-20 seconds. Rest a minute then repeat.
2. Hold static compression with thumb, finger or tool on the spot with a pain level of 4-5 and deep breathe. You will soon find the pain decreasing. Increase pressure into spot as pain goes down, it will come back up, keep repeating (less pain more pressure) for 1-2 minutes. If it’s getting worse than your pain of 5 is actually a 7 or 8….ease up…Trigger points do not like to be irritated. We are not using the same pressure as with a foam roller on your IT band adhesions.
After doing either or both techniques, go find more spots. Then come back and treat again (up to 3 times each spot). Trigger points are by definition, hyperirritable. If you go too deep they will get angry and get worse, not better.
Remodeling the Tendon: Deep cross fiber frictioning
Find the gnarly spot. Holding tight, rub and rub back and forth between thumb and forefinger (Achilles tendon) or pressing deep then rubbing with a thumb or hard tool into the base of the plantar fascia near the heel. Do this for 20-30 seconds. This should hurt, not a 10, but more than a 5. Rest a minute then repeat 2-3 more times. Then ice for 3 minutes and repeat 1 more time treating and icing.
By “frictioning” the tendon, the tissue micro-tears, causing the injury then healing response, resulting in new collagen being laid down (just like injuring and reinjuring the tendon).
To finish, ice the entire tendon for 5-7 minutes, not the muscle (which prefers heat). Icing immediately after frictioning limits the injury response (pain, swelling, secondary cell death) and provides a pain free stretch to begin the healthy remodeling process. Do this technique every 2-3 days for 2-4 weeks or until tendon feels smooth.
Place positive stress on the tendon:
Positive stress means putting healthy strain on the tendon followed by ice. For example, if a runner has Achilles tendonitis, they should bike or do the elliptical or life cycle (mild intensity the first two weeks then moderate intensity) and not run until the tendon is healed. I also recommend isometric strengthening exercises to ensure positive strain and a smooth tendon. Note: Time of return to intense activity or even light running is determined by how bad the injury is. It maybe 2 weeks or 2 months. Please be reasonable.
In summary, treatments that focus on “allowing the tendon to heal while strengthening the joint” miss the mark. Left alone or with common techniques, tendinopathies only sometimes heal themselves over the course of a year or so. Treatment that includes manual soft tissue care shortens healing time to a matter of a few months or even weeks. Empower yourself with this non-invasive treatment and get back to your sport or activity in no time!
1 Traditional Tendon Remedies Fall Flat in Trials – NYTimes.com, Personal Health For Tendon Pain, Think Beyond the Needle By JANE E. BRODY Published: February 28, 2011 A review of 41 “high-quality” studies involving 2,672 patients, published in November in The Lancet, revealed only short-lived benefit from corticosteroid injections. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomized controlled trials, The Lancet, Volume 376, Issue 9754, Pages 1751 – 1767, 20 November 2010
2 Simons DG. New views of myofascial Trigger Points: etiology and diagnosis. Archives of Physical Medicine and Rehabilitation 2008;89:157-9.
3 Fernández-Carnero, Josué PT, et. Al. Prevalence of and Referred Pain From Myofascial Trigger Points in the Forearm Muscles in Patients With Lateral Epicondylalgia. The Clinical Journal of Pain: May 2007 – Volume 23 – Issue 4 - 353-360).
